Seizures

  • April 2020
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CONVULSIVE DISORDER (CONVULSIONS)-

disorder of the CNS char. by paroxysmal seizures with or

without loss of consciousness; abnormal motor activity, alteration in sensation & perception & change in behavior. Can you outgrow febrile seizure?

Difference between: Seizure---- 1st convulsive attack

Febrile seizure: Normal if < 5 yo

Epilepsy – 2nd and with history of seizure

Pathologic: if > 5 yo Predisposing Factor •Head injury due birth trauma •Toxicity of carbon monoxide •Brain tumor •Genetics •Nutritional & metabolic deficit •Physical stress •

Sudden withdrawal to anticonvulsants will bring about status epilepticus



Status epilepticus – drug of choice: Diazepam & glucose

Types: I. Generalized Seizure – a.) Grand mal / tonic clonic seizures With or without aura – warning symptoms of impending seizure attack5. Epigastric pain- associated with olfactory, tactile, visual, auditory sensory experience 6. Loss of consciousness 3 – 5 min 7. Tonic clonic contractions 8. Direct symmetrical extension of extremities-TONIC. ContractionsCLONIC 9. Post ictal sleep -state of lethargy or drowsiness - unresponding sleep after tonic clonic b.) Petit mal seizure – (same as daydreaming!) or absent seizure. - Blank stare - Decrease blinking eye - Twitching of mouth - Loss of consciousness – 5 – 10 secs (quick & short)

II. Localized/partial seizure •Jacksonian seizure or focal seizure – tingling/jerky movement of index finger/thumb & spreads to shoulder & 1 sideof the body with jacksonian march •Psychomotor/ focal motor - seizure -Automatism – stereotype repetitive & non-purposive behavior - Clouding of consciousness – not in control with environment -Mild hallucinatory sensory experience HALLUCINATIONS •Auditory – schitzo – paranoid type •Visual – korsakoffs psychosis – chronic alcoholism •Tactile – addict – substance abuse

III. Status epilecticus – continuous, uninterrupted seizure activity, if untreated, lead to hyperprexia – coma – death Seizure: inc electrical firing in brain=increased metabolic activity in brain=brain using glucose and O2=dec glucose, dec O2. Tx:Diazepam (drug of choice), glucose Dx-Convulsion- get health history! 7.CT scan – brain lesion 8.EEG electroencephalography •Hyperactive brain waves

Nsg Mgt Priority – Airway & safety 3.Maintain patent a/w & promote safety Before seizure: 1.Remove blunt/sharp objects 2.Loosen clothing 3.Avoid restraints 4.Maintain siderails 5.Turn head to side to prevent aspiration 6.Tongue guard or mouth piece to prevent biting of tongue-BEFORE SEIZURE ONLY! Can use spoon at home. 7.Avoid precipitating stimulus – bright glaring lights & noises 8.Administer meds

Administer meds: 3.Dilantin (Phenytoin) –( toxicity level – 20 ) SE: Gingival hyperplasia H-hairy tongue A-ataxia N-nystagmus A-acetaminophen- febrile pt Mix with NSS -Don’t give alcohol – lead to CNS depression 2. (Tegretol) Carbamasene- given also to Trigeminal Neuralgia. SE: arrythmia 3. Phenobarbital (Luminal)- SE: hallucinations

2.Institute seizure & safety precaution. Post seizure: Administer O2. Suction apparatus ready at bedside 3. Monitor onset & duration - Type of seizure -Duration of post ictal sleep. The longer the duration of post ictal sleep the higher chance of having status epilepticus! 4. Assist in surgical procedure. Cortical resection. 5. Complications: Subarachnoid hemorrhage and encephalitis

SPECIFICS

Types of Seizures Seizures take many forms. Before your doctor can prescribe the right treatment, he or she must figure out which type (or types) you have.  Epilepsy is a disorder characterized by transient but recurrent disturbances of brain function that may or may not be associated with impairment or loss of consciousness and abnormal movements or behavior.  There are so many kinds of seizures that neurologists who specialize in epilepsy are still updating their thinking about how to classify them. Usually, they classify seizures into two types, primary generalized seizures and partial seizures. The difference between these types is in how they begin:

Primary generalized seizures Primary generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures. Partial seizures Partial seizures begin with an electrical discharge in one limited area of the brain. Some are related to head injury, brain infection, stroke, or tumor, but in most cases the cause is unknown.

