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34 Cards in this Set
- Front
- Back
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*Seizure definition and causes |
-Rapid, synchronous firing in the brain -Caused by metabolic/electrolyte changes (Ca and Na), intra/extracranial disorders, meds, withdrawal, tumors, trauma, kidney disorders or idiopathic |
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*Epilepsy definition and causes |
-Chronic neuronal misfiring with NO underlying cause! -Uncontrolled electrical activity in the brain -Recurrent episodes of LOC, convulsions, sensory phenomena, behavior abnormalities |
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*What usually is the biggest clue for the underlying cause? |
AGE |
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Seizure etiology and patho |
-Some role of heredity - threshold and predisposition is inheirited -If threshold is low enough, you are susceptible to having seizures with trauma, disease, high fever |
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*Epilepsy etiology and patho |
Spontaneous firing begins in an abnormal cluster of neurons (FOCI), cause is unclear, and firing can spread |
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*Generalized seizure |
Abnormal electrical activity involving whole brain (could be 1 or 2 foci) |
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Consequences of seizure |
-Brain uses a TON of O2 and glucose - can cause hypoxia, exhaustion -Gliosis - scarring -LOC can cause severe injury and death
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*What determines seizure symptoms? |
WHERE THE FOCI IS |
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Terms to help Grande Petit Mal A Tonic |
Grande - big Petit - small Mal - bad A - without Tonic - tone |
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Seizure stages |
Prodromal - just a feeling, warning Aural - sensory warning Ictal - seizure Post-ictal - rest and recover |
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*Seizure classification |
Partial (local) or Generalized (bilateral) |
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*Types of partial seizures |
Simple (LOC=alert) Complex (LOC=altered) |
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*Types of generalized seizures |
ALL HAVE LOC Tonic-clonic Absence |
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*Tonic-clonic seizure |
-AKA grand mal -Generalized (bilateral) -Bilateral Tonic muscle rigidity (10-20s), clonic jerking phase (30-40s) -Apnea, frothing, tongue biting, Incontinence, fall to ground -Post ictal = EXHAUSTION, CNS depression, H/A, confusion |
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*Absence seizure |
- AKA Petit mal - Brief staring spell common in children/adolescents - if LOC, very brief, flashing lights, hyperventilation - can have 100+/day - relatively benign |
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*Simple partial seizure |
-S/S depend on area of brain affected! -Unilateral jerking in one par of body for <1min -Alert, psychic sx, facial movements, sensory/visual sx -Autonomic sx - bradycardia, hypotension, urine retention |
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*Complex partial seizure |
-Temporal lobe - affects behavioral, emotional and cognitive fx -Altered LOC aka "cloudiness", unable to respond to verbal/visual commands -Lipsmacking and automatisms -Less then 1min -Deja vu |
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*Secondarily Generalized |
-Starts as partial seizure but focus spreads to entire brain -Get aura and Todd's paralysis (focal weakness 1-36h after) -Often misdiagnosed as generalized
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*Status epilepticus |
-Neurologic emergency! -State of constant or multiple seizures in rapid succession with no return to conciousness (>20mins) -Tonic-clonics are most severe -Neurons become exhausted causing hypoxia and potentially permanent brain damage |
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*Seizure meds (AEDs) - general info |
*MEDS ARE SPECIFIC TO SEIZURE TYPE -get baseline labs because meds can affect them -all AEDs have a narrow therapeutic index and are highly individualized to the pt -usually AED therapy is lifelong, might taper *AVOID ALCOHOL because it lowers seizure threshold, hurts liver and depresses CNS |
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*Phenytoin |
-Traditional AED -Monitor LFTs! and serum levels -Toxicity= nystagmus, sedation, ataxia, diplopia, cognitive impairment, seizures (careful, can mean too much or not enough!) AE =depressed CNS, gingival hyperplasia (see dentist) |
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*Carbamazepine (Tegretol) |
-Tradtional -DONT DRINK GRAPEFRUIT MARGARITAS ON THE BEACH IN ST JOHNS WORT |
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*Valproic acid (Depakote) |
-Tradtional -AE=hepatotoxicity, pancreatitis, hyperammoniemia |
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Ethosuximide |
-Tradtional -Minimal CNS side effects |
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Phenobarbital |
-Tradtional -Barbituate -Depresses CNS |
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Lorazepam and diazepam |
-Tradtional -Benzos -Can cause seizures |
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Newer AEDs - general info |
Easier to tolerate, less SE, better in pregnancy |
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Seizure Mgmt: DX |
Hx, seizure log, EEG, labs, imaging only to r/o |
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Seizure Mgmt: go to ED? |
Only if injury sustained or new onset |
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Seizure Mgmt: meds |
Do not d/c abruptly |
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Seizure Mgmt: surgical options |
-Anterior lobe resection, craniotomy to remove focus -Corpus callousotomy to prevent spread to both hemispheres |
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Seizure Mgmt: what toavoid |
-Alcohol cuz it lowers threshold, affects liver, decreases med efficacy and depresses CNS -Flashing lights, video games, lout noise for absence seizures |
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Seizure Mgmt: acute care |
Maintain airway, support head, turn to side, nothing in mouth |
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Seizure Mgmt: other tx |
Vagal nerve stimulation |
