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35 Cards in this Set

  • Front
  • Back
epilepsy
a condition in which a person has recurrent seizures due to a chronic, underlying process; 2 or more unprovoked seizures
seizure
a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of CNS neurons
3 types of seizures
partial
generalized
unclassified
partial seizure
seizure activity restricted to discrete areas of the cerebral cortex;
usually associated with brain structural abnormalities
generalized seizure
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)
unclassified seizures
neonatal seizures
infantile spasms;
these are often due to an immature CNS
3 types of partial seizures
simple partial seizure
complex partial seizure
partial seizure with secondary generalization
simple partial seizure
consciousness is fully preserved during the seizure (with motor, sensory, autonomic, or psychic signs)
complex partial seizure
consciousness is impaired during the seizure
partial seizure with secondary generalization
begins as a partial seizure, then typically manifests as a grand mal seizure (tonic-clonic)
signs of partial seizure
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
Jacksonian march
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
Todd's paralysis
localized paresis for minutes to many hours in the involved region following the seizure
epilepsia partialis continua
a partial seizure that continues for hours or days
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
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
phases of a complex partial seizure
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
automatisms
chewing
lip smacking
swallowing
"picking" movements of the hand
display of emotion
running
complex partial seizure diagnosis caution
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
diagnosis of partial seizures with secondary generalization
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
5 types of generalized seizures
absence (petit mal), including atypical absence seizures
tonic-clonic (grand mal)
tonic
atonic
myoclonic
absence (petit mal) seizures
sudden, brief lapses of consciousness without loss of postural control;
usually accompanied by subtle, bilateral motor signs;
can be provoked by hyperventilation
bilateral motor signs of absence seizures
rapid blinking of the eyelids
chewing movements
small-amplitude, clonic movements of the hands
occurrence of absence seizures
usually begin at ages 4 to 8 or early adolescence;
many patients will have a spontaneous remission during adolescence
atypical absence seizures
usually longer duration
less abrupt in onset and cessation
more obvious motor signs
may accompany mental retardation
tonic-clonic (grand mal) seizures
most common seizure type resulting from metabolic derangements;
may be pure tonic or pure clonic seizures also
pre- and initial (tonic) phase of a tonic-clonic seizure
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
clonic phase of a tonic-clonic seizure
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
postictal phase of a tonic-clonic seizure
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
after the postictal phase of a tonic-clonic seizure
headache
fatigue
muscle ache
- these may last for many hours
atonic seizures
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
myoclonic seizures
sudden and brief muscle contraction that may involve one part of the body or the entire body;
predominant feature of juvenile myoclonic epilepsy
epilepsy syndrome
disorder in which epilepsy is a predominant feature, and there is sufficient evidence to suggest a common underlying mechanism
Juvenile myoclonic epilepsy
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
Lennox-Gastaut syndrome
occurs in children
triad:
1. multiple seizure types
2. EEG showing abnormalities
3. impaired cognitive function
Mesial temporal lobe epilepsy
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