Seizure

Nota:

• may not have EEG abonoral 

1. Tonic clonic

   Nota:

   • Tonic 10-20s, clonic 30-40s, excessive salivation, tongue/cheek  biting, Cyanosis- "fall to ground"  * post ictal - muscle soreness, fatigue, pt. may sleep for hours, may not feel normal for hours or days, Nop memory of seizure  
   1. Preceded by aura!- this is generalized secondarily
   2. Second generalized- Todd's Paralysis (focal weakness)
2. clonic Seizure

   Nota:

   • begin with loss of consciouness and sudden loss of muscle tone, limb jerking, hyperventilation, eye roll back, froth at mouth  
3. Atonic
   1. Sudden loss of muscle tone, consciousness returns by the time they hit the ground
4. Myclonic

   Nota:

   • forceful enough to cause fall 
   1. Excessive jerking
5. Tonic

   Nota:

   • sudden increase tone, incontinence, breathing cessation, cyanosis, fixed dilated pupils, fall 
6. Absence Seizure
   1. Typical

      Nota:

      • children rarely beyond adolescent, cease with maturity or develope into another type, percipitation of flashlights & hyperventilation 
      1. Staring spells "daydreaming"
      2. percipitated by hyperventilation & lights
      3. 3hz per second EEG spike & wave pattern
      4. often unnoticed, may be 100x a day, eyelid fluttering, automatisms
   2. Atypical
      1. Staring spells with other S&S
      2. Brief warning
      3. Peculiar behavior durning
      4. EEG greater or less than 3Hz spike & wave pattern
      5. confusion after
      6. Longer lasting & loss of postural tone

1. Complex

   Nota:

   • Display strange behaviors, Lip smacking, automatisms- repetitive movement, retrograde amnesia- not daydreaming that is how you differentiate 
2. Simple

   Nota:

   • sudden and unexplaibable feelings, may hear,taste, feel or see things that are not real, psychic symptoms, recurrent muscle contractions, abnormal sensation of hallucinations, Tachycardia, flushing hypotension/hypertension

Nota:

• Pseudoseizure, Use video EEG 

Nota:

• child transient disorder 

1. Antipyretics

   Nota:

   • acetaminophen, ibuprofen 
2. NO tepid Baths
3. Protect from injury
4. rectal diazepam/diazempam gel (second seizure likely)

Nota:

• (1) Prodromal - signs precede seizure (2) aural- sensory warning  (3) Ictal- active  (4) postictal- recovery after seizure (muscle aches, headache, confusion)

1. Absence & Myoclonic

   Nota:

   • ethosuzimide, divaleproex, clonazepam , 
2. Tonic clonic & focal

   Nota:

   • phenytoin- peeling rash, Hyperplasia of gums, hirutism in young adults common.  carbamezapine, phenobarbitol, divalproex, primid
3. Broad spectrum

   Nota:

   • gabapentin, lamotrigene, toprimate, tigabine, levitarectam, zonisamide 
4. weened off seizure free 2-5yrs do not stop abruptly , fall rsisk , monitor dizzyness/drowsiness
   1. common side effeect- diplopia, drowsiness, ataxia, mental slowing
   2. dose missed wait for next dose
   3. Toxicity- nystagmus, hand- eye coordination, cognitive functionaing and general alertness
5. Pregabalin
6. Status Epilepticus
   1. #1 lorezapam & diazempam
   2. follow by long acting
   3. intubated, EEG continuous
   4. children may need general anasthesia
7. OLDER age & drugs
   1. monitor Liver function on phyentoin
   2. Phenabarbitol, carbmazepine, primidone effects cognitiion
   3. Safer for older

      Nota:

      • gabapentin, levatricetam, oxcarbmazepine, lamotrigene 

Nota:

• (1) no satisfaction with drugs (2) define electroclinical syndrome- need to which point (focal)  (3) confirmed epilepsy 

1. anterior temporal lobe resection

Nota:

• not candidate for surgery alternative

1. Teach pt. to avoid MRIs, microwaves,
2. adverse- cough, hoarseness, dyspnea & tingling at the neck

Nota:

• high fat, low carbohydrate

1. if the pt. has anticoagulant then teach to watch for bleeding

1. Padded side rails (do not restrain)
2. protect from injury
3. Maintain patent airway/ensure ABC's
4. Establish IV
5. Loosen clothing

Nota:

• EMERGENCY 

1. Lorazempam & Diazempam IV bolus

Nota:

• sedation (without external signs) 

Nota:

• Sudden unexplainable death of epilepsy 

Nota:

• acidosis, electrolyte imbalance, hypoglycemia, hypoxia, dehydration/water intoxication, alcohol & barbituate withdrawal 

Nota:

• hypertension, SLE, DM, septecemia 

Nota:

• Age after 50 - tumor/stroke 20-30- structural lesion, vascular disease, brain tumor  2-20 birth injury, infection, trauma, genetic factors  6months or younger - birth injury, severe cognential birth defect involving the CNS, infection, inborn errors of metabolism