Neuro: Seizures

_________ — abnormal, exxcessive, hypersynchronous neuronal discharges in the cerebral cortex

seizures

What is the pathophysiology of seizures?

imbalance between excitatory and inhibitory neural signaling, resulting in sudden bursts of abnormal electrical actviity

Trauma, stroke, tumors, malformations, and neurodegenerative diseases are examples of what type of causes of strokes?

structural

Hyponatremia, hypocalcemia, hypoglycemia, kidney injury, pesticide exposure, and alcohol withdrawal are examples of what type of causes of strokes?

metabolic/toxic

Identify the phases of seizure activity:

1. _________________ — subtle mood or behavioral changes that may precede a seizure by hours or days

2. ________________ — a subjective sensation or perception marking the onset of a seizure. Represents a focal seizure that may progress to a larger event. May be visul, auditory, gustatory, or sensory in nature

3. ________________ — the actual seizure devent, characterized by abnormal electrical activity and clinical manifestations. Typically involves musculoskeletal activity and may include altered consciousness

4. ________________ — recovery period following seizure termination. Marked by confusion, somnolence, or irritability. Duration varies from minutes to hours depending on seizure type and severity

1. Prodromal — subtle mood or behavioral changes that may precede a seizure by hours or days

2. Aura — a subjective sensation or perception marking the onset of a seizure. Represents a focal seizure that may progress to a larger event. May be visul, auditory, gustatory, or sensory in nature

3. Ictal — the actual seizure devent, characterized by abnormal electrical activity and clinical manifestations. Typically involves musculoskeletal activity and may include altered consciousness

4. Postictal — recovery period following seizure termination. Marked by confusion, somnolence, or irritability. Duration varies from minutes to hours depending on seizure type and severity

Identify the types of seizure:

• _____________ — originate within networks limited to one hemisphere

• _____________ — originate within and rapidly engage networks in both hemispheres

• focal — originate within networks limited to one hemisphere

• generalized — originate within and rapidly engage networks in both hemispheres

Identify the type of focal onset seizure:

• Patient remains conscious and aware during the seizure event

• Motor symptoms: Clonic movements, tonic rigidity, atonic weakness, myoclonic jerking, or epileptic spasms

• Automatisms: Repetitive, purposeless movements like lip smacking, chewing, or hand rubbing

• Non-motor symptoms: Sensory, autonomic (heart racing, nausea), emotional, or cognitive disruptions

focal onset aware seizures

Identify the type of focal onset seizure:

• Patient experiences altered consciousness during seizure activity

• Confusion during event with impaired responsiveness

• May involve staring, behavioral arrest, or automatisms

• Post-ictal confusion common

• Typically lasts 1-2 minutes

focal onset impaired awareness seizures

What is the most common origin for focal seizures in adults?

temporal lobe

Identify the type of motor manifestations for generalized onset seizures:

• _____________ — Initial tonic phase (stiffening) followed by clonic phase (rhythmic jerking), with postictal confusion. Previously called "grand mal"

• _____________ — Sustained muscle rigidity and posturing lasting 10-20 seconds

• _____________ — Rhythmic jerking movements without initial tonic phase

• _____________ — Sudden loss of muscle tone ("drop attacks") causing falls

• _____________ — Brief, shock-like muscle jerks without loss of consciousness

• tonic-clonic — Initial tonic phase (stiffening) followed by clonic phase (rhythmic jerking), with postictal confusion. Previously called "grand mal"

• tonic — Sustained muscle rigidity and posturing lasting 10-20 seconds

• clonic — Rhythmic jerking movements without initial tonic phase

• atonic — Sudden loss of muscle tone ("drop attacks") causing falls

• myoclonic — Brief, shock-like muscle jerks without loss of consciousness

Identify the type of absence seizure:

• ______________ — Brief episodes (5-10s) of staring with impaired awareness

• ______________ — Longer duration, less abrupt onset/offset, more pronounced motor components

• ______________ — Absence with myoclonic components

• typical — Brief episodes (5-10s) of staring with impaired awareness

• atypical — Longer duration, less abrupt onset/offset, more pronounced motor components

• myoclonic — Absence with myoclonic components

________ — sodium channel blocker that is a first-line medication for focal seizures; inhibits rapid firing of brain cells

carbamazepine

___________ — sodium channel blocker that is a classic agent for multiple seizure types

phenytoin

____________ — GABA enhancers used for the emergency treatment of seizures

benzodiazepines (diazepam & lorazepam)

___________ — GABA enahncer useful for myoclonic and absence seizures

clonazepam

____________ — GABA enhancer that has broad spectrum efficacy across seizure types

valproate

__________ —seizure activity lasting 5 minutes or more, or multiple seizures without full recovery in between (life-threatening emergency)

status epilepticus