PT 535: Understanding Seizures

what is a seizure?

result of paroxysmal excessive discharge of cerebral neurons, resulting in transient impairment or loss of consciousness

abnormal electrical activity can originate in a localized area or spread across broad neural networks throughout the brain

what are the 3 main categories of seizures?

generalized onset

focal onset

unknown onset

what are generalized onset seizures?

affects both sides of the brain or large bilateral networks from the start from the very beginning of the event. networks may be on the surface of the brain or involve deeper areas

*does not need to be whole brain, but does cross

what are focal onset seizures?

begins in an rea or network on one side of the brain (does not cross corpus collosum

aka partial seizures

refers to seizures that start in an area or network on one side of the brain

may start on the surface or in deeper areas, can be very localized or spread to larger areas, and sometimes more than one network is involved

only one side of the brain is involved

what are unknown onset seizures?

beginning of the seizure is not clearly established

what is a generalized motor seizure?

involve bilateral motor manifestations from onset

what are the different types of generalized motor seizures?

tonic-clonic

myoclnic-tonic-clonic

atonic

clonic/tonic/myoclonic

myoclonic-atonic

epileptic spasms

what is is tonic clonic generalized motor seizure?

sustained stiffening & rhythmic jerking

formerly known as grand mal

what is a myoclonic-tonic-clonic generalized motor seizure?

describes a sequence beginning with myoclonic jerks followed by tonic and clonic phases

what is an atonic generalized seizure?

no change

characterized by sudden loss of muscle tone, often causing drop attacks or falls

"drop seizures"

what is a clonic generalized motor seizure?

rhythmic jerking

what is a tonic generalized motor seizure?

sustained stiffening

what is a myoclonic generalized motor seizure?

brief muscle jerks

what is a myoclonic-atonic generalized motor seizure?

involved myoclonic jerks immediately followed by loss of muscle tone

what is an epileptic spasm generalized motor seizure?

brief, sudden flexion or extension of the trunk and limbs; previously described only under infantile spasms

*this will either evolve into another type or go awaY

what are generalized non-motor (absence) seizures?

brief lapses in awareness without prominent motor activity

what are the different types of generalized non-motor (absence) seizures?

typical

atypical

myoclonic

eyelid myoclonia

what is a typical absence seizures?

no change from prior classification

formerly petit mal

characterized by sudden, brief lapses of consciousness with staring, typically lasting 5-30 seconds

what is a atypical absence seizures?

similar to typical absence but with a more gradual onset and offset, often associated with cognitive impairment and other seizure types (often associated with developmental delay)

what is a myoclonic absence seizures?

combines absence with rhythmic myoclonic jerking, typically involving the shoulder, arms, and legs bilaterally

(jerking motion and absent seizure)

what is a eyelid myoclonia absence seizures?

involves rapid myoclonic jerking of the eyelids, often triggered by eye closure or light, with or without absence

what are focal motor seizures?

involve a change in muscle activity originating from one side of the brain

the specific motor manifestation depends on the region of the cortex involved

what are the types of focal motor seizures?

clonic (jerking)

tonic (stiffness)

atonic (loss of tone)

automatisms

what is a clonic focal motor seizure?

rhythmic, repetitive jerking movements of a limb or a body part

reflects repetitive inhibitory and excitatory discharges in the motor cortex

what is a tonic focal motor seizure?

sustained muscle contraction causing stiffening of a limb or one side of the body. may cause the head or eyes to deviate toward the affected side

what is a automatisms focal motor seizure?

repeated or automatic movements such as lip smacking, hand fumbling, or picking at clothing

often associated with impaired awareness

what are the different types of a focal non-motor seizure?

autonomic

behavioral arrest

cognitive

emotional

sensory

what is an autonomic focal non motor seizure?

changes in heart rate, breathing, skin color, sweating, or pupil dilation - reflecting involvement of autonomic regulatory networks

what is a behavioral arrest focal non motor seizure?

blank stare, cessation of speech, or sudden stopping of movement

the person appears frozen or unresponsive for the duration of the event

what is a congitive focal non motor seizure?

confusion, slowed thinking, problems talking or understanding language. may resemble a transient ischemic attack in presentation

what is an emotional focal non motor seizure?

sudden fear, dread, anxiety, or even pleasure arising without external cause

fear is the most common emotional manifestation in temporal lobe seizures

what is a sensory focal non motor seizure?

changes in hearing, vision, taste, or feelings of numbness, tingling, or pain

reflects involvement of primary or association sensory cortices

when can a seizure be classified as an unknown onset?

