Myoclonic Myoclonic-Atonic Myoclonic-Tonic

Seizures Flashcards by O lawformonde

Recurrent , unprovoked seizures

Epilepsy

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Abnormal electrical activity in the brain

Seizure

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range from sensory symptoms, autonomic changes, psychic experiences
Confusion to full-blown convulsions

Semiology

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Epilepsy

failure of 2+anti-eleptic Rx

Intractability –> Surgery Eval

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Generalized Seizure

List

Absence Seizure
Myoclonic Seizures
Tonic-clonic seizures
Tonic
Atonic
Clonic

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Absence Seizures

Types

Typical
Atypical
With Special Features
- Myoclonic Absences
- Abscences w/ Eyelid Myoclonia

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Myoclonic Seizures

Myoclonic
Myoclonic-Atonic
Myoclonic-Tonic

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Focal Seizures

Complex Partial

Focal discognitive WITH impaired awareness

aura
NO loss of consciousness

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Focal Seizures

Simple Partial

Focal WITHOUT impairment of consciousness/awareness

*isolated motor s/s (tonic/clonic)

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Childhood/teenage onset
Sudden onset, sudden offset
NO aura
Loss of consciousness
Eyelid flutter/minor automisms
3-15 seconds duration

Absence Seizure

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Absence Seizure

EEG:

3Hz Spike-Wave/HV Sensitive

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Sudden siffening
Maximal extension in arms
A few seconds long
W/ Falls/Injury

Tonic Seizures

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Tonic Seizures

Where in brain?

Extra-temporal

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Tonic Seizures

EEG

Flattening/high frequency discharge

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Abrupt onset
Sudden loss in tone
1-2 seconds long
Head drop/Falls/Injuries
Poor prognosis
poor response to AEDs

Atonic Seizures

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Atonic Seizure

EEG

Slow spike-wave/flattening

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Sudden jerks
Bilateral, maximal in arms
1 second long, multiple usually
possibly photic/sensory triggered

*Myoclonic Seizures

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*Myoclonic Seizures

EEG

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Generalized polyspike-wave burst

Loss of Consciousness
Post seizure Mental status change
Focal/Generalized
Tonic limb extension 20-40 seconds
INTO Rhythmic Clonic Jerking of Extremities (30-50 secs)
STOP Breathing, tongue biting, incontinence
Post-ictal sleep

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Tonic-Clonic

Tonic Clonic

EEG

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Variable,

*maybe Obscured

Premature morality rate for Epilepsy sufferers

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2-3x normal person

Epilepsy

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*Hx
-Auras
-Witness reports
-Post-ictal s/s /b
-Experiences following
seizure
*EEG
-Generalized vs. partial seizures
*MRI

Epilepsy Foundation Goal of Treatment =

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No Seizures + No Side Effects

Epilepsy

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*Anti-seizure Rx
*Epilepsy Surgery
*Neuromodulation
-Vagal N Stimuation
-Responsive Neurostim
*Diet
(keto, mod atkins)

* 30 or more minutes of continuous seizure/repetitive seizures with no intervening recovery of consciousness * generalized convulsive variant

Status Epilepticus (SE)

Generalized Tonic-Clonic Seizures * Generalized Onset * Childhood/Juvenile Onset * Normal Brain * Generalized Ictal Discharge on EEG *GOOD Prognosis 1ary/2ndary?

1ary Generalized Seizure

Generalized Tonic-Clonic Seizures * Partial Onset/Aura * Any Age * MRI/Exam May Be Abnormal * Focal Sharp/Spikes *VARIABLE Prognosis

2ndary Generalized

* NO Loss of Consciousness/Awareness * Focal Seizure s/s * Progress to Dyscognitive seizures/Tonic-Clonic Seizures

Focal Seizures without Impairment of Consciousness

Focal Seizures w/o Impairment of Consciousness EEG

* Interictal-focal sharp/slow | * Ictal-rhythmic discharge = normal

* ALTERED Consciousness/Awareness * 30 sec - 3 minutes * Automatisms (Arms, Oral) * Amnesia

Focal Dyscognitive Seizures

Focal Dyscognitive Seizures EEG

Interictal-sharp waves or spikes; Ictal - focal or bilateral rhythmic sharp

Seizure Workup Hx

Ask witness: * act out/what look like * Duration * Fall? Hit body part? * Describe patient AFTER episode. Awake? Drowsy? * Urinate on self? Bite tongue? * ETOH/Drugs prior to seizure?

Seizure Workup PE

* Current Mental Status * Full Body exam - injuries - Neuro exam * Urinate?

Seizure Workup Tests

* EEG * Glucose * Infxn cause * ETOH/Drug screen * MRI - brain abnormalities/strokes/tumors

Seizure Tx Rx 1st line most seizures

Phenytoin Valproic Acid Carbemazepine

Seizure Tx Rx 1st line = Generalized, non-convulsive seizures

Ethosuximide | valproic acid

Status Epilepticus Tx

TREAT + ASSESS SAME TIME 1) Secure airway + High flow O2 2) Low glucose? Give glucose 3) Alcoholic? Thiamine + magnesium 4) Lorazepam 5) LORAZEPAM NO EFFECT? Phenytoin 6) PREVIOUS 2 NO EFFECT? Phenobarbitol / General anesth.

* only in front of others * w/ stress/emotion * rarely injured in seizure * often w/ psyc issues * SEIZURE RX NO EFFECT

Psychogenic Non-Epileptic Seizures (PNES) S/s

Fake seizure for attention/avoid responsibilities

Factitious Disorder | NOT PNES

Syncope Hx

* Feel anything b/f event? * Other s/s of systemic illness? * hypoglycemia/dehydration risks? * FH Sudden Cardiac Death? * Witnesses around?

Syncope PE

* Fully alert/oriented now? * Signs of injury (fall)? * Orthostatic? * Sinus rhythm? * O2%? * Systemic illness signs?

Syncope Tests

* EKG * Glucose * Electrolyte * CBC * others....

Syncope Tx

* Underlying cause * Glucose + Hydration * Rx dose decrease? - ->Follow-up

Seizures Flashcards

(43 cards)