power point 7 seizures

8/6/2019 Power Point 7 Seizures

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AHPT 551 Medical Issues in

Neurological Physical Therapy

Seizure Disorders


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Seizure Disorders

Epileptic seizures are the most commonserious neurological disorder seen inoutpatient clinics

Up to 10% of the population will haveat least one seizure in their lifetime

Seizures have no geographic or genderpredominance, and can begin at anyage.


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What is it?

Epilepsy is an intermittent derangement ofthe nervous system due presumably to a

sudden, excessive disorderly discharge ofcerebral neurons.

The discharge can result in almostinstantaneous disturbance of sensation,

consciousness or cognition, and can causeconvulsive movements (or in combination)

There may be one seizure associated withan illness or injury, or many


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Etiology and Time of Onset

Newborns

Perinatal injury Metabolic defect

Myoclonic syndrome

Cerebrovascular

Metabolic encephalopathy


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Etiology and Time of Onset

Newborn

Perinatal injury

Metabolic defect

Myoclonic syndrome

Cerebrovascular

Metabolicencephalopathy

Infancy

Same as newborns

Congenitalmalformation

Genetic disease

Head trauma


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Etiology and Time of Onset Childhood and

Adolescence

Congenital malformation Genetic disease

Myoclonic syndrome

Head trauma

Brain tumor

Idiopathic

Metabolicencephalopathy

Adulthood

Same as childhood

except for genetic andmyoclonic

Cerebrovascular


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Classification of Seizures Generalized

Bilaterally symmetrical and without localonset)

Partial or focal

Seizures beginning locally

Special syndromes


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Generalized Seizures Tonic: clonic, or tonic-clonic (grand mal)

Absence (petit mal) Simple lack of responsiveness

Complex with brief tonic, clonic, or automaticmovements

Lennox-Gastaut syndrome

Juvenile myoclonic

Infantile spasms

Atonic


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Generalized Tonic-Clonic

(Grand Mal)

The term convulsion is most applicable to thisform of seizure

May be preceded by a prodrome or an aura Has a tonic, clonic, and postictal phases

Tonic phase: brief flexion followed by extension,epileptic cry, cyanosis

Clonic phase: violent flexion spasms of all musclegroups, alternating with relaxation tongue bitesand limb injuries are common

Postictal phase: all muscle activity ceases and adeep coma occurs followed by gradual rise inconsciousness


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Absence SeizuresA common form of minor motor generalized

seizure of childhood and young adulthood

Best known absence petit mal Seizure begins abruptly with a state of

unresponsiveness

May have some automatic movement

Petit mal attacks usually last 6 10 secondsand end quickly with immediate resumptionof normal consciousness and no postictalconfusion.


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Myoclonic Seizures Seen in children and young adults without

loss of consciousness

Attacks of facial twitching with irregular armand/or leg myoclonic jerking lasts manyseconds

Occur suddenly, often within a hour of

waking Often induced by simple sensory stimuli such

as repetitively flashing lights


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Simple Partial Seizures Largest group of seizure disorders are

those in which only a portion of thecortical neurons develop epilepticdischarges

In a simple partial seizure,

consciousness is not impaired Signs and symptoms depend on the

location of the seizure focus


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Types of Simple Partial

Seizures Focal motor; tonic or clonic contractions of

one limb or one side of the body (frontal)

Somatosensory: paresthesias or dysethesias(parietal)

Auditory: uncommon, usually involves thetemporal lobe, auditory hallucinations

Visual: uncommon, occipital lobe, poorlyformed visual hallucinations of light flashes

Uncinate: olfactory hallucination of anoxious, but hard to characterize odor


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Complex Partial Seizures Changes in consciousness

Most difficult to control of the common adultseizure types

Lasts about 2 minutes starts with anabsence-like stare, then automaticmovements

Primary site is the temporal lobe, but can beat other sites

There is amnesia of the seizure and some ofthe post-ictal period


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Management Diagnosis

Primarily based on history

Attempt to find focal sites Differential diagnosis

Treatment Almost all patients can be managed with anti-

convulsant medication Table 8 4 in text lists the most common meds

Side effects are listed in Table 8 7

With intractable seizures may remove a part or

the entire hemisphere


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Special Syndromes

Reflex epilepsy

Febrile and other seizures of childhood Hysterical seizures


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Causes of Status Epilepticus Inadequate anti-convulsant therapy

Metabolic imbalance

Drug overdose

Alcohol and other sedative drug withdrawal

Head trauma

Brain tumor Cerebrovascular disease

CNS infections

Cardiac arrest


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Treatment of Status Epilepticus

The seizures must be stopped and the

underlying cause recognized andmanaged

The goal is to terminate seizures within20 minutes (brain damage can thenstart to occur)

There is a set protocol (Table 8 5)

power point 7 seizures

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