3. Convulsive disorders

Epilepsy

A symptom complex arising from disordered brain function that may be secondary to a variety of pathologic processes. The word epilepsy describes a syndrome of recurrent, unprovoked seizures unrelated to fever or to acute cerebral insult. not all seizures imply epilepsy

Pathophysiology of respiratory seizure disorders

Airway obstruction Apnea Pulmonary edema Aspiration pneumonia

The etiologies of SE can be organized into which 4 categories

Atypical febrile seizures Acute CNS disorder (trauma, infection, metabolic) Idiopathic symptomatic epilepsy Chronic, progressive neurological disorders

Cause and diagnosis of TIC

Causes: no definite causes (emotional factors like stress) Diagnosis: accidental, no specific test, R/O other conditions with similar presentations

Pathophysiology of CNS seizure disorders

Cerebral ischemia Brain edema Cerebral hemorrhage Brain damage

Autonomic changes

Changes in the part of the CNS that automatically controls body function Strange or unpleasant sensation in stomach, chest or head Change in heart rate Sweating Goose bumps

What are some common causes of convulsive disorders

Head Injury CNS Infection Toxins Metabolic Disorders Systemic Disorders Degenerative Brain Disorder Cerebrovascular Disease Pyridoxine Deficiency Hereditary Specific Epilepsy Syndromes

convulsive disorders

May be confined to one area of the brain or involve the whole brain (i.e can be focal (partial) or generalized) originate from the CNS Are episodic neurological dysfunction and leading to sensory or motor manifestations in the form of sensory, cognitive, emotional or abnormal motor movements.

Pathophysiology of metabolic seizure disorders

Metabolic acidosis Hyperpyrexia Hypoglycemia hyponatremia

Tonic- Clonic Grand Mal Seizures

Most common form of seizure (90% have tonic-clonic seizures at some phase of the disorder & 60% have this form exclusively) Characterized by physical manifestations Rhythmical contraction of muscle groups following the tonic phase (Muscle rigidity and apnea) Followed by the clonic phase with jerking of the limbs, irregular breathing, cyanosis Loss of consciousness Lose control of bladder and bowels Perioral cyanosis Followed by 30-60 minute period of deep sleep and postictal headache

Absence (petit mal) seizures

Most common in children under age of 14 Brief (5-20 sec) lapses in consciousness, speech, motor activity or awareness Not accompanied by an aura Hyperventilation for 3-4 minutes frequently induces a seizure No post=ictal period Usually no recollection of seizure

Generalized seizures

No warning, symmetrical brain misfire. The person will have muscle spasms and lose consciousness. tonic-clonic or absence seizures

Seizure history

Onset, duration and time Pre-ictal and ictal phase Post-ictal phase Family history Growth and development history Past Medical History - previous hx of seizures or neurologic abnormalities

Focal (partial) seizures

Preceded by an aura, these start in a particular part of the brain. They can cause both physical and emotional effects and make a person feel, see, or hear things that are not real. About 60% of people with epilepsy have focal seizures. Sometimes, the symptoms of a focal seizure can be mistaken for signs of mental illness or nervous disorder.

Pathophysiology of CVS disorders

Shock Heart failure Hypertension Cardiac arrest

Sensory changes

Smell or taste changes that are not there Hear clicking, ringing, or voice without actual sounds Feel sensations of "pins and needle" / numbness Feel floating or spinning in space Visual hallucinations

TIC

Sudden, repetitive movement or sound that can be difficult to control Affects 25% of people before age of 18 Usually a temporary condition Can manifest as motor or vocal tics (simple or complex) Shoulder shrugging is the most common simple tic (nose wrinkling, head twitching, eye blinking, lip biting, kicking, jumping) Vocal tics: coughing, throat clearing, sniffing, hissing

Mortality is often related to the underlying etiology, with highest mortality associated with tumors

TRUE

Seizures are not always an either-or occurrence. Some people have seizures that start as one kind and morph into another resulting in difficulty in classification. Also, there is a type of seizure called Unknown-Onset seizures which can cause both sensory and physical symptoms.

TRUE

Seizures of prolonged duration may be associated with increased morbidity

TRUE

short, repetitive seizures are more serious than prolonged seizures because prolonged seizures induce cerebral vascular compensatory changes

TRUE

FACTS and febrile convulsion

The most common age of onset is 14-18 months The convulsion is usually generalized tonic-clonic of a few seconds duration Recurrence of convulsion after the first febrile is common (>33%) < 5% of children who have febrile convulsions develop epilepsy The problem resolves without sequelae although very long febrile convulsions may carry some risk of brain damage

STATUS epilepticus

as continuous seizure activity for at least 30 minutes, or recurrent seizures without a return to base line level of consciousness between seizures

During a seizure

cerebral O2 consumption increase to 300% cerebral blood flow increase to 900%

Seizure

clinical event in which there is a sudden disturbance of neurological function caused by an abnormal or excessive neuronal discharge

Facts about tremor

common of all involuntary movements and can affect the hands, arms, head, face, vocal cords, trunk, and legs tremor is a symptom of another neurological disorder tremor commonly occurs in otherwise healthy people

Febrile convulsion

convulsion associated with fever between 6 mo and 5 yr of age without evidence of intracranial infection or other CNS pathology

What is the most common convulsive disorder of childhood

febrile convulsion

Convulsion

muscles contract abnormally because of rapid firing or brain activity that transpires during a seizure episode, with or without loss of consciousness, sensory, autonomic or behavioral disturbances.