One question that is used to further classify partial seizures is whether consciousness or unconsciousness or state of awareness is present; if consciousness is preserved during a seizure, the person can respond (either in words or actions, such as raising a hand on command) and recall what occured during the spell. Memory (the ability to respond and remember) is "impaired" or "preserved." The difference may seem obvious, but really there are many degrees of impairment or preservation of consciousness. Identifying certain seizure -sudden, excessive discharge of nervous-system electrical activity that usually causes a change in behavior and other characteristics of a person's epilepsy like the age at which it begins, for instance, allows doctors to classify some cases into epilepsy syndromes. This kind of classification helps us to know how long the epilepsy will last and the best way to treat it.

Primary Generalized Seizures Absence seizures Atypical absence seizures Myoclonic seizures Atonic seizures Tonic seizures Clonic seizures Tonic-clonic seizures Partial Seizures Simple partial seizures Complex partial seizures Secondarily generalized seizures

1.Absence Seizures What are they like? Here's a typical story: Frank, a 7-year-old boy, often "blanks out" anywhere from a few seconds to 20 seconds at a time. During a seizure, SeizureA sudden, excessive discharge of nervous-system electrical activity that usually causes a change in behavior.Close Frank doesn't seem to hear his teacher call his name, he usually blinks repetitively, and his eyes may roll up a bit. During shorter seizures, he just stares. Then he continues on as if nothing happened. Some days Frank has more than 50 of these spells.

How long do they last? Usually less than 10 seconds, but it can be as long as 20. They begin and end suddenly. Tell me more Absence seizures are brief episodes of staring. (Although the name looks like a regular English word, your neurologist may pronounce it ab-SAWNTZ.) Another name for them is petit mal (PET-ee mahl). During the seizure, awareness and responsiveness are impaired.  People who have them usually don't realize when they've had one. There is no warning before a seizure, and the person is completely alert immediately afterward.

Simple absence seizures are just stares. Many absence seizures are considered complex absence seizures, which means that they include a change in muscle activity. The most common movements are eye blinks. Other movements include slight tasting movements of the mouth, hand movements such as rubbing the fingers together, and contraction or relaxation of the muscles. Complex absence seizures are often more than 10 seconds long.

Who gets them? Absence seizures usually begin between ages 4 and 14. The children who get them usually have normal development. Development- the process of physical growth and the attainment of intelligence and problem-solving ability that begins in infancy; any interruption of this process by a disease or disorder is called developmental delay.

What's the outlook? In nearly 70% of cases, absence seizures stop by age 18. Children who develop absence seizures before age 9 are much more likely to outgrow them than children whose absence seizures start after age 10. Children with absence seizures do have higher rates of behavioral, educational, and social problems. What else could it be? Absence seizures can resemble some complex partial seizures or episodes of daydreaming:

How is the diagnosis made? The EEG (electroencephalogram) Electroencephalogram (EEG)--A diagnostic test of brain electrical activity; helpful in diagnosing records brain waves, is helpful in diagnosing absence seizures. Having the child breathe very rapidly often will produce a seizure. Images of the brain such as CT and MRI scans are usually normal, so they are seldom needed if the EEG and other features are typical.

2.Atypical Absence Seizures What are they like?

Here's a typical story: "It's hard to tell when Kathy's having one of her "staring spells". During the spells she doesn't respond as quickly as at other times. But even when she's not having a seizure she often just stares and responds slowly.

How long do they last? Usually 5 to 30 seconds (commonly more than 10), with a gradual beginning and ending. Tell me more Atypical (a-TIP-i-kul) means unusual or not typical. The person will stare (as they would in any absence seizure) Absence seizureA primary generalized epileptic seizure, usually lasting less than 20 seconds, characterized by a stare sometimes associated with blinking or brief automatic movements of the mouth or hands; formerly called petit mal seizure.

