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Neurology > Seizures Lecture Powerpoint > Flashcards

Seizures Lecture Powerpoint Flashcards

1
Q

Telltale sign of a seizure

A

If you grab hold of their arm it will NOT stop seizing

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2
Q

Ictal

A

Relating to or caused by stroke/seizure (during a seizure)

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3
Q

Post-ictal

A

Altered state of consciousness after seizure

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4
Q

New onset of seizures age 30 onward assume…

A

….tumor until proven otherwise

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5
Q

Tonic

A

Producing tone or contraction of muscles within seizure

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6
Q

Clonic

A

Alternating pattern of relaxation and contraction in muscles within seizure

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7
Q

Aura (seizures)

A

Distinctive visual or sensation warning sign typically predictive of an impending seizure episode

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8
Q

Clonic vs myoclonic vs myoclonic tonic

A

Very slow vs very fast (

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9
Q

Epilepsy epidemiology

A

3.4 million americans, 1% of population, 50% of people with it develop by age of 25 but can get it at any time, twice as many with epilepsy who are 60 or older as children aged 10 or younger

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10
Q

Localized/partial epilepsy

A

Seizure located on one side or part of body initially that may evolve into entire body involvement (secondarily generalized), either simple (not lost consciousness) or complex (have change in state of consciousness)

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11
Q

Generalized seizures and their subclasses (5)

A

Seizure that occur over whole body symmetrically without local onset including several classes such as:

  • tonic clonic (grand mal)
  • absence (petit mal)
  • myoclonic
  • clonic
  • atonic
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12
Q

70% of epiplepsy is ___, most common causes of provoked include the following (5)

A

idiopathic,

  • head trauma
  • infection
  • brain tumor
  • genetic anomalies
  • prenatal disturbance of brain development
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13
Q

Seizures

A

Uncontrolled electrical activity in the brain resulting in physical convulsion and other manifestations in the body

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14
Q

Signs and symptoms of seizure (4)

A
  • Fever (may be indicative of infectious etiology - febrile seizure)
  • papilledema
  • headache
  • focal neurologic finding
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15
Q

Todd’s paralysis

A

Focal residual abnormality such as paralysis of one sided limb that may suggest post - focal onset of seizure

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16
Q

Seizure is not a ___, it is a ___

A

diagnosis, symptom

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17
Q

Focal seizures can progress if left untreated for a period of time to…

A

….generalized (secondary generalized)

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18
Q

Epilepsy

A

Recurrent seizures unrelated to fever or acute cerebral insult with no underlying provocation, generalized tonic-clonic characterized by rigidity (tonic phase) followed by repetitive clonic activity (of all extremities), may be accompanied by oral frothing, resp distress, cyanosis, incontinence, blackout, and convulsions

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19
Q

Psychogenic nonepipleptic seizures

A

Seizure activity characterized by sudden and time limited disturbances of motor, sensory, autonomic, cognitive, and/or emotional functions, mimics seizures but not associated with physiological CNS dysfunction (as measured on an EEG), tends to last longer than 2 min, pelvic thrust but no incontinence, can still communicate, forced eye closure, and no increase in prolactin levels (which is always seen in a true seizure)

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20
Q

Things that mimic seizures (4)

A
  • syncope
  • sleep disorders
  • migraines
  • TIA
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21
Q

Nonepileptic seizures (pseudoseizures)

A

More common in females that present with asynchronous movements, fluctuating course, extended duration, tight eye shuts, pelvic thrusting, etc. that shares distinct differences from a true seizure

22
Q

Lennox gastaut syndrome triad of presentation

A
  • developmental delay
  • absence and tonic seizures
  • slow spike wave discharges on EEG
23
Q

Lennox gastaut syndrome

A

Infantile spasms onset 2-7 years

24
Q

Complex partial seizures (psychomotor seizures)

A

Represents events of focal cerebral onset, characteristically manifests with variety of motor, sensory, or behavioral alterations, motor activity during complex partial seizure may remain focal

25
Q

Juvenile myoclonic epilepsy

A

Recessive inherited epilepsy that is distinct in that it does not have a bad prognosis

26
Q

Rhabdo and seizures

A

prolonged hours of seizing is concern

27
Q

Febrile seizures

A

Most common in children, affect 3-5% of kids, does not indicate likelihood of developing seizures later in life, typically have tonic clonic motor activity lasting 1-2 min with rapid return to consciousness, tend to occur in conjugation with rapid rise in body temp

