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42 Cards in this Set
- Front
- Back
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What is a seizure?
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an excessive & abnormal electrical discharge of brain neurons that is manifested by behavior or EEG changes
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What is epilepsy?
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a brain disorder arising from many causes that leads to RECURRENT, usually spontaneous, epileptic seizures (unprovoked)
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How can seizures be induced?
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different electrical or chemical stimuli
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Seizures result in...
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changes in:
1. involuntary movement 2. sensation 3. perception 4. behavior 5. LOC |
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Possible mechanisms of seizure...
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1. defect in neuronal membrane
2. defect in inhibitory mechanism (GABA failure) 3. defect in excitatory mechanism (Glutamate failure) 4. defect in modulation system governing +/- |
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Epidemiology
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• 10% of the population will have a seizure during their lifetime
• 3% of the pop will develop epilepsy |
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Etiology: Infant
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idiopathic
birth vascular (hypoxia) congenital anomalies (hyperkalcemia, hypernatremia), inherited metabolic disorder (hypoglycemia) head injury (cerebral contusion) infection tumors & genetic |
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Etiology: Adult
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Idiopathic
stroke head injury drug/alcohol abuse brain tumor vascular malformation infection MS (plaque in focal lesion) Alzheimer's disease (degredation of neural output) |
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What are the 2 types of epilepsy?
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idiopathic
symptomatic |
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What are the major types of epilepsy?
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type 1: idiopathic generalized
type 2: idiopathic partial type 3: symptomatic generalized type 4: symptomatic partial |
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What is the PARTIAL (focal) classification of seizures?
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• local onset
• SIMPLE symptoms - motor, sensory, autonomic, psychic • COMPLEX symptoms- with or w/o above symptoms + impairment of awareness or LOC |
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What is the GENERALIZED classification of seizures?
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• focal leading (specific area in brain) to generalized (more diffuse, spreads to subcortical structures)
• symptoms involves the whole body |
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Type 2: idiopathic partial-focal
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1. age: onset in childhood--> outgrown by puberty
2. mildest types 3. seizures: occur in sleep 4. involves the face, can progress to Grand Mal |
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Type 4: Symptomatic partial-focal
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1. age: adulthood
2. caused by local brain abnormality: stroke, tumor, trauma, sclerosis, infection |
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Symptoms of PARTIAL-FOCAL seizures affect:
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Sensory - any sensory modality ie smell, light, touch
Motor - involves a focus (discrete) motor area ie face, arm, leg Autonomic - racing HR, upset stomach, loss of bladder Psychologic - feelings of deja-vu, jamais-vu, ictal EEG normal, no LOC |
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what is jamais-vu?
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familiar situation that's not recognized by the observer...
when a person momentarily doesn't recognize a word, person, or place that he/she already knows |
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Symptoms of COMPLEX PARTIAL-FOCAL seizures....
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1. include impairments of awareness
2. described as "out of touch, out of it, staring into space" 3. automatisms |
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What are automatisms?
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involuntary, coordinated movements
that are purposeless and repetitive ie lip smacking, fidgeting, chewing, walking |
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What are 2 types of GENERALIZED seizures?
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Non-convulsive and convulsive
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generalized seizures show diffuse EEG abnormalities, T or F?
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True
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What is absence seizure (generalized non-convulsive)?
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Characteristics:
age: 5-20 yo abrupt onset lasting 5-30 sec +EEG: 2-4Hz spike CT normal |
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What is atonic seizure (generalized non-convulsive)?
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Characteristics:
• brief LOC, postural tone • not assoc. w/ muscular contractions |
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What is generalized tonic-clonic seizure (GRAND MAL)?
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Characteristics:
• abrubt onset lasting 2-3 min.- may have aura to warn • increased HR, BP • EEG: abnormal • BEGINS with: sudden LOC, falls (common), followed by tonic phase (generalized rigidity) then clonic phase (rapid generalized jerky movements) • possible incontinence of bowel/bladder |
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What is myoclonic?
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Characteristics:
• sporadic (isolated) • brief single or repetitive muscle contractions involving one body part or the entire body |
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What is ictal?
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abrupt onset of seizure
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What is interictal?
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between seizures
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What is postictal?
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confusion stage following a seizure
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What is status epilepticus?
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• Prolonged epileptic state - continuous or series of seizures
• can be any type of seizure - generalized tonic/clonic (most common); can be life threatening (call 911 if affecting whole body or if medical emergency) • may require surgery |
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What are febrile seizures?
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• onset of fevers causes seizures
• age: infants • increased risk of developing epilepsy IF: - prolonged seizure >15 min. - recurrent seizure w/n 24 hrs - family hx - neurologic damage |
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What is the ketogenic diet?
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• HIGH in FAT, LOW in carbs and protein
• referred to as a rigid metabolic therapy • usual candidates: pts with generalized seizures not amenable to surgery or meds, have to remain on the diet~2 yrs |
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What is the effect of exercise training on individuals with seizures?
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• trend toward EEG normalization
• LESS seizure frequency during exercise • exercise doesn't affect anti-epilepsy meds HOWEVER weight change of 10% may affect blood levels of medication from exercise |
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What are the conditions that can precipitate seizures?
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hypoglycemia
hypoxia hyperventilation extreme fatigue hyperthermia |
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What is the FIRST AID for seizures?
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1. protect body head and body
2. after tonic/clonic phase - place in semi prone position to avoid aspiration 3. if elderly, remove dentures 4. maintain airway |
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What may cause uncontrolled seizures?
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under dosage
non-comliance wrong drug wrong dx |
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How to decrease seizure triggers...
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• take meds
• good nutrition - avoid hypoglycemia • no excessive alcohol or binge drinking • consistent sleep patterns • treat fever early • decrease stress • avoid hyperventilation • avoid flashing lights, loud noise, video games |
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Behavioral changes with epilepsy
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• seen w/ partial complex seizures
• esp. seen w/ temporal-limbic seizures • greater w/ long seizure hx • mimics psychotic syndrome • personality traits correlated w/ epilepsy - depression, psychosis, excessive behaviors |
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Advice for these guys
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• avoid sleep deprivation
• avoid excessive alcohol • don't swim alone • IF LOC, avoid extreme sports • maintain good dental care (avoids systemic infection) |
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What is a seizure?
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an excessive and abnormal electrical discharge of brain neurons that is manifested by behavior or electrocephalographic changes
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what is epilepsy?
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disorder characterized by recurrent seizures
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What can seizures be induced by?
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induced by a variety of different electrical or chemical stimuli
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What do seizures result in?
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involuntary change in movement, sensation, perception, behavior and/or LOC
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What are 4 possible mechanisms for seizures?
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defect in neuronal membrane, either in transport of ions or in properties of ion channels, defect in the inhibitory mechanism (GABA failure), defect in the excitatory mechanism (glutamate failure), defect in modulation system governing
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