NURS 271 - Neurological Conditions: Seizures, Parkinson's, and Stroke

What are seizures?

Brief episodes of abnormal electrical activity in the brain.

Can a person have a seizure without convulsions?

Yes, a person can have a seizure without convulsion.

What is a convulsion?

A severe seizure characterized by physically shaking the whole body; involuntary spasmotic contractions

Define epilepsy.

A chronic and recurrent pattern of seizures due to excess electrical discharges.

What percentage of epilepsy patients might appear normal on an EEG?

50% of patients may appear normal on an EEG.

What is an Electroencephalogram (EEG)?

A test that measures electrical activity in the brain; a positive result indicates seizures.

What is the purpose of a skull radiography?

To take an X-ray of the head.

What does a CT scan do?

It provides a better view of the brain's structure to detect problems.

What is an MRI?

An imaging technique that uses strong magnetic fields to take pictures inside the body.

List some causes of seizure disorders.

Fever, brain injury/trauma, strokes, dehydration, metabolic issues, drug overdoses.

What is a simple partial seizure?

A seizure where the person remains aware and experiences sensory, motor, psychic, or autonomic symptoms; no impairment of consciousness at all

What characterizes a complex partial seizure?

It occurs in one part of the brain with altered awareness and impairment of consciousness.

What is an absence seizure?

A generalized seizure that results in a blank stare lasting less than 10 seconds, with impaired awareness; common in children and usually resolves before 14 years of age

What happens during the tonic phase of a tonic-clonic seizure?

The person may cry out/groan, lose awareness, and experience muscle stiffening; previously known as grand mal seizures

What is a serious complication of a tonic-clonic seizure?

Cessation of respiration (person could stop breathing)

What is a myoclonic seizure?

A seizure that results in a sudden jerk of part of the body without loss of consciousness; affects one body part

What is an atonic seizure?

A seizure involving a sudden loss of muscle tone, causing the person to fall or drop objects; (THINK: ATOMIC BOMB) aka drop seizure

What is aura (warning?)

Acts as a warning if a seizure will occur, followed by a sudden loss of conciousness and loss of motor control

What is the postictal phase?

A deep sleep following a seizure caused by CNS depression.

What is status epilepticus?

A medical emergency characterized by continuous seizures without recovery.

What medications are commonly used for partial seizures?

Carbamazepine (Tegretol), Phenytoin (Dilantin), and Valproic Acid (Depakene).

What is the MOA (mechanism of action) for Carbamazepine (Tegretol) and Phenytoin (Dilantin)?

Interferes with Na movement across the cell membranes, keeping the Na inactivated for a prolonged period of time, essentially decreasing the ability of the neurons to fire at high frequency

What are the adverse effects of Carbamazepine (Tegretol) and Phenytoin (Dilantin)?

Ataxia - loss of ability to coordinate muscular movements

Nystagmus - rapid, involuntary movement of the eyeball

What are the adverse effects only seen in Phenytoin (Dilantin)?

Gingival hyperplasia - excessive growth of the gum tissue

What is the treatment for absence seizures?

Ethosuximide (Zarontin) and Valproic Acid (Depakene).

What is the MOA of Ethosuximide (Zarontin)?

Controls seizures by suppressing neurons in the thalamus (the neurons responsible for absent seizures), and decreases the firing of these neurons

What is the treatment for Atonic seizures (drop seizures)?

Antiepileptic drugs may or may not work, but a high-fat, low CHO diet (e.g., ketogenic/Atkins diet) and vagal nerve stimulation may be implemented

What is vagal nerve stimulation?

Sends messages to the brain and the rest of the body to stimulate the nerves to decrease the frequency of seizure

What is the treatment for tonic-clonic seizures?

Carbamazepine (Tegretol), Phenytoin (Dilantin), and Valproic Acid (Depakene).

What is Valproic Acid (Depakene)?

Used to treat all types of seizures

What are the 3 mechanisms of Valproic Acid (Depakene)?

1. Shares MOA as Dilantin and Tegretol, specifically suppressing the high frequency of neuronal firing, blocking the influx of Na+ channels.

2. Suppresses the influx of Ca2+ through t-type Ca2+ channels

3. Increases the influences of GABA (non-essential a.a.), functioning as a neurotransmitter that decreases neuronal activity, therefore decreasing neuronal firing

What are the side effects of Valproic Acid?

