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35 Cards in this Set
- Front
- Back
epilepsy
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a condition in which a person has recurrent seizures due to a chronic, underlying process; 2 or more unprovoked seizures
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seizure
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a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of CNS neurons
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3 types of seizures
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partial
generalized unclassified |
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partial seizure
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seizure activity restricted to discrete areas of the cerebral cortex;
usually associated with brain structural abnormalities |
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generalized seizure
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seizure that involves diffuse areas of the brain simultaneously;
may result from cellular, biochemical, or widespread brain structural abnormalities no detectable focal onset (i.e. not a partial seizure with secondary generalization) |
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unclassified seizures
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neonatal seizures
infantile spasms; these are often due to an immature CNS |
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3 types of partial seizures
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simple partial seizure
complex partial seizure partial seizure with secondary generalization |
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simple partial seizure
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consciousness is fully preserved during the seizure (with motor, sensory, autonomic, or psychic signs)
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complex partial seizure
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consciousness is impaired during the seizure
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partial seizure with secondary generalization
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begins as a partial seizure, then typically manifests as a grand mal seizure (tonic-clonic)
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signs of partial seizure
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synchronous abnormal movements of various body parts
repetitive (clonic) flexion/extension movements at a frequency of 2-3 per second may be tonic posturing Jacksonian march Todd's paralysis epilepsia partialis continua |
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Jacksonian march
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abnormal motor movements that begin in a very restricted region (e.g. fingers) and gradually progress (over seconds to minutes) to include a larger portion of the extremity
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Todd's paralysis
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localized paresis for minutes to many hours in the involved region following the seizure
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epilepsia partialis continua
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a partial seizure that continues for hours or days
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signs and symptoms of simple partial seizures that may serve as an aura (warning) of a complex partial seizure or a partial seizure with secondary generalization
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changes in somatic sensations (e.g. paresthesias)
changes in vision (flashing lights or formed hallucinations, micropsia, macropsia) changes in equilibrium (sensation of falling or vertigo) changes in autonomic function (flushing, sweating, piloerection) changes in hearing (sensation of crude or highly complex sounds) changes in olfaction (sensation of unusual, intense odors) epigastric sensation that rises from the stomach or chest to the head odd, internal feelings (fear, sense of impending change, detachment, depersonalization, déjà vu) psychic symptoms |
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phases of a complex partial seizure
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frequently begin with an aura
ictal phase - begins with a sudden behavioral arrest (automatisms) or motionless state postictal - confusion, aphasia, anterograde amnesia full recovery may take seconds or up to an hour |
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automatisms
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chewing
lip smacking swallowing "picking" movements of the hand display of emotion running |
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complex partial seizure diagnosis caution
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the range of potential clinical behaviors is so broad that extreme caution is advised before concluding that stereotypic episodes of bizarre or atypical behavior are not due to seizure activity
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diagnosis of partial seizures with secondary generalization
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hx is important - bystanders will emphasize the dramatic convulsive phase of the seizure and often ignore the subtle focal symptoms present at onset;
ensure your questioning identifies any preceding aura; evaluation and treatment of partial vs generalized seizure disorders may be substantially different - partial seizures with secondary generalization are still considered partial seizures |
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5 types of generalized seizures
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absence (petit mal), including atypical absence seizures
tonic-clonic (grand mal) tonic atonic myoclonic |
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absence (petit mal) seizures
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sudden, brief lapses of consciousness without loss of postural control;
usually accompanied by subtle, bilateral motor signs; can be provoked by hyperventilation |
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bilateral motor signs of absence seizures
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rapid blinking of the eyelids
chewing movements small-amplitude, clonic movements of the hands |
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occurrence of absence seizures
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usually begin at ages 4 to 8 or early adolescence;
many patients will have a spontaneous remission during adolescence |
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atypical absence seizures
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usually longer duration
less abrupt in onset and cessation more obvious motor signs may accompany mental retardation |
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tonic-clonic (grand mal) seizures
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most common seizure type resulting from metabolic derangements;
may be pure tonic or pure clonic seizures also |
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pre- and initial (tonic) phase of a tonic-clonic seizure
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may be vague premonitory symptoms in the hours leading up to the seizure (these are distinct from the stereotypic auras associated with focal (partial) seizures that secondarily generalize);
initial phase - 10 to 20 second tonic contraction of muscles throughout the body; loud moan aka ictal cry; impaired respirations, drooling, cyanosis; tongue biting; increase in HR, BP, and pupil size |
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clonic phase of a tonic-clonic seizure
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periods of muscle relaxation between tonic contractions;
periods of relaxation increase until the end of the ictal phase; usually lasts no more than 1 minute |
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postictal phase of a tonic-clonic seizure
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unresponsiveness
muscular flaccidity excessive salivation that causes stridor and partial airway obstruction bladder or bowel incontinence gradual regaining of consciousness over minutes to hours, with period of postictal confusion; recovery after many hours may occur with prolonged seizures and underlying CNS diseases e.g. alcoholic cerebral atrophy |
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after the postictal phase of a tonic-clonic seizure
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headache
fatigue muscle ache - these may last for many hours |
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atonic seizures
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sudden loss of postural muscle tone lasting 1 to 2 seconds;
brief loss of consciousness usually no postictal confusion may be a quick head drop or nod, or the patient may collapse if the seizure is longer |
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myoclonic seizures
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sudden and brief muscle contraction that may involve one part of the body or the entire body;
predominant feature of juvenile myoclonic epilepsy |
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epilepsy syndrome
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disorder in which epilepsy is a predominant feature, and there is sufficient evidence to suggest a common underlying mechanism
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Juvenile myoclonic epilepsy
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appears in early adolescence
single or repetitive bilateral myoclonic jerks most frequent in the morning after waking; can be provoked by sleep deprivation patient stays conscious, unless the myoclonus is especially severe may experience generalized tonic-clonic seizures or absence seizures |
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Lennox-Gastaut syndrome
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occurs in children
triad: 1. multiple seizure types 2. EEG showing abnormalities 3. impaired cognitive function |
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Mesial temporal lobe epilepsy
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the most common syndrome associated with complex partial seizures
does not respond well to anticonvulsants patient may have hx of: - febrile seizures - family hx of epilepsy - early onset - seizures may remit then reappear - seizures often intractable s/sx: - aura is common - behavioral arrest/stare - complex automatisms - unilateral posturing - postictal disorientation, memory loss, dysphasia |