37759223
Recurrent Seizures
- Main
causes
- Neoplastic
disease
- Tumors, especially rapidly growing
ones, occupy space and increase
intracranial pressure
- Perinatal hypoxia
- Tumors, especially rapidly growing
ones, occupy space and increase
intracranial pressure
- Pediatric disorders
- Rapid increases in
body temp
causing febrile
seizures
- Rapid increases in
body temp
causing febrile
seizures
- Metabolic disorders
- Trauma
- Infectious diseases, such as
meningitis and encephalitis
- Neoplastic
disease
- What is a
seizure?
- disturbance in the normal
electrical activity in the brain;
can stay in one area or spread
to other areas of the brain
- Triggers include
strobe/flickering lights
or the occurrence of
small fluid & electrolyte
imbalances.
- Occurs more
often when pt. is
sleep deprived
- Occurs more
often when pt. is
sleep deprived
- Differential
Diagnosis
- Pseudo-seizure
- physical reactions to
mental or
psychological stress
- physical reactions to
mental or
psychological stress
- Syncope
- Pseudo-seizure
- Convulsions
- Convulsion refers to
the involuntary, violent
spasms of the large
skeletal muscles
- All convulsions are
seizures but not all
seizures are
convulsions
- All convulsions are
seizures but not all
seizures are
convulsions
- Convulsion refers to
the involuntary, violent
spasms of the large
skeletal muscles
- disturbance in the normal
electrical activity in the brain;
can stay in one area or spread
to other areas of the brain
- Signs & Symptoms
- Amnesia
- Paralysis
- Aphasia
- Aura
- Falling down/ injuring one's
self
- getting stiff muscles
- Amnesia
- Types
- Determining cause of recurrent
seizures is important for
appropriate drug selection
- Partial
- Simple
- fully conscious, but experience a motor
contraction or abnormal sensation
- fully conscious, but experience a motor
contraction or abnormal sensation
- Complex
- Alteration of consciousness.
Amnesia, anxiety, incoherent speech
- Alteration of consciousness.
Amnesia, anxiety, incoherent speech
- Simple
- Generalized
- Absence (petit mal)
- transient loss in awareness,
usually in children
- May be misdiagnosed as
ADHD or daydreaming
- May be misdiagnosed as
ADHD or daydreaming
- transient loss in awareness,
usually in children
- Atonic (drop attacks)
- Falling/stumbling for no reason; lasts a
couple of secs
- Falling/stumbling for no reason; lasts a
couple of secs
- Tonic-clonic (grand mal)
- Preceding aura
- Intense muscle contraction (tonic phase), followed by
alternating contraction and relaxation (clonic phase)
- Disorientation & deep sleep after
seizure
- Crying at beginning; loss of
bowel/bladder control;
- jerking movements are seen;
Contraction of respiratory muscles
(sounds)
- Disorientation & deep sleep after
seizure
- Intense muscle contraction (tonic phase), followed by
alternating contraction and relaxation (clonic phase)
- Preceding aura
- Absence (petit mal)
- Special
- Febrile
- Tonic-conic activity lasting 1-2
min; rapid return to
consciousness.
- Mostly in children between
3 months & 5 yrs old
- Mostly in children between
3 months & 5 yrs old
- Tonic-conic activity lasting 1-2
min; rapid return to
consciousness.
- Myoclonic
- Large jerking movement
of major muscle group
- falling from sitting or
dropping object being
held
- less severe than tonic
clonic, patient usually
conscious
- falling from sitting or
dropping object being
held
- Large jerking movement
of major muscle group
- Status
epilepticus
- Medical
emergency
- Continuous seizure
activity that can lead to
coma & death
- Medical
emergency
- Febrile
- Determining cause of recurrent
seizures is important for
appropriate drug selection
- can develop into
- Epilepsy
- central nervous system (neurological)
disorder in which brain activity becomes
abnormal, causing seizures or periods of
unusual behavior, sensations, and
sometimes loss of awareness.
- central nervous system (neurological)
disorder in which brain activity becomes
abnormal, causing seizures or periods of
unusual behavior, sensations, and
sometimes loss of awareness.
- Epilepsy
- Management
- Antiepileptic
drugs
- Tonic-clonic and
focal seizure drugs
- Carbamazepine
- Lamotrigine
- Levetiracetam
- Phenytoin
- Valporate
- Carbamazepine
- Myoclonic
seizure drugs
- clonazepam
- lamotrigine
- valporate
- clonazepam
- Absence seizure
drugs
- Ethosuximide
- Lamotrigine
- Valporate
- Ethosuximide
- Back-up and
adjunctive drugs
- Felbamate
- Gabapentin
- Lacosamide
- Retigabine
- Vigabatrin
- Felbamate
- Overall side-effects
- Antiseizure drugs
decrease
effectiveness of
birth control
- Moat antiseizure drugs are
pregnancy category D
- A lot of them might cause
Stevens-johnson
syndrome
- Antiseizure drugs
decrease
effectiveness of
birth control
- Tonic-clonic and
focal seizure drugs
- Antiepileptic
drugs
- Diagnosis/
Investigations
- EEG
- type of waves
found in EEG
- Beta Waves
- dominant during mental activities
- dominant during mental activities
- Alpha
Waves
- dominant when someone is awake but at rest
- dominant when someone is awake but at rest
- Gamma
Waves
- dominant during light sleep
- dominant during light sleep
- Delta
Waves
- dominant during deep sleep
- dominant during deep sleep
- Beta Waves
- type of waves
found in EEG
- Physical Examination
- pay attention to
bruises and tongue
bites
- pay attention to
bruises and tongue
bites
- Proper History taking
- ask
about
history of
- stroke
- Head
trauma
- Potential triggers
- Tumors/
infections
- stroke
- ask
about
history of
- EEG
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