w9 seizures

Question 1

what are seizure disorders?

Answer 1

Is a symptom of disease, not a specific disease

Question 2

what is a seizure?

Answer 2

is a sudden, transient disruption in brain electrical function caused by abnormal excessive discharges of cortical neurons

Question 3

what is epilepsy?

Answer 3

is a recurrence of seizures and a disorder for which no cause can be found

Question 4

what is convulsion?

Answer 4

-is a tonic-clonic (jerky, contract-relax) movements associated with some seizures

Question 5

what are conditions that are associated w/ seizure disorders?

Answer 5

any conditions that affect the CNS or neuronal environment

• metabolic disorders
• congenital malformations
• genetic predispositions
• perinatal injury
• postnatal trauma
• myoclonic syndromes
• infection
• brain tumour
• vascular disease
• drug/alcohol abuse
• some environmental stimuli (blinking lights) known to imitate seizures

Question 6

types of seizures -generalized seizures

Answer 6

affect neurons bilaterally

Question 7

types of seizures-focal (partial) seizures-

Answer 7

affect neurons unilaterally

Question 8

types of seizures-epilepsy syndromes

Answer 8

-usually a genetic or developmental cause

Question 9

types of seizures-unclassified epileptic seizures-

Answer 9

the etiology is unknown

Question 10

what is status epilepticus?

Answer 10

is a medical emergency !!

-continuing/recurring seizures w/ incomplete recover, unrelenting seizure activity that lasts 30 minutes or more

Question 11

what are the 6 causes of epilepsy?

Answer 11

• genetic
• structural
• metabolic
• immune
• infections
• unknown

Question 12

patho of epilepsy

Answer 12

• is the interaction of complex genetic mutations w/ environmental effects
• abnormalities synaptic transmission
• imbalance in the brain’s neurotransmitters
• development of abnormal nerve connections after injury

Question 13

what is epileptogenic focus -epilepsy

Answer 13

• Group of neurons that appear chronically hyperexcitable; fire more frequently and with greater amplitude
• Cortical excitation spreads when the intensity threshold is reached

Question 14

what is the tonic phase -epilepsy

Answer 14

A state of muscle contraction in which there is excessive muscle tone

• Excitation of subcortical thalamic and brainstem areas
• Associated with loss of consciousness

Question 15

what is the clonic phase in epilepsy?

Answer 15

(alternating contraction and relaxation of muscles)

• Inhibitory neurons in cortex, anterior thalamus, and basal ganglia react to cortical excitation –> muscle contractions gradually cease
• Epileptogenic neurons exhausted

Question 16

what is the postictal phase -epilepsy

Answer 16

• following an epileptic seizures and pt returns to baseline

- Headache, confusion, aphasia, memory loss, and paralysis, lip-biting

Question 17

what are the consequences of epilepsy?

Answer 17

• cerebral blood flow increase
• cerebral oxygen consumption is increased by 60%
• glucose depletion
• accumulation of lactate in brain tissues
• potential for progressive brain injury and irreversible damage

Question 18

what is prodroma?

Answer 18

Early clinical manifestations, such as malaise, headache, or a sense of depression, that may occur hours to a few days before the onset of a seizure

Question 19

what is aura?

Answer 19

-A focal seizure experienced as a peculiar sensation preceding the onset of a generalized seizure or complex partial seizure that may take the form of gustatory, visual, or auditory experience; a feeling of dizziness or numbness; or just “a funny feeling”
-sensation that occurs that is a warning sign of a seizure
“smelling, lip-smacking

Question 20

what is ictus?

Answer 20

The episode of the seizure

Relaxation of urinary and bowel sphincters → incontinence

Question 21

treatment of seizures

Answer 21

• Antiseizure medication
• Ketogenic diet for epilepsy
• Surgery; vagal nerve stimulation

Question 22

what is the ketogenic diet?

Answer 22

• high in fat, moderate in protein, and low in carbohydrates
• limits water intake to avoid ketone dilution and carefully controls caloric intake
• used when seizures cannot be controlled through pharmacotherapy or when the adverse effects of an antiepileptic drug (AED) are unacceptable
• equally effective for every seizure type but not all clients respond to the diet

Question 23

what is drug therapy for seizure disorders? goal

Answer 23

• goal of antiseizure pharmacotherapy is to suppress neuronal activity just enough to prevent abnormal or repetitive firing
• drug choice depends on the type of seizure
• drug therapy: pt is placed on an initial low dose
• amount is gradually increased until seizure control is achieve or drug side effects prevent additional increase
• if seizure activity continues, different medication in small dose increments are added while reducing the initial dose of the first drug

Question 24

what are the 3 vernal mechanisms of drug therapy for seizures?

