Seizures and Epilepsy

Question 1

Epilepsy

Answer 1

• condition of recurrent and unprovoked seizures
• genetic
• 2nd most frequent chronic neurologic condition

Question 2

Epilepsy

Epilepsy syndromes- characteristics

Answer 2

• EEG characteristics
• imaging findings
• age-dependent features
• triggers
• prognostic features

Question 3

Seizures

Answer 3

• symptom of brain dysfunction
• finite event
• acute symptomatic seizures (males>females)
• unprrovoked seizures
• can hit anywhere in the brain that may cause different symptoms
• not all seizures are the same but are similar within the individual

Question 4

Seizures

Stages

Answer 4

• prodrome
• Aura
• ictal phase
• Post ictal phase

Question 5

Seizures

prodrome

Answer 5

• might see subtle mood or behavioral change
• anxiety or sleep disturbance

Question 6

Seizures

Aura stage

Answer 6

• panic
• nausea
• headaches
• intense fear
• numbness heart racing

Question 7

Seizures

ictal phase

Answer 7

• loss of awareness
• may see freezing
• twitching
• convulsions
• Tonic phase: neurons continue to fire and associated with with extension
• Clonic phase: when seizure is going away and there is an interuption of firing + flexion

Question 8

Seizures

Stages: post-ichtal phase

Answer 8

• residual effects but signs and symptoms go away
• tiredness

Question 9

Seizures

Pathogenesis

Answer 9

• imbalance between excitatory and inhibitory influences
• activation of N-methyl-D-asparatate type glutamate receptors, Decrease GABA
• excitory: continuously firing = tonic pahse
• repolarization = clonic phase
• temorary hyperpolarization - posttictal depression

Question 10

Seizures

how can Seizures tun into epilepsy

Answer 10

• mossy fibers sprouting –> epilepsy
• repeated seizure disorder unmanaged can become epilepsy

Question 11

Look at slide box 36.2 potential causes of acute symptomatic seizures

Question 12

Classification of seizures

Focal onset clinical manifestations

Answer 12

• impaired awareness

Motor:

• automatisms
• atonic
• clonic
• epileptic spasms
• hyperkinetic
• myoclonic
• tonic

Nonmotor onset:

• autonomic
• behavior arrest
• cognitive
• emotional
• sensory
• sense of impending doom

Question 13

Seizures

Focal onset

Answer 13

• 1-2 mins followed by confusion and disorientation
• jacksonian marching
• impaired cognition
• > 5 minutes = medical emergnecy/1st time

Question 14

Seizures Classifications

Generalized onset clinical manifestations

Answer 14

Motor:

• Tonic-clonic
• myoclonic
• myoclonic-tonic-clonic
• myoclonic atonia
• atonic
• epileptic spasms

Nonmotor:

• absence
• typical
• atypical
• myoclonic
• eyelid myoclonia

Question 15

Seizures classifications

Generalized onset

Answer 15

• both side of brain
• generalized motor seizure

Question 16

tonic-clonic

Answer 16

• most common “grand mal”
• LOC
• rigid (tonic) = 30-60 sec
• rhythmic jerking, relaxation (clonic phase)
• post seizure smptoms up to 24 hours

Question 17

Atonic seizure

Answer 17

• drop attack
• conscious
• sudden loss of muscle tone

Question 18

Seizures

Generlized nonmotor

Answer 18

• formerly pertit mal
• 1-10 seconds
• no aura or post-seizure symptoms
• common in children
• generalized freezing

Question 19

Seizures classifications

Unknown onset clinical manifestations

Answer 19

Motor:

• Tonic-clonic
• eplieptic spasms

nonmotor:

• behavior arrest

Question 20

reflex Seizures

Answer 20

• specific triggers
• females>males
• onset around puberty
• can be food, lightes., sounds, smells

Question 21

Status epilepticus

Answer 21

• A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes
• convulsive or nonconvulsive
• tonic-clonic: tumor, CNS infection, drug abuse
• Nonoconvulsive: trauma, stroke
• No recovery between attacks
• Medical emergency

Question 22

Seizures diagnosis

Answer 22

• Observation: hard many times its famil and friends that are seeing the activity
• have to rrole out other things
• EEG
• Magnetoencephalopath
• metabolic studies

Question 23

Seizures

treatment

Answer 23

• medications
• surgery: cut the connection between hemispheres
• neural stimulation (vagus nerve, focal area)

Question 24

Seizures

Prognosis

Answer 24

• depends on the tpe and involvement in the brain and can be lifelong
• increase mortality rate assoicated with individuals who have Seizures

Question 25

typical side effects of Seizures medications

Answer 25

• tired
• dizzy
• headaches
• vision changes
• depression
• changes in acid/base relationship

Question 26

Seizures medications

Answer 26

• Antiepileptic: most cause dizziness, fatigue, nausea, ataxia, headahces, hematologic abnormalities, increase risk of suicide
• phenolbarbital: sedative/interaction effects
• carbamazepine: blurrred vision, drop in WBCs rash
• Lacosamide: blurred vision, nausea, diplopia, tremors
• phenytoin: confusion, rash, osteopenia
• Gabapentin and pregabalin: sedation, tremor, weight gain, peripheral edema
• Valproic acid: tremor, weight gain hair loss
• Topiramate: anorexia, paresthesias, metabolic acidosis

Question 27

Seizures

Epilepsies of infancy and childhood

Answer 27

• Febrile Seizures
• Dravet sydnrome
• myoclonic epilepsy of infancy
• lennox-Gastaut sndrome
• landau-kleffner sndrrome
• childhoos adbsence epilepsy
• juvenile myoclonic epilepsy

chance that it can greatly impact development

Question 28

Epilepsy not related to age

Answer 28

• Posttraumatic epilepsy: post-penetrating wounds, impact Seizures
• Epilepsia Partialis Continua: Severe strokes, brain tumors, encephalopathies, chornic inflammation of the brian
• anytime you have insult to the brain - symptoms may be short lived but if they damaged the brain could cause more severe or chronic conditions

Question 29

Special implications for the therapist with epilepsy

Answer 29

• safety of individuals
• knowns triggers
• evaluation of home, work, school
• be aware of side-effects of medications