28
Q

Atypical febrile seizure

A

Deviate from febrile seizure either by being prolonged exceeding 15 min, focal seizure manifestations, or multiple in the same febrile illness

29
Q

Alcohol withdrawal seizures

A

Most commonly seen in alcohol dependent patients when sudden cessation, often precede other classic symptoms of withdrawal, untreated may progress to delirium tremens, most common 12-36 hrs after withdrawal, CT often considered for initial to rule out underlying process

30
Q

Delirium tremens and 2 treatments

A

Rapid onset of confusion following alcohol withdrawal, treated with valium or ativan (lorazapem)

31
Q

Seizure diagnosis (4)

A
  • Clinical assessment
  • EEG
  • CT
  • Neurologic exam
32
Q

Tuberous sclerosis/von recklinghausen

A

Common type of neurocutaneous syndrome that is neurofibromatosis type I clinically diagnosed by hypmelanotic macules as first manifestation followed by progression and eventual seizures

33
Q

Classic triad of tuberous sclerosis

A

adenoma sebaceum, seizures, and developmental delay

34
Q

common seizure triggers (6)

A
  • missed medication (#1)
  • stress/anxiety
  • hormonal changes
  • fatigue
  • photosensitivity
  • fever
35
Q

Seizure treatment principles

A

Control frequency while limiting side effects, medication depends on etiology, acute management includes benzos, often require sedation

36
Q

Absence (Petit mal) seizures

A

Generalized seizures with spells lasting up to 10 sec a piece and occurs dozens of times daily, patients have no recollection of events and will resume previous activity without any postictal symptoms

37
Q

Classic EEG finding for absence seizures

A

3 cycle per second spike and waves

38
Q

Status epilepticus

A

Seizure lasting longer than 30 min or occurrence of serial seizures from which there is no return to same level of consciousness as occurred prior to seizure, can be febrile, idiopathic, or symptomatic status

39
Q

Treatment principles of status epilepticus (ABCDD)

A

Airway
Breating
Circulation (hypertension is normal finding)
Dextrostix (may be hypoglycemic)
Draw blood (get glucose, electrolytes, etc.)

40
Q

Seizure episode treatment options (8)

A
  • Lorazepem (ativan)
  • diazepam (valium)
  • phenobarbital in neonatal first line
  • Phenytoin (dilantin) DOC, cannot be given IM
  • mannitol (brain swelling)
  • dexamethasone (same)
  • Valproic acid (useful in treating generalized and artial seizure disorders)
  • Ethosuximide (zarontin) DOC for absence epilepsy but other meds can make the condition worse
41
Q

Not all initial, brief, uncomplicated seizures need to be…

A

….treated if no underlying pathology found, just treat underlying disorder (its possible to just have one)

42
Q

Diagnostic studies for seizures (5)

A
  • EEG with provocation testing
  • MRI
  • Metabolic panel
  • Lumbar puncture
  • EKG
43
Q

Phenytoin ADR’s (4)

A
  • gingival hyperplasia
  • hirsutism
  • lymphadenopathy
  • hepatotoxicity
44
Q

CT and MRI findings in seizure patients

A
  • CT findings not visualized

- MRI present in 100% of cases, see streaky linear or wedge shaped lesions extending from ventricles

45
Q

Potential complications of epilepsy (2)

A
  • sudden unexpected death in epilepsy

- brain damage

46
Q

Alternative treatment options for seizures (3)

A
  • ketogenic diet
  • lifestyle mods
  • marijuana
47
Q

Positive characteristics of new seizure meds (4)

A
  • efficacy at least equal to older meds
  • safer and more tolerated
  • blood testing not necessary
  • less drug interactions
48
Q

Anticonvulsant withdrawal

A

Indicated only slowly after 2 years of seizure free activity in child with no underlying contributing neurological or systemic dz

49
Q

Surgical treatment for seizures (3)

A
  • Resection when foci can be isolated
  • laser ablation
  • vagal nerve stimulator inplantation
50
Q

Safety issues for patients with epilepsy (4)

A
  • Cannot drive for year after last seizure
  • shouldn’t swim or bathe alone
  • cooking should be monitored
  • taking care of children can be challenging
51
Q

Best anticonvulsant for pregnant women

A

Lamotrigine

Neurology (23 decks)

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