Answer 24

• Stimulate a influx of chloride ions → potentiates GABA (inhibitory)
• Delay an influx of sodium ions
• Delay an influx of calcium ions

Question 25

what are the 3 vernal mechanisms of drug therapy for seizures?

Answer 25

- Stimulate a influx of chloride ions → potentiates GABA (inhibitory) - Delay an influx of sodium ions - Delay an influx of calcium ions

Question 26

Benzodiazepines: diazepam

Answer 26

- Indication: Anxiety, adjunct in seizure disorders - Mechanisms of action: binds to GABA (inhibitory) receptor-chloride channels through the CNS. Suppresses abnormal neuronal activity in the limbic system and subsequent impulses to the reticular activating system that may seizures. - Desired effects: Decreased seizures, anxiety, restlessness

Question 27

Benzodiazepines: diazepam-adverse effects

Answer 27

Dizziness, headache, hypotension, blurred vision, constipation, nausea & vomiting, neutropenia, respiratory depression

Question 28

Gamma-aminobutyric acid (GABA) Inhibitors: valproic acid

Answer 28

- Indication: Seizures - Mechanisms of action: desensitizes sodium channels in the CNS that are responsible for neuronal responsibility. Desensitization prevents the spread of disruptive electrical charges in the brain the produces seizures. - Desired effects: Decreased symptoms of epilepsy, bipolar disorder

Question 29

Gamma-aminobutyric acid (GABA) Inhibitors: valproic acid-adverse effects

Answer 29

sedation, drowsiness, GI upset, and prolonged bleeding time -Other effects: visual disturbances, muscle weakness, tremor, psychomotor agitation, bone marrow suppression, weight gain, abdominal cramps, rash, alopecia, pruritus, photosensitivity, erythema multiforme, and fatal hepatotoxicity

Question 30

Anticonvulsants: Succinimides: ethosuximide

Answer 30

- Indiciation: seizure disorders - Mechanisms of action: delay entry of Ca++ = increase the electrical threshold and decrease neurons from firing too quickly - Desired effects: absence of seizures

Question 31

ethosuximide -adverse effects

Answer 31

: psychosis or extreme mood swings, depression with suicidal intent, dizziness, headache, lethargy, fatigue, ataxia, sleep pattern disturbances, attention difficulty, and hiccups

Question 32

what is generalized absence seizure?

Answer 32

- last seconds- no change in muscle tone - may occur over several times in a day - appears as if they are daydreaming - more common in children and often misdiagnosed w/ ADHD

Question 33

what is tonic-clonic?

Answer 33

may begin w/ an aura- "I smell burnt toast" - a warning sign tonic phase- muscle stiffness and rigidity last 10-20 seconds, followed by unconsciousness clonic phase- hyperventilation and jerking of the extremities - last about 30 seconds

Question 34

what is atonic or akinetic "drop attacks"

Answer 34

-sudden loss of muscle tone

Question 35

what is myoclonic?

Answer 35

it is jerking or stiffening of the extremities | -may fall from the seizure

Question 36

what is simple partial?

Answer 36

- produces sensory and motor symptoms localized or confirmed to an area - remains consciousness and may result in aura - no post-ictal phase

Question 37

what is complex partial?

Answer 37

psychomotor seizures - temporal lobe is most often involved - altered behaviour of the client- loss of consciousness for a few seconds -altered behaviour in these pt's - has a post-ictal phase

Question 38

interventions for seizures

Answer 38

- ensure patent airway -support airway, prepare to suction - first thing--> make sure pt are on the floor and protecting the head and body, never restrain the pt - side-rail are paded- - make sure nothing is in the mouth - preventing injury at this time, removing/loosen restrictive clothing - assess behaviour at the onset of the seizure- the client has experienced an aura, if a change in facial expression occurs - if client is sitting/standing plane on the floor and protect head/body - turn client to the side to allow secretions to drain - note type, character and progression of seizure