Who gets them? They generally begin before age 6. Most of the children affected have below-average intelligence and other types of seizures that are difficult to control. What's the outlook? Atypical absence seizures usually continue into adulthood.

How is the diagnosis made? The diagnosis can be difficult if the behavior during seizures is similar to the child's usual behavior. Electroencephalogram (EEG)--A diagnostic test of brain electrical activity; helpful in diagnosing epilepsy which records brain waves, will be used; but most children with these seizures have patterns on their EEG when they're not having a seizure that are similar to the seizure pattern.

How is the diagnosis made? The diagnosis can be difficult if the behavior during seizures is similar to the child's usual behavior. Electroencephalogram (EEG)--A diagnostic test of brain electrical activity; helpful in diagnosing epilepsy which records brain waves, will be used; but most children with these seizures have patterns on their EEG when they're not having a seizure that are similar to the seizure pattern.

3.Myoclonic Seizure What are they like? Here's a typical story: "In the morning, I get these 'jumps.' My arms fly up for a second, and I often spill my coffee or drop what I'm holding. Now and then my mouth may shut for a split second. Sometimes I get a few jumps in a row. Once I've been up for a few hours, the jumps stop."

How long do they last? They're very brief jerks. Usually they don't last more than a second or two. There can be just one, but sometimes many will occur within a short time. Tell me more Myoclonic (MY-o-KLON-ik) seizures are brief, shock-like jerks of a muscle or a group of muscles. "Myo" means muscle and "clonus" (KLOH-nus) means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle.

In epilepsy, myoclonic seizures usually cause abnormal movements on both sides of the body at the same time. They occur in a variety of epilepsy syndromes that have different characteristics:

Juvenile myoclonic epilepsy: The .seizures usually involve the neck, shoulders, and upper arms. In many patients the seizures most often occur soon after waking up

Lennox-Gastaut syndrome: This is an uncommon syndrome--a group of signs and symptoms that collectively define or characterize a disease or disorder; signs are objective findings such as weakness, and symptoms are subjective findings such as a feeling of fear or tingling in a finger. •Progressive myoclonic epilepsy: The rare syndromes in this category feature a combination of myoclonic seizures and tonic-clonic seizures. Treatment is usually not successful for very long, as the patient deteriorates over time.

Who gets them? The epileptic syndromes that most commonly include myoclonic seizures usually begin in childhood, but the seizures can occur at any age. Other characteristics depend on the specific syndrome. What's the outlook? The outlook for patients with the various syndromes that include myoclonic seizures varies widely.

What else could it be? As mentioned, some episodes of myoclonus are normal. Some myoclonic seizures occur in reflex epilepsies, triggered by flashing lights or other things in the environment. How is the diagnosis made? The seizures themselves are easy to identify. The syndromes usually can be diagnosed on the basis of the medical history and on the account of a patient's presentations plus EEG patterns.

4.Atonic Seizures What are they like? Here's a typical story: "When Bob has a 'drop' seizure, a sudden, excessive discharge of nervous-system electrical activity that usually causes a change in behavior. He falls to the ground and often hits his head and bruises his body. Even if I'm right next to him and prepared, I may not catch him. Even with carpet in the bedroom and mats in the bathroom, he gets hurt." How long do they last? Less than 15 seconds.

Tell me more Muscle "tone" is the muscle's normal tension. "Atonic" (a-TON-ik) means "without tone," so in an atonic seizure, an epileptic seizure characterized by sudden loss of muscle tone it may cause the head to drop suddenly, objects to fall from the hands, or the legs to lose strength, with falling and potential injury; usually not associated with loss of consciousness while the muscles suddenly lose strength. The eyelids may droop, the head may nod, and the person may drop things and often falls to the ground. These seizures are also called "drop attacks" or "drop seizures." The person usually remains conscious.

Another name for this type of seizure is "akinetic" (a-kin-ET-ik), which means "without movement.“ Who gets them? Atonic seizures often begin in childhood. What's the outlook? They often last into adulthood. Many people with atonic seizures are injured when they fall, so they may choose to use protection such as a helmet.