Hepatotoxicity and contraindication in pregnant women due to risk of spina bifida.

What medications are used to treat Myoclonic Seizures?

Valproic Acid (Depakene)

What medications are used to treat status epilepticus?

Diazepam (Valium), Lorazepam (Ativan), and Phenobarbital (Luminal).

What is Phenytoin (Dilantin) used for?

Long-term control of seizures.

What is the therapeutic blood level range for Phenytoin?

10-20 mcg/ml. (necessary for seizure suppresion)

What should be done during a seizure to reduce aspiration risk?

Turn the patient to the side.

Define Parkinson's Disease

A progressive, debilitating disease of the CNS characterized by resting tremors, bradykinesia, muscle rigidity, weakness, and forward flexion of the trunk

What neurotransmitter imbalance is associated with Parkinson's Disease?

High acetylcholine and low dopamine.

Neurotransmitter balance theory

There is a disorder in the extrapyramidal system (responsible for regulating gross-motor movements, posture, and coordination) in the brain

What happens when there is a full loss of dopamine?

There will be an increase in acetylcholine (ACh), which causes the release of GABA, leading to an overactivity of neurons, contributing to movement disorders.

What is the primary treatment goal in Parkinson's Disease?

To restore the balance of dopamine and acetylcholine.

Name a drug that releases dopamine for Parkinson's Disease treatment.

Amantadine (Symmetrel).

Amantadine (Symmetrel) promotes?

Promotes the release of dopamine from the remaining dopamine neurons; may block the reuptake of dopamine into the presynaptic neuron, allowing more central collection of dopamine (first known as an antiviral drug)

Name the drug(s) that increase dopamine for Parkinson's Disease treatment.

Benzotropine (Cogentin) and Trihexyphenidyl (Artane)

Benzotropine (Cogentin) and Trihexyphenidyl (Artane)

Examples of anticholinergic drugs, which work to block ACh receptors from binding to their receptor sites

Drugs that are classified as Dopaminergic agonists

Bromocriptine (Parlodel) and Pramipexole (Mirapex)

Bromocriptine (Parlodel) and Pramipexole (Mirapex)

Drugs that stimulate the nerves in the brain that are receiving the dopamine it needs; stimulate nerves in the brain that are not normally stimulated (mimics)

What is the 'gold standard' treatment for Parkinson's Disease?

Levodopa (L-Dopa).

How does Levodopa work in the brain?

It promotes the synthesis of dopamine in the striatum.

What enzyme converts Levadopa (L-DOPA) to dopamine?

Decarboxylase

What are common adverse effects of Levodopa?

Dyskinesias and bradykinesias.

What is the role of Carbidopa in Parkinson's treatment?

It inhibits the decarboxylation of Levodopa in the intestines.

What causes an ischemic stroke?

Severe blockages of blood flow to the brain.

What is a hemorrhagic stroke?

A rupture of blood vessels causing bleeding in surrounding tissue.

What is the acronym to recognize a stroke?

B.E.F.A.S.T. (Balance, Eyes, Face, Arms, Speech, Time).

What is the recommended treatment window for thrombolytic therapy after a stroke?

Within 3 hours for best prognosis.

What are common risk factors for stroke?

Hypertension, diabetes, obesity, smoking, and high cholesterol.

What medication is commonly used for clot prevention before a stroke?

Aspirin.

What is expressive aphasia?

The ability to understand language but difficulty in speaking clearly.

What is receptive aphasia?

The ability to speak but using meaningless words.

What type of therapy is important for life after a stroke?

Speech therapy, physical therapy, and talk therapy.

What is the effect of Levodopa on movement over time?

It may lead to involuntary movements and slow movements (bradykinesias).

How is Levodopa absorbed in the body?

It is rapidly absorbed from the small intestines.

What happens to less than 1% of Levodopa dose?

It reaches the brain due to peripheral metabolism.

What is the effect of a sedentary lifestyle on stroke risk?

It increases the risk of stroke.

What is the significance of LDL cholesterol in stroke risk?

High LDL (bad cholesterol) increases stroke risk.

What is the relationship between atrial fibrillation and stroke?

Atrial fibrillation increases the risk of stroke due to potential blood clots.