when the beginning of the seizure is not clearly established

unknown onset seizures include what motor seizures?

tonic clonic

epileptic spasms

unknown onset seizures include what non- motor seizures?

behavioral arrest - person stops activity and appears unresponsive, but the laterality of onset cannot be determined

what are common seizure triggers?

stress & emotions

poor nutrition and skipped meals (destabilizes glucose & electrolyte balance)

missed meds

flickering lights

illness

fever & allergies

heat & humidity

what is the prognosis on mortality if you have seizures?

increased mortality compared to the general population

what are the primary causes of death related to seizures?

asphyxia - airway compromise during or after seizure

drowning - loss of consciousness in or near water

cardiac event - arrhythmias associated with ictal and postical states

what is the relationship between seizures and depression?

significantly more prevalent among individuals with epilepsy than in general population

depression can lower seizure threshold, and seizures can exacerbate depressive symptoms. screening for mood disorders should be a routine component of epilepsy care

what is the treatment for epilepsy?

pharmacological management with antiepileptic medications

diet therapy, neuromodulation, and surgical intervention

what do you do when someone is seizing?

clear area

prevent fall

turn on side

observe and record

call 911

what is the first step to do when someone is seizing?

clear the area

remove any hard, sharp, dangerous objects from the immediate area around the person. do not restrain the person this can cause injury

cushion the head if possible and loosen any tight clothing around the neck

what is the second step to do when someone is seizing?

prevent a fall

if the person is standing or seated when the seizure begins, gently guide them to the ground to prevent injury from falling.

support the head and body as safely as possible without forceful restraint

what is the third step to do when someone is seizing?

turn on side

if there is any vomiting, excessive secretions, or loss of protective reflex, place person in recovery position on their side. this prevents aspiration and maintains airway patency

what is the fourth step to do when someone is seizing?

observe and document

note the time the seizure begins, the type, and the sequence of the movement, the time it ended

video is possible

what is the fifth step to do when someone is seizing?

call 911

if the person has no known history or seizures

status epilepticus (seizure lasting longer than 5 minutes and medication does not help them)

define static epilepticus?

seizure lasting greater than 5 minutes, or two or more seizures without full recovery of consciousness between them. it represents a failure of the normal seizure-termination mechanisms and constitutes a life threatening neurological emergency

what is the response protocol for statis epilepticus?

call 911

maintain airway, breathing, and circulation

if have known seizure, will have protocol FOLLOW IT!

- may have to give meds

document time of onset and all interventions to give to EMS team

how do antiepileptic drugs (AEDs) work?

stabilize neuronal membranes, enhacing inhibitory neurotransmission, or reducing excitatory activity to prevent the paroxysmal discharges that cause seizures

beyond meds, in refractory cases, what treatment is used?

ketogenic dietary therapy, vagus nerve stimualtion, responsive neurostimulation, and surgical resection of the seizure focus

what is a focal aware seizure?

the person retains full awareness and consciousness throughout the seizure. they may experience motor, sensory, autonomic, or emotional symptoms but remain oriented and able to response

what is a focal impaired awareness seizure?

awareness is impaired at any point during the seizure. the person may appear confused, unresponsive, or engage in automatisms

what are the motor signs of a seizure?

jerking (clonic), stiffening (tonic), loss of tone (atonic), or automatisms. motor signs help localize the seizure focus and distinguish focal from generalized onset

what are the sensory signs of a seizure?

numbness, tingling, pain, visual disturbances, auditory changes, or altered taste/smell. sensory auras often precede more prominent seizure activity and can serve as a warning

what are the autonomic signs of a seizure?

changes in heart rate, blood pressure, breathing, skin color, or sweating

autonomic manifestations reflex involvement of insular and limbic networks

what are the cognitive and emotional signs of a seizure?

confusion, language difficulties, sudden fear, deja vu, or jamais vu

these symptoms are particularly associated with temporal lobe seizures and focal impaired awareness

what do we need to document in order to diagnose a seizure?

time of onset and duration

describe the sequence of events

note level of awareness

record postictal state

what are febrile seizures?

most common in children aged 6 months to 5 years

while most are benign and self limited they require careful evaluation to run out serious underlying causes such as meningitis or encephalitis

caused by a fever

what tool is used to idenitfy depression in the epileptic population?

NDDI -E

what is the social stigma of epilepsy?

driving restrictions, employment challenges, and fear of public seizures

when should you call 911?

no seizure history

lasts more than 5 minutes

does not regain consciousness

person is injured

seizure in water