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44 Cards in this Set

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definition of Seizure
An excessive and abnormal electrical discharge of brain neurons that is manifested by behavior or electroencephalographic changes.
more interesting facts about seizures
Seizures can be induced by a variety of different electrical or chemical stimuli

Seizures may result in involuntary
change in movement, sensation,
perception, behavior and/ or level of
consciousness
Definition of ___

A brain disorder arising from many
causes that leads to recurrent,
usually spontaneous, epileptic seizures (unprovoked)
Epilepsy
Possible Mechanisms of ____
Defect in neuronal membrane, either in transport of ions or in properties of ion channels
Defect in the inhibitory mechanism
 (Gaba failure)
Defect in excitatory mechanism
 (Glutamate failure)
Defect in modulation system governing +/-
Epilepsy
Epidemiology

~ ___% of the population will have a
seizure during their lifetime and 3% of the population will develop epilepsy

Inherited in 5-10 % of cases --> typically the generalized and febrile seizures
10%
Etiology

____

 Idiopathic
 Birth
 Vascular anomalies
 Congenital anomalies
 Inherited metabolic disorder
 Head injury
 Infection
 Tumors
 Genetic
Infants
Etiology

____

 Idiopathic
 Stroke
 Head Injury
 Drug/ alcohol abuse
 Brain Tumor
 Vascular malformation
 Infection
 MS
 Alzheimer’s disease
Adult
Must be differentiated from:?
Syncope
Hysterical pseudoseizure
TIA
Migraine
Hypoglycemia
What are the two main types of Epilepsy?
Idiopathic – unknown cause; thought to
be genetic
Symptomatic – caused by physical
defects in brain
Major Types of ____

Type 1: Idiopathic Generalized
Type 2: Idiopathic Partial
Type 3: Symptomatic Generalized
Type 4: Symptomatic Partial
Epilepsy
International Classification of ____

PARTIAL (FOCAL)
 Simple
 Complex
GENERALIZED
 Tonic-clonic
 Absence
 Myoclonic
 Clonic
 Atonic
 Tonic
Seizures
____- Focal (evidence of local onset)

Simple
 Motor
 Sensory
 Autonomic
 Psychic

Complex
 With or without above symptoms +
impairment of awareness or LOC
Partial
Partial-Focal

_____
 Age= onset in childhood usually
 One of mildest types of epilepsy
 Often outgrown by puberty
 Seizures tend to occur in sleep
 Often involve face --> can progress to
grand mal
Idiopathic
Partial-Focal

______
 Age= most common type that begins in adulthood
 Caused by localized abnormality in brain; i.e., stroke, tumor, trauma, sclerosis, infection
Symptomatic
____

Sensory – may occur in any sensory modality
Motor – usually involves a focus motor area; face, arm, leg
Autonomic – racing HR, stomach upset, loss of bladder
Psychologic – deja-vu, jamais-vu
**Ictal EEG often normal
Partial-Focal
____ Partial-Focal

Includes impairment of awareness
Observers describe as:
 “out of touch”, “out of it”, “staring into space”
Automatisms: involuntary, coordinated
movements that are purposeless & repetitive
 Lip smacking, chewing, fidgeting, walking
Complex
____ Seizures
Generalized Non convulsive
 Absence (petit-mal)
 Atonic
Generalized convulsive
 Grand mal (tonic-clonic)
 Tonic
 Clonic
 Tonic-Clonic
 Myoclonic
** generalized seizure shows diffuse EEG abnormalities
Generalized
Generalized Seizures

Generalized Non convulsive
-______
Characteristics
 Age= 5-20
 Abrupt onset
 Duration = 5-30 sec
 + EEG 2-4 Hz spike
 CT normal
Absence (petit-mal)
Generalized Seizures

Generalized Non convulsive
-_____
Characteristics
 Brief loss of consciousness
 Brief loss of postural tone
 Not associated with
muscular contractions
Atonic
Generalized ____

Characteristics
 Onset: abrupt, but may have aura to warn
 Duration : 2-3 minutes
 Increased HR
 Increase BP
 EEG: abnormal
 Seizure begins with sudden LOC, falls common followed by generalized rigidity- tonic phase then followed by rapid generalized jerky movements- clonic stage
 May have incontinence of bowel or bladder
Tonic Clonic (Grand Mal)
____ Seizures
Begins with Tonic Phase (stiffening of the limbs),
followed by Clonic Phase (jerking of the limbs).
 Breathing may decrease or cease altogether.
 Cyanosis (blueing) of the lips, nail beds, and face.
 Breathing typically returns during the clonic (jerking) phase, but it may be irregular.
Variability
 Some experience only the tonic, or stiffening phase
 Others exhibit only the clonic or jerking movements;
 Others may have a tonic-clonic-tonic pattern.
Other Concerns
 Incontinence may occur as a result of the seizure.
 The tongue or inside of the mouth may be bitten during the episode
 Breathing afterwards may be noisy and appear to be labored.
Nothing should be placed in the mouth during the seizure
 Turning the patient on one side will help prevent choking and keep the airway clear.
Following the seizure
 Lethargy, Confusion, Exhaustion, Headache
Full recovery takes minutes to hours, depending on the individual.
Grand Mal
____ Seizure