What else could it be? Patients who have seizures that cause them to fall when they're standing often have tonic seizures (involving sudden muscle contraction) rather than atonic seizures. How is the diagnosis made? Usually descriptions of the seizures by witnesses will suggest the diagnosis. Some EEG monitoring may be performed to confirm it. If the seizures persist, other tests may be used to make sure that changes in the heart rhythm or blood pressure are not causing the patient to fall down.

5.Tonic Seizures What are they like? Here's a typical story: "When Jeff has an episode, he just stiffens up. Both arms are raised over his head and his face has a grimace, as if someone is pulling on his cheeks. If he's standing, he may lose his balance and fall. These seizures don't knock him out like the tonic-clonic seizures, but if he has a few close together, he is often tired."

How long do they last? Usually less than 20 seconds. Tell me more Muscle "tone" is the muscle's normal tension at rest. In a "tonic" seizure sudden, excessive discharge of nervous-system electrical activity usually causes a change in behaviour--the tone is greatly increased and the body, arms, or legs make sudden stiffening movements. Consciousness is usually preserved. Tonic seizures most often occur during sleep and usually involve all or most of the brain, affecting both sides of the body. If the person is standing when the seizure starts, he or she often will fall.

Who gets them? They are particularly common in people who have the epilepsy syndrome What's the outlook? Tonic seizures is seen in Lennox-Gastaut syndrome – a group of signs and symptoms that collectively define or characterize a disease or disorder; signs are objective findings such as weakness, and symptoms are subjective findings such as a feeling of fear or tingling in a finger. What else could it be? Children with neurological impairments sometimes make movements that could be mistaken for tonic seizures. The EEG should be able to tell the difference. How is the diagnosis made? The EEG can clearly show these seizures if they occur during monitoring.

6.Clonic Seizures What are they like? Clonic seizures consist of rhythmic jerking movements of the arms and legs, sometimes on both sides of the body. How long do they last? The length varies. Tell me more "Clonus" (KLOH-nus) means rapidly alternating contraction and relaxation of a muscle -- in other words, repeated jerking. The movements cannot be stopped by restraining or repositioning the arms or legs. Clonic (KLON-ik) seizures are rare, however. Much more common are tonic-clonic seizures, in which the jerking is preceded by stiffening (the "tonic" part). Sometimes tonic-clonic seizures start with jerking alone. These are called clonic-tonicclonic seizures!

Who gets them? Clonic seizures are not seen very often. They can occur at various ages, including in newborns. What's the outlook? Brief and infrequent clonic seizures in infants usually disappear on their own within a short time. Other types may need prolonged treatment. What else could it be? Occasionally "jitteriness" in a young infant can be mistaken for a clonic seizure, Seizure a sudden, excessive discharge of nervous-system electrical activity usually causes a change in behaviour especially if it is severe (during crying, for instance). Changing the position of the baby's arms or legs should reduce or stop jitteriness.

How is the diagnosis made? The doctor should recognize the appearance of a clonic seizure if he or she witnesses an episode. The EEG pattern will change during a seizure, so video-EEG is very useful. A factor distinguishing clonic from tonic-clonic seizures is that clonic seizures are not followed by a period of tiredness or confusion. Tonicclonic seizures usually are.

7.Tonic-clonic Seizure What are they like? Here's a typical story from a parent's view: "These seizures frighten me. They only last a minute or two but it seems like an eternity. I can often tell my daughter is going to have one because she acts cranky and out of sorts. It begins with an unnatural shriek. Then she falls, and every muscle seems to be activated. Her teeth clench. She's pale, and later she turns slightly bluish. Shortly after she falls, her arms and upper body start to jerk, while her legs remain more or less stiff. This is the longest part of the seizure. Finally it stops and she falls into a deep sleep."

