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44 Cards in this Set
- Front
- Back
definition of Seizure
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An excessive and abnormal electrical discharge of brain neurons that is manifested by behavior or electroencephalographic changes.
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more interesting facts about seizures
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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 |
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Definition of ___
A brain disorder arising from many causes that leads to recurrent, usually spontaneous, epileptic seizures (unprovoked) |
Epilepsy
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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
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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%
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Etiology
____ Idiopathic Birth Vascular anomalies Congenital anomalies Inherited metabolic disorder Head injury Infection Tumors Genetic |
Infants
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Etiology
____ Idiopathic Stroke Head Injury Drug/ alcohol abuse Brain Tumor Vascular malformation Infection MS Alzheimer’s disease |
Adult
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Must be differentiated from:?
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Syncope
Hysterical pseudoseizure TIA Migraine Hypoglycemia |
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What are the two main types of Epilepsy?
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Idiopathic – unknown cause; thought to
be genetic Symptomatic – caused by physical defects in brain |
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Major Types of ____
Type 1: Idiopathic Generalized Type 2: Idiopathic Partial Type 3: Symptomatic Generalized Type 4: Symptomatic Partial |
Epilepsy
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International Classification of ____
PARTIAL (FOCAL) Simple Complex GENERALIZED Tonic-clonic Absence Myoclonic Clonic Atonic Tonic |
Seizures
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____- Focal (evidence of local onset)
Simple Motor Sensory Autonomic Psychic Complex With or without above symptoms + impairment of awareness or LOC |
Partial
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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
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Partial-Focal
______ Age= most common type that begins in adulthood Caused by localized abnormality in brain; i.e., stroke, tumor, trauma, sclerosis, infection |
Symptomatic
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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
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____ 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
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____ 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
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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)
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Generalized Seizures
Generalized Non convulsive -_____ Characteristics Brief loss of consciousness Brief loss of postural tone Not associated with muscular contractions |
Atonic
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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)
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____ 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
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____ 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
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_____
Characteristics Sporadic (isolated) Brief single or repetitive muscle contractions involving one body part or the entire body |
Myoclonic
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Clonic or Tonic
____ Repetitive jerking movements ____ Muscle stiffness, rigidity |
Clonic or Tonic
Clonic = Repetitive jerking movements Tonic = Muscle stiffness, rigidity |
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Definitions
____ : abrupt onset of seizure |
Ictal
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Definitions
____: between seizures |
Interictal
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Definitions
____: confusion stage following seizure |
Postictal
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Prognosis
Must weigh the following factors: Likelihood of remission off medication Probability of seizure control with medications Ultimate psycho-social adjustment |
ok
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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
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____
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
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____ 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
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Medications
_____ Dilantin Tegretol Valproate-Depakene Phenabarbital Myosoline Diazepam-valium Clonazeam-klonopin |
Generalized Tonic-clonic
or Partial Seizures |
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Medications
_____ Zarontin Valproate-Depakene Clonazepam- Klnonopin |
Absence seizures
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Medications
____ Valroate- Depakene Phenytoin-Dilantin Clonazepam- Klonopin |
Myoclonic Seizures
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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
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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
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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
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Effects of Exercise Training
The following conditions can precipitate ____ Hypoglycemia Hypoxia Hyperventilation Extreme fatigue Hyperthermia |
seizure activity
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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
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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
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____ Seizures
Under dosage Non compliance Wrong drug Wrong diagnosis |
Uncontrolled
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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
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______
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
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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!
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