(a) there is a cry and loss of
consciousness, arms flex up then
extend
(b) and remain rigid (the tonic
phase) for a few seconds. A series
of jerking movements take place
(the clonic phase) as muscles
contract and relax together.
(c) the jerking is slowing down and
will eventually stop.
(d) the man has been placed on his
side to aid breathing and to keep
the airway clear.
Grand Mal Seizure
_____

Characteristics
 Sporadic (isolated)
 Brief single or repetitive muscle
contractions involving one body part or the entire body
Myoclonic
Clonic or Tonic

____
 Repetitive jerking movements

____
 Muscle stiffness, rigidity
Clonic or Tonic

Clonic = Repetitive jerking movements

Tonic = Muscle stiffness, rigidity
Definitions

____ : abrupt onset of seizure
Ictal
Definitions

____: between seizures
Interictal
Definitions

____: confusion stage following
seizure
Postictal
Prognosis
Must weigh the following factors:
 Likelihood of remission off medication
 Probability of seizure control with medications
 Ultimate psycho-social adjustment
ok
Prognosis
Very specific regarding childhood syndromes
A newly diagnosed adolescent or adult using
one medication has about 75% chance of a 2
year remission within 8 years of start of tx.
About 50% of all patients can eventually go
without medication with a prolonged
remission.
During the 1st decade post-dx, patients with
epilepsy have twice the mortality rate as
population as a whole
ok
____
Prolonged epileptic state
 Continuous seizure
 Series of seizures
Can be any type of seizure
 Most common Generalized Tonic-Clonic
 Can be life threatening
May require surgery
Status epilepticus
____ Seizures
Occur in infants with fever
4% of children 6 months- 5 years
Increased risk of developing Epilepsy if:
 Prolonged seizure > 15 min
 Recurrent seizure within 24 hours
 Family history
 Neurologic damage
Febrile
Medications
_____
 Dilantin
 Tegretol
 Valproate-Depakene
 Phenabarbital
 Myosoline
 Diazepam-valium
 Clonazeam-klonopin
Generalized Tonic-clonic
or Partial Seizures
Medications
_____

 Zarontin
 Valproate-Depakene
Clonazepam-
Klnonopin
Absence seizures
Medications

____
Valroate- Depakene
 Phenytoin-Dilantin
 Clonazepam-
Klonopin
Myoclonic Seizures
treatment

____ Diet

High in fat
Low in carbohydrates and proteins
Referred to as a rigid metabolic therapy
Usual candidates
 Patients with generalized seizures that are not
amenable to medications or surgery
 Remain on the diet for ~ 2 years--> then most
patients remain seizure free and do not require
medication
The Ketogenic Diet
Treatment

____

Phase I
Surface EEG to reveal the focal source
Of seizure activity
Phase II
Intracranial grid for Telemetry monitory
Used for surgical candidates to localize
Source of seizure activity
Phase III
Surgery
Anterior temporal lobectomy or removal
Of a section of the anterior temporal lobe and
Hippocampus
Phase IV
Long term follow-up
Surgery
Effects of ___

Exercise has shown to produce a trend
toward normalization of EEG
Seizure frequency has been reported to
be less during exercise
Exercise does not directly affect antiepileptic
drug metabolism- howeverweight
change of 10% may affect blood
levels of medication
Exercise Training
Effects of Exercise Training

The following conditions can precipitate
____
 Hypoglycemia
 Hypoxia
 Hyperventilation
 Extreme fatigue
 Hyperthermia
seizure activity
Exercise Training/Testing
Avoid exercise/ testing during postictal
state
Be aware of medication side effects
 Some medications can alter alertness,
balance, coordination and cause fatigue
The exercising professional should
know seizure first aid
ok
Fist Aid For ____
Protect head and body
After tonic clonic phase- place in semi
prone position to avoid aspiration
If elderly with dentures remove
Maintain airway
Seizures
____ Seizures

Under dosage
Non compliance
Wrong drug
Wrong diagnosis
Uncontrolled
Behavioral changes with
____
Seen with partial complex seizures
Especially seen with temporal- limbic
seizures
Greater with long hx of seizures
Mimic psychotic syndrome
Personality traits correlated with epilepsy
 Depression
 Psychosis
 Excessive behaviors
Epilepsy
______

Take medications as prescribed
Good Nutrition- avoid hypoglycemia
Caution: alcohol
Sleep patterns
Treat fever early
Decrease stress
Avoid hyperventilation
Avoid
 Flashing lights
 Loud noise
 Video games
Triggers
Advice

Avoid sleep deprivation
Avoid Excessive alcohol
Do Not Swim alone
If LOC avoid extreme sports
 downhill skiing; hang gliding; ski diving;
scuba diving
Maintain good dental care
thanks for the advice!