How long do they last? Generally, 1 to 3 minutes. A tonic-clonic seizure – a newer term for grand mal or major motor seizure; characterized by loss of consciousness, falling, stiffening, and jerking; electrical discharge involves all or most of the brain sometimes lasts longer than 5 minutes. A seizure that lasts more than 30 minutes, or three seizures without a normal period in between, indicates a dangerous condition called convulsive status epilepticus. Status epilepticus, a prolonged seizure (usually defined as lasting longer than 30 minutes) or a series of repeated seizures; a continuous state of seizure activity; may occur in almost any seizure type. Status epilepticus is a medical emergency, and medical help should be obtained immediately

Tell me more This type is what most people think of when they hear the word "seizure." An older term for them is "grand mal. Grand mal—an older term for a tonic-clonic seizure as implied by the name, combine the characteristics of tonic seizures and clonic seizures. The tonic phase comes first: all the muscles stiffen. Air being forced past the vocal cords causes a cry or groan. The person loses consciousness; if consciousness is preserved during a seizure, the person can respond (either in words or actions, such as raising a hand on command) and recall what occured during the spelland later falls to the floor. The tongue or cheek may be bitten, so bloody saliva may come from the mouth. The person may turn a bit blue in the face. After the tonic phase comes the clonic phase: The arms and usually the legs begin to jerk rapidly and rhythmically, bending and relaxing at the elbows, hips, and knees. After a few minutes, the jerking slows and stops. Bladder or bowel control sometimes is lost as the body relaxes. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed.

Who gets them? They affect both children and adults. What's the outlook? For children who have had a single tonic-clonic seizure, the risk that they will have more seizures depends on many factors. Some children will outgrow their epilepsy What else could it be? Some nonepileptic (psychogenic) seizures resemble tonic-clonic seizures. The surest way to tell the difference is with video-EEG monitoring. In some cases, the same person may have both tonic-clonic and nonepileptic seizures. People who faint sometimes develop tonic or clonic movements. These movements are rarely as intense or prolonged as a tonic-clonic seizure.

8.Simple Partial Seizure What are they like? They are remarkably different from person to person, depending on the part of the brain where they begin. The one thing they all have in common is that the person remains alert and can remember what happens. Here are a couple of experiences: •"I almost enjoy them. The feeling of déja vu, as if I've lived through this moment and I even know what's going to be said next. Everything seems brighter and more alive." •"It is a pressure that starts in my stomach, then rises to my chest and throat. When it reaches my chest, I smell an unpleasant odor of something burnt. At the same time I feel anxious."

How long do they last? Only a short time, usually less than 2 minutes. Tell me more Doctors often divide simple partial seizures into categories depending on the type of symptoms the person experiences: Motor seizures: These cause a change in muscle activity. For example, a person may have abnormal movements such as jerking of a finger or stiffening of part of the body. These movements may spread, either staying on one side of the body (opposite the affected area of the brain) or extending to both sides.

Sensory seizures: These cause changes in any one of the senses. People with sensory pertaining to the senses (touch, vision, hearing, taste, smell) may smell or taste things that aren't there; hear clicking, ringing, or a person's voice when there is no actual sound; or feel a sensation of "pins and needles" or numbness. Autonomic seizures: These cause changes in the part of the nervous system that automatically controls bodily functions. These common seizures may include strange or unpleasant sensations in the stomach, chest, or head; changes in the heart rate or breathing; sweating; or goose bumps.

Psychic seizures: These seizures change how people think, feel, or experience things. They may have problems with memory, garbled speech, an inability to find the right word, or trouble understanding spoken or written language. They may suddenly feel emotions like fear, depression, or happiness with no outside reason. Some may feel as though they are outside their body or may have feelings of déja vu ("I've been through this before") or jamais vu ("This is new to me"— even though the setting is really familiar). Who gets them? Anybody can get them. They may be more likely in people who have had a head injury, brain infection, stroke, or brain tumor but most of the time the cause is unknown.

What's the outlook? These seizures often can be controlled by seizure medicines. What else could it be? Medical disorders such as, stomach disorders or a pinched nerve can cause some similar symptoms. Hallucinations can accompany psychiatric illness or the use of certain drugs. And some symptoms (such as déja vu) are experienced by almost everyone at some time. Whether the symptoms represent simple partial seizures depends on how often they occur and whether they are associated with other episodic changes or other seizure types. How is the diagnosis made? A complete medical history and close physical examination can help to rule out other possible causes of the symptoms and assess the likelihood of epilepsy.

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