Chapter 2: Epilepsy

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Chapter 2: Epilepsy
2015-03-10 22:39:19
NPTE: Chapter 2
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  1. Definition
    • Disorder characterized by recurrent seizures
    • Repetitive abnormal electrical discharges within the brain
  2. Symptoms
    • Altered consciousness
    • Altered motor activity (convulsion) = involuntary contraction of muscles; tonic activity (stiffening and rigidity of muscles; clonic activity (rhythmic jerking of extremities) 
    • Sensory phenomena = pt experiences somatosensory, visual, auditory, olfactory, gustatory, and vertiginous sensations
    • Autonomic phenomena = associated with sudden attack of anxiety, tachycardia, sweating, piloerection, abnormal sensation rising up in upper abdomen and chest 
    • Cognitive phenomena = sudden failure of comprehension, inability to communicate, intrusion of thought, illusions, hallucinations, affective disturbances (intense feelings of anger, fear, and hate)
  3. Common Causes
    • Acquired brain disease or trauma = tumor, stroke
    • Degenerative brain disease = Alzheimers, dementia, amyloidosis
    • Developmental brain defects
    • Drug overdose (cocaine, antihistamines, cholinesterase inhibitors, methylxanthines, tricyclic antidepressants)
    • Drug withdrawal (alcohol, benzodiazepines)
    • Electrolyte disorders = hyponatremia, hyernatreamia, hypoglycemia, hypomagnesemia
    • Hyperthermia
    • Infections 
    • Brain abscess, meningitis, neurocysticercosis 
    • Pregnancy compilcations (eclampsia)
  4. Classification of Seizures
    • Generalized
    • Partial
    • Secondarily generalized seizures
    • Status epilepticus
  5. Generalized Seizures
    • Tonic-clonic (grand mal)
    • Absence seizures (petite mal)
  6. Tonic-Clonic (Grand Mal)
    • Dramatic loss of consciousness with a cry, fall, and tonic-clonic convulsions of all extremities
    • Often with dengue biting and arrested breathing, urinary, and fecal incontinence
    • After 2-5 min, contractions subside and consciousness is gradually regained
    • Pt confused, drowsy and amnesiac about event
    • Full recovery may take several hours
    • Some attacks preceded by a brief aura
  7. Absence Seizures (Petit Mal)
    • Brief, almost imperceptible lapse of consciousness followed by immediate and full return to consciousness
    • Posture is maintained, with no convulsive muscle contractions
    • May occur as often as 100x/day
  8. Partial Seizures
    • Simple partial seizures
    • Focal motor
    • Focal motor with march (Jacksonian)
    • Temporal lobe seizure
    • Complex partial seizures
  9. Simple Partial Seizures
    • Focal, begin locally
    • Limited to a portion of the body
    • Consciousness preserved
    • Usually has an identifiable structural cause
  10. Focal Motor
    Clonic activity involving a specific area of the body
  11. Focal Motor with March (Jacksonian)
    An orderly spread or march of clonic movements from initial muscles to involved adjacent muscles with spread to entire side
  12. Temporal Lobe Seizure
    • Episodic changes in behavior 
    • Complex hallucinations
    • Automatisms (lip smacking, chewing, pulling on clothing)
    • Altered cognitive and emotional function (sexual arousal, depression, violent behaviors)
    • Preceded by an aura
  13. Complex Partial Seizures
    Simple partial seizures followed by impairment of consciousness
  14. Secondarily Generalized Seizures
    Simple or complex partial seizures followed by impairment of consciousness
  15. Status Epilepticus
    • Prolonged seizure or series of seizures (lasting > 30 min) 
    • Very little recovery between attacks
    • May be life threatening
    • Medical emergency (generalized status epilepticus)
  16. Medical Interventions
    • Antiepileptic Meds (drugs may have significant ADRs) 
    • Surgical intervention (drug resection, hemispherectomy)