Myoclonic Myoclonic-Atonic Myoclonic-Tonic

Seizures Flashcards by O lawformonde

Recurrent , unprovoked seizures

Epilepsy

How well did you know this?

Not at all

Perfectly

Abnormal electrical activity in the brain

Seizure

How well did you know this?

Not at all

Perfectly

range from sensory symptoms, autonomic changes, psychic experiences
Confusion to full-blown convulsions

Semiology

How well did you know this?

Not at all

Perfectly

Epilepsy

failure of 2+anti-eleptic Rx

Intractability –> Surgery Eval

How well did you know this?

Not at all

Perfectly

Generalized Seizure

List

Absence Seizure
Myoclonic Seizures
Tonic-clonic seizures
Tonic
Atonic
Clonic

How well did you know this?

Not at all

Perfectly

Absence Seizures

Types

Typical
Atypical
With Special Features
- Myoclonic Absences
- Abscences w/ Eyelid Myoclonia

How well did you know this?

Not at all

Perfectly

Myoclonic Seizures

Myoclonic
Myoclonic-Atonic
Myoclonic-Tonic

How well did you know this?

Not at all

Perfectly

Focal Seizures

Complex Partial

Focal discognitive WITH impaired awareness

aura
NO loss of consciousness

How well did you know this?

Not at all

Perfectly

Focal Seizures

Simple Partial

Focal WITHOUT impairment of consciousness/awareness

*isolated motor s/s (tonic/clonic)

How well did you know this?

Not at all

Perfectly

Childhood/teenage onset
Sudden onset, sudden offset
NO aura
Loss of consciousness
Eyelid flutter/minor automisms
3-15 seconds duration

Absence Seizure

How well did you know this?

Not at all

Perfectly

Absence Seizure

EEG:

3Hz Spike-Wave/HV Sensitive

How well did you know this?

Not at all

Perfectly

Sudden siffening
Maximal extension in arms
A few seconds long
W/ Falls/Injury

Tonic Seizures

How well did you know this?

Not at all

Perfectly

Tonic Seizures

Where in brain?

Extra-temporal

How well did you know this?

Not at all

Perfectly

Tonic Seizures

EEG

Flattening/high frequency discharge

How well did you know this?

Not at all

Perfectly

Abrupt onset
Sudden loss in tone
1-2 seconds long
Head drop/Falls/Injuries
Poor prognosis
poor response to AEDs

Atonic Seizures

How well did you know this?

Not at all

Perfectly

Atonic Seizure

EEG

Slow spike-wave/flattening

How well did you know this?

Not at all

Perfectly

Sudden jerks
Bilateral, maximal in arms
1 second long, multiple usually
possibly photic/sensory triggered

*Myoclonic Seizures

How well did you know this?

Not at all

Perfectly

*Myoclonic Seizures

EEG

Generalized polyspike-wave burst

Loss of Consciousness
Post seizure Mental status change
Focal/Generalized
Tonic limb extension 20-40 seconds
INTO Rhythmic Clonic Jerking of Extremities (30-50 secs)
STOP Breathing, tongue biting, incontinence
Post-ictal sleep

Tonic-Clonic

Tonic Clonic

EEG

Variable,

*maybe Obscured

Premature morality rate for Epilepsy sufferers

2-3x normal person

Epilepsy

*Hx
-Auras
-Witness reports
-Post-ictal s/s /b
-Experiences following
seizure
*EEG
-Generalized vs. partial seizures
*MRI

Epilepsy Foundation Goal of Treatment =

No Seizures + No Side Effects

Epilepsy

*Anti-seizure Rx
*Epilepsy Surgery
*Neuromodulation
-Vagal N Stimuation
-Responsive Neurostim
*Diet
(keto, mod atkins)

* 30 or more minutes of continuous seizure/repetitive seizures with no intervening recovery of consciousness * generalized convulsive variant

Status Epilepticus (SE)

Generalized Tonic-Clonic Seizures * Generalized Onset * Childhood/Juvenile Onset * Normal Brain * Generalized Ictal Discharge on EEG *GOOD Prognosis 1ary/2ndary?

1ary Generalized Seizure

Generalized Tonic-Clonic Seizures * Partial Onset/Aura * Any Age * MRI/Exam May Be Abnormal * Focal Sharp/Spikes *VARIABLE Prognosis

2ndary Generalized

* NO Loss of Consciousness/Awareness * Focal Seizure s/s * Progress to Dyscognitive seizures/Tonic-Clonic Seizures

Focal Seizures without Impairment of Consciousness

Focal Seizures w/o Impairment of Consciousness EEG

* Interictal-focal sharp/slow | * Ictal-rhythmic discharge = normal

* ALTERED Consciousness/Awareness * 30 sec - 3 minutes * Automatisms (Arms, Oral) * Amnesia

Focal Dyscognitive Seizures

Focal Dyscognitive Seizures EEG

Interictal-sharp waves or spikes; Ictal - focal or bilateral rhythmic sharp

Seizure Workup Hx

Ask witness: * act out/what look like * Duration * Fall? Hit body part? * Describe patient AFTER episode. Awake? Drowsy? * Urinate on self? Bite tongue? * ETOH/Drugs prior to seizure?

Seizure Workup PE

* Current Mental Status * Full Body exam - injuries - Neuro exam * Urinate?

Seizure Workup Tests

* EEG * Glucose * Infxn cause * ETOH/Drug screen * MRI - brain abnormalities/strokes/tumors

Seizure Tx Rx 1st line most seizures

Phenytoin Valproic Acid Carbemazepine

Seizure Tx Rx 1st line = Generalized, non-convulsive seizures

Ethosuximide | valproic acid

Status Epilepticus Tx

TREAT + ASSESS SAME TIME 1) Secure airway + High flow O2 2) Low glucose? Give glucose 3) Alcoholic? Thiamine + magnesium 4) Lorazepam 5) LORAZEPAM NO EFFECT? Phenytoin 6) PREVIOUS 2 NO EFFECT? Phenobarbitol / General anesth.

* only in front of others * w/ stress/emotion * rarely injured in seizure * often w/ psyc issues * SEIZURE RX NO EFFECT

Psychogenic Non-Epileptic Seizures (PNES) S/s

Fake seizure for attention/avoid responsibilities

Factitious Disorder | NOT PNES

Syncope Hx

* Feel anything b/f event? * Other s/s of systemic illness? * hypoglycemia/dehydration risks? * FH Sudden Cardiac Death? * Witnesses around?

Syncope PE

* Fully alert/oriented now? * Signs of injury (fall)? * Orthostatic? * Sinus rhythm? * O2%? * Systemic illness signs?

Syncope Tests

* EKG * Glucose * Electrolyte * CBC * others....

Syncope Tx

* Underlying cause * Glucose + Hydration * Rx dose decrease? - ->Follow-up