UNIT 2 SEIZURES AND EPILEPSY

Question 1

What is a seizure?

Answer 1

1. Transient, uncontrolled electrical discharge of neurons in brain, interrupting normal function

Question 2

What are some metabolic disturbances associated with seizures?

Answer 2

1. Acidosis
2. Electrolyte imbalance (sodium)
   3.Hypoglycemia
3. Hypoxia
4. Alcohol or barbiturate withdraw
5. dehydration or water intoxication

Question 3

True or false: Seizures resulting from systemic or metabolic disturbances are not considered epilepsy if the seizures stop when all the underlying conditions have been corrected.

Answer 3

True

Question 4

What are some extracranial disorders associated with seizures?

Answer 4

1. Hypertension
2. Heart, lung, liver, kidney disease
3. Systemic lupus erythematosus
4. DM
5. Septicemia: All patients with sepsis are high risk

Question 5

What is epilepsy?

Answer 5

Disease w/continuing predisposition to seizure w/consequences “chronic” reoccurrence of unprovoked seizures and mutually unpredictable

Question 6

What is the patho of Epilepsy?

Answer 6

Group of abnormal neurons spontaneously firing. It is important to know where the seizure originates and the pattern of spread/extent of involvement.

Question 7

When a patient is sent to the epilepsy monitoring unit, they are going to want the patient to have a min of _____ seizures in order to narrow location down.

Answer 7

3

Question 8

What are the two major classes of seizures?

Answer 8

1. Generalized
2. Focused

Question 9

What are the different types of focal seizures?

Answer 9

1. Simple
2. Complex

Question 10

What are the different types of generalized seizures? List 6

Answer 10

1. Tonic-Clonic
2. Absence
3. Myoclonic
4. Atonic
5. Tonic
6. Clonic

Question 11

What are the 4 phases of seizures?

Answer 11

1. Prodromal phase: Only pt is aware- sensation or behavioral changes
2. Aural phase: Sensory warning that is similar each time but different for each patient
3. Ictal phase: 1st symptom that last up until the end of seizure, we don’t exactly know when this starts/ends on EEG
4. Postictal phase: “recovery phase” end of seizure

Question 12

What can trigger a seizures?

Answer 12

1. Anything extreme- drinking, flashing lights, emotions, up all night, exercise, stress, abrupt medication stop

Question 13

What are generalized tonic-clonic seizures characterized by?

Answer 13

Loss of consciousness and falling. Body stiffens (Tonic) with subsequent jerking of extremities (clonic)

postictal- muscle soreness and fatigue, may sleep for hours, may not feel normal for days, NO memory of seizure

Question 14

What might a patient in a tonic-clonic seizure (generalized) present with?

Answer 14

1. cyanosis, excessive salivation, tongue, or check biting and incontinence may occur

Question 15

What are interventions for generalized tonic-clonic seizures?

Answer 15

1. Seizure pads, fall precautions, tele sitter, suction available

Question 16

How long do the tonic-clonic phases last?

Answer 16

Tonic- 10-20 seconds
Clonic 30-40 seconds

Question 17

When do we normally see typical absence seizures?

Answer 17

1. Usually occurs only in children and rarely beyond adolescence

Question 18

Generalized typical absence seizures can be precipitated by what?

Answer 18

1. Flashing lights and hyperventaltion

Question 19

Typical symptoms of a generalized typical absence seizure can include what?

Answer 19

1. Staring spell “day dreaming”- last few seconds and may have 100’s per day.

Question 20

True or false: An EEG can demonstrate patterns unique to a typical absence seizure?

Answer 20

1. True

Question 21

What is a generalized atypical absence seizure?

Answer 21

1. Characterized by staring spell with other manifestations
   
   • Eye blinking, chewing
   • Jerking movements of the lips
   • Last more than 10 seconds
     -Can continue through adulthood

Question 22

What is a generalized myoclonic seizure?

Answer 22

1. Characterized by sudden, excessive jerk or twitch of body and extremities, brief altered mental status this can be forceful enough to cause falls and may occur in clusters

Question 23

What is a generalized atonic seizure?

Answer 23

1. Involves tonic episodes or paroxysmal loss of muscle tone also known as the “drop attack”. It begins suddenly and person falls. Typically last less than seconds. Person usually remains conscious and can resume normal activity immediately. This type of seizure puts them at great risk of falling. Hard to dx because they believe they are clumsy

Question 24

What is a generalized clonic seizure?

Answer 24

1. Begins with loss of consciousness and sudden loss of muscle tone followed by rhythmic limb jerking that may or may not be symmetric these are relatively rare

Question 25

What are focal seizures?

Answer 25

Also called partial or partial focal seizures. They begin in a specific region or cortex in 1 hemisphere of brain.

Question 26

How are manifestations determined with a focal seizure?

Answer 26

Based on function of area of brain involved

Question 27

What are characteristics of a simple focal seizure?

Answer 27

Person remains conscious and alert Experience unusual feelings or sensations that take many forms. 1. Sudden and unexplainable feelings of joy, sadness, anger or nausea 2. May hear, smell, taste, see or smell things that are not real

Question 28

What is a complex focal seizure?

Answer 28

1. Patients have a loss of consciousness or alteration in awareness. 2. Eyes remain open but cannot interact 3. May display strange behaviors 4. Automatisms- repetitive, purposeless actions 5. Do not remember an activity started before or continued during seizure 6. Last between 30 seconds and 2 mins

Question 29

What is a psychogenic focal seizure?

Answer 29

Can be misdiagnosed as epilepsy 1. History of emotional or physical abuse or a specific traumatic event. 2. Accurate dx usually requires use of video-EEG monitoring

Question 30

What is status epilepticus (SE)

Answer 30

1. State of continuous seizure activity or condition when seizure recurs in rapid succession without return to consciousness between seizures. 2. Any seizure lasting longer than 5 mins it is considered an NEUROLOGICAL EMERGENCY and can occur with ANY type of seizures and my result in permanent brain damage

Question 31

What diagnostic information do we need from a seizure patient.

Answer 31

1. H&P 2. Seizure history

Question 32

What are some diagnostic studies for seizure patients?

Answer 32

1. CBC 2. UA 3. Electrolytes 4. Creatinine 5. Fast blood glucose 6. lumbar puncture for CSF analysis 7. Electroencephalography EEG

Question 33

What are some antiseizure medication side effects?

Answer 33

1. Sedation, 2. mental dulling, 3. impaired memory and concentration, 4, mood changes, 5. GI upset, 6. dizziness

Question 34

What are drugs for simple and complex focal seizures?

Answer 34

1. Carbomazepine 2. Fosphenytoin, Phenytoin 3. Valproic acid 4. Primidone, Phenobarbital

Question 35

What are drugs for primary generalized tonic-clonic, absence, atonic seizures?

Answer 35

1. Carbamazepine 2. Phenytoin 3. Pnenobarbital, valproic acid 4. Levetiracetam

Question 36

What are the goals of medication treatment for seizures?

Answer 36

1. Reduce seizures to a level that allows the patient to live as normal of a life as possible 2. Balance the desire to complete seizure control w/acceptable side affects

Question 37

How do antiepileptic drugs work

Answer 37

1. Suppress discharge of neurons w/in a seizure focus 2. Suppress propagation of seizure activity from the focus to the other area of the brain

Question 38

What are the mechanisms of action for antiepileptic drugs?

Answer 38

1. suppression of sodium influx 2. suppression of calcium influx 3. suppression of potassium influx 4. Blockage of receptors of glutamate 5. Protient of gamma-aminobutyric acid (GABA_

Question 39

Why is monitoring plasma drug levels so important for antiepileptic drugs?

Answer 39

Serves as a guide for dosage adjustments

Question 40

How can we promote patient adherence to their seizure medication?

Answer 40

1. education about importance of adhering to prescribed regimen 2. Monitoring plasma levels to encourage and elevate adherence 3. Deepening patient and family involvement by maintaining a seizure frequency chart

Question 41

What is the management of acute seizures & status epilpticus?

Answer 41

1. Lorazepam (ativan) #1 IVP recommended as 1st line treatment 2. Diazepam (valium)- Short duration 3. Phenytoin (Dilantin) 4. Fosphytoin (less irritating) 5. Magnesium sulfate

Question 42

What patients are at risk for potential seizures?

Answer 42

1. Brain surgery, head trauma, hypoxia, hypoglycemia, drug overdose, alcohol withdrawal.