Seizures and Seizure Planning Flashcards
(121 cards)
1
Q
what are one of the most common neurological conditions seen in veterinary practice?
A
seizures
2
Q
how many dogs present with seizures each year?
A
1 in 125
3
Q
in what animals are seizures most commonly seen?
A
dogs but can be seen in cats
4
Q
if seizures are seen in cats what is the usual cause?
A
usually secondary to another condition
5
Q
what are the key considerations that must be made about an owner when their pet has a seizure?
A
it can be very distressing for the owner especially the first one as they don’t know what is going on
6
Q
how do neurons transmit information in the normal brain?
A
through chemical and electrical signals
7
Q
what are interneurons?
A
large group of inhibitory cells which regulate the neurons in the brain
8
Q
how is a seizure caused?
A
balance between excitatory and inhibitory input is altered leading to hypersynchronisation of neurons and so a seizure
9
Q
define hypersynchronisation
A
The excessive synchronization of the firing of neurons that leads to seizures
10
Q
what is a seizure?
A
an abnormal, uncontrollable, hypersynchronus electrical activation of a large group of neurons which may produce convulsions, minor physical signs, cognitive disturbances or a combination of symptoms
11
Q
what is an isolated seizure?
A
lasts less than 5 mins and animal fully recovers after
12
Q
what is a cluster seizure?
A
2 or more seizures within a 24 hour period with complete recovery in between
13
Q
what type of seizure is a neurological emergency?
A
status epilepticus
14
Q
describe status epilepticus
A
seizure lasting longer than 5 minutes
2 seizures without complete recovery in between (so may seem continuous)
15
Q
why is status epilepticus dangerous?
A
brain damage will occur and worsen the longer the seizure goes on
16
Q
what are the 2 main types of seizure?
A
partial or focal
generalised (tonic / clonic)
17
Q
what part of the brain is affected in a partial or focal seizure?
A
asymmetric - only one side
18
Q
what are the signs of partial / focal seizures?
A
facial twitching
hypersalivation
behavioural changes
consciousness maintained
19
Q
what are the 2 types of partial / focal seizure?
A
simple
complex
20
Q
what is the difference between a simple and complex focal / partial seizure?
A
in simple there is no change in mentation whereas in complex change in mentation is seen
21
Q
what areas of the brain are involved in generalised (tonic/clonic) seizures?
A
bilateral cerebral hemisphere involvement
22
Q
describe what happens during a generalised (tonic/clonic) seizure
A
autonomic signs (urinate and defecate) loss of consciousness
23
Q
what are the 3 phases of generalised (tonic/clonic) seizures?
A
pre-ictal
ictal
post-ictal
24
Q
how long does the pre-ictal phase last for?
A
minuites
25
when does the pre-ictal phase occur?
before the seizure happens
26
what are the signs of the pre-ictal seizure phase?
may be subtle
behaviour changes
altered mentation
attention seeking behaviour
27
when does the ictal phase occur?
the actual seizure
28
what happens during the ictal phase?
loss of consciousness
muscle contraction
urination / defecation
29
when does the post-ictal phase occur?
after the seizure
30
how long does the post ictal phase of a seizure last?
minutes to days
| depends on individual
31
what are the signs of the post-ictal phase?
abnormal neurological signs which may be subtle or marked
32
what are the 2 main extracranial causes of seizures?
toxins
| metabolic
33
what are the main toxins which cause seizures?
```
methaldehyde (slug bait)
ethylene glycol (antifreeze)
permethrin (cats)
pesticides
Ivermectin (collies)
human drugs
```
34
what are the metabolic causes of seizures?
portosystemic shunt
hypoglycaemia
hypocalcaemia
35
why can a postosystemic shunt lead to seizures?
change in blood flow will collect toxins from vessels that have been bypassed before shunt placed that are then moved around the body
36
what are the 2 main intracranial causes of seizures?
structural
| functional
37
what are the structural causes of seizures?
brain tumor
inflammation
hydrocephalus
38
what is the functional cause of seizures?
idiopathic epilepsy
39
what is the most common cause of seizures?
idiopathic epilepsy
40
what age are animals that present with idiopathic epilepsy?
6 months to 6 years
41
what signs will suggest that an animal has idiopathic epilepsy?
```
recurrent single seizures
normal inter-ictal neuro exam
normal metabolic investigation
normal brain MRI
normal CSF (if tap taken)
```
42
how is idiopathic epilepsy / seizure cause diagnosed?
```
history
blood tests
MRI scan with contrast
CSF analysis
video assessment of seizure
monitoring and recording (e.g. seizure diary)
retinal exam
blood pressure (if possible)
```
43
what information can be gained when taking a history of a patient with seizures?
is it a true seizure
| any history of toxin ingestion, head trauma or meidacation
44
what blood tests will be used to diagnose the cause of seizures?
haematology
biochem
fasted blood glucose
pre and post prandial bile acids
45
what contrast is used in MRI scans of the brain?
gadolinium
46
what is needed when preparing for CSF tap?
clip and surgical prep
47
what position must the animals head be held in for a CSF tap?
flexed downwards
48
why is important to know the difference between seizures and seizure mimics/
testing and mediaction are different
49
what are the main seizure mimic disorders?
```
narcolepsy/cataplexy
fly-catching
movement disorder
syncope
3rd degree AV block
canine epileptoid cramping syndrome
peripheral vestibular disease
```
50
what is narcolepsy/cataplexy?
sleep wake disorder - limbs will go floppy and animal will suddenly collapse
51
describe how to identify narcolepsy/cataplexy
```
collapses are flaccid
inherited
loss of muscle tone (increased in seizures)
no autonomic signs
will return to normal straight after
```
52
what is the cause of fly-catching?
unknown
53
what happens during fly-catching?
animal appears as if they are chasing or trying to catch imaginary flies
54
how long can fly-catching last for?
minutes to hours
55
is mentation altered during fly catching behaviour?
no - normal
56
are there autonomic signs associated with fly-catching?
no
57
describe movement disorder
episodic
patient remains conscious
involuntary movements that are spontaneous and uncontrolled
neurologically normal between episodes
58
what is syncope often mistaken for?
narcolepsy / cataplexy
59
what is syncope?
fainting - temporary loss of conciousness
60
what causes syncope?
reduced oxygenation to the brain which is usually cardiac related
61
what may cause syncope that is not cardiac related?
neurological
hypoglycaemia
hypocalcaemia
62
describe how 3rd degree AV block differs from seizures
prolonged hypoxic event
partial seizure like presentation (may be wobbly)
but not actually seizing
63
what dogs are most commonly affected by canine epileptiod cramping syndrome?
boarder terriers
64
what is canine eplieptiod cramping syndrome?
movement disorder
65
describe a canine eplieptiod cramping syndrome presentation
```
conscious and responsive
no autonomic signs
normal mentation
cramping or stiffness
occurs during normal movement
```
66
when should emergency seizure management only be performed?
under the guide/instruction of the VS
67
what is involved in emergency management of the seizing patient?
```
provide O2
place IV catheter when possible
administer diazepam
assess circulation and temp
intubate if needed
provide active cooling if hyperthermic
collect full bloods
```
68
when will it not be possible to place an IV catheter?
in ictal phase of seizure
69
how may diazepam be administered to the seizing patient?
IV bolus
rectally
intranasally
70
what volume of diazepam is given IV in seizing patients?
0.5mg/kg
71
what volume of diazepam is given rectally in seizing patients?
2mg/kg
72
what volume of diazepam is given intranasally in seizing patients?
0.5 mg/kg
73
when may you give mannitol (0.5 mg/kg) to a seizing patient?
IV (slowly) if seizure activity lasts more than 15 minutes or there is reason to suggest cerebral oedema and raised ICP
74
what should be tested first when bloods are taken from a seizing patient?
glucose, electrolyte and calcium
75
what should be done if the seizing patient is on phenobarbital?
collect baseline blood sample to assess drug conc. and see if alterations to prescription are needed
76
what questions should be asked on phone triage to an owner of an animal that's seizing?
```
any history of seizures
known toxin exposure
known head trauma
length of seizure
how many seizures
is the patient conscious and responsive
any urination or defecation
```
77
when should owners be advised to travel to the practice with their seizing pet?
when safe to do so - wait for recovery or until owner feels able
78
what are the main considerations when nursing a seizure patient?
area of ward with least noise
lights dimmed wherever possible
bottom kennel
seizure plan on kennel with doses calculated
seizure pack with medication drawn up
sign on door to limit staff member entry and traffic
79
what is the main goal of the environment around seizure patients?
quiet and calm as possible with as little stimulation as possible to reduce any potential seizure triggers
80
what should you do if the patient you are caring for seizes?
```
stay calm
note the time
inform vet in charge of case and ask for help
remove any surrounding dangers
dim the lights
reduce noise
limit handling once safe
monitor vital signs if possible
follow seizure plan if one in place
```
81
what should you not do with a seizing patient?
put your hands in or near their mouth
82
what must you try to get from the owner when they are calling with an emergency?
contact number in case you are cut off
83
what should you do when a seizing patient arrives in hospital?
```
reassure the owner
triage - ABC
O2 therapy
IV access ASAP
anticonvulsants
check temp
active cooling if hyperthermia
mannitol, CRI and intubation if needed
```
84
what is the aim of seizure management in an emergency?
stop the patient seizuring
85
what is the aim of seizure management for recurrent seizures?
improve QOL for owner and patient
reduce seizure frequency
reduce severity
balance acceptable levels of side effects and cost
86
what is essential for recurrent seizure management?
owner education and compliance
87
what is the first line of treatment for medical management of idiopathic epilepsy?
Phenobarbitol (Epiphen)
88
what receptors does Phenobarbitol work at?
barbituate that acts on GABA receptors in the brain
89
how does phenobarbital have it's effect?
increases frequency of synaptic inhibition and reduces neuronal excitability
90
what are the benefits of Phenobarbital?
high efficacy
high safety
low cost
91
how long does it take for plasma Phenobarbitol concentration to reach steady state?
~2 weeks
92
what is the significance of steady state drug plasma concentration?
the level of drug required in the plasma to exert full effect
93
why does Phenobarbital require regular blood tests?
to check steady state plasma conc
94
what are the side effects of Phenobarbital?
```
hepatotoxicity with high doses
sedation
polydipsia
polyuria
polyphagia
ataxia
```
95
what symptoms usually decrease after the fist few weeks on Phenobarbital?
sedation
polydipsia
polyuria
polyphagia
96
what drugs are used for medical management of idiopathic epilepsy?
Phenobarbital (Epiphen)
Potassium bromide (Libromide)
Levetiracetam (Keppra)
Imepitoin (Pexion)
97
when is Potassium bromide often used?
used as first line AED or in conjunction with another AED
98
what is the most common use of potassium bromide?
in conjunction with another AED
99
what is the role of Potassium bromide?
reduced neuronal excitability
100
how long does it take to achieve steady state plasma concentration of Potassium bromide?
~4 months
101
how is Potassium bromide excreted?
renally - care in compromised patinets
102
what is the issue with Potassium bromide in cats?
can cause serious lung issues
103
what are the side effects of Potassium bromide?
```
gastric irritation
nausea
polydipsia
polyuria
sedation
pancreatitis
```
104
what is the method of action of Levtiracetam (Keppra)?
unknown
105
what is Levtiracetam (Keppra) used for?
adjunct to other AEDs
106
why is Levtiracetam (Keppra) safe for patients with kidney disease?
primarily excreted unchanged in the urine
107
how is Levtiracetam (Keppra) excreted?
unchanged via the kidneys
108
what are the advantages of Levtiracetam (Keppra)?
excellent oral bioavailability
well tolerated with few side effects
safe for kidney patients
109
what are the side effects of Levtiracetam (Keppra)?
ataxia
vomiting
sedation
110
what is Imepitoin (Pexion) licenced for?
idiopathic epilepsy only
111
what receptors does Imepitoin (Pexion) act on?
GABA receptors
112
how does Imepitoin (Pexion) work?
reduced electrical activity of GABA receptors
113
what animals should not be given Imepitoin (Pexion)?
dogs with impaired hepatic function, renal or cardiovascular disorders
114
what are the side effects of Imepitoin (Pexion)?
ataxia
vomiting
polyphagia
115
what other AEDs may be used to manage seizures?
gabapentin
diazepam
zonisimide
(all less effectie)
116
what are the main home care considerations for seizure patients?
```
manage owner expectations
family situation
financial situation
type of property
communication
build client trust and a rapport
encourage repeat visits
```
117
what must be considered about family situation when creating a seizure home care plan?
work patterns
children (drugs and distress from seizures)
ability to administer medication on time and reliably
118
what must be considered about financial situation when creating a seizure home care plan?
medication is lifelong
there will be repeated blood tests and consults
medication may be altered and added to
119
what must be considered about the type of property when creating a seizure home care plan?
access for patient
| is garden safe (e.g. steps they could fall down)
120
what must be considered about communication when creating a seizure home care plan?
involve the whole family inculding children
121
what are the main things to consider offering to clients with a seizure dog in terms of support?
nursing consultations after initial diagnosis
follow up calls to check in
written communication
support groups / evening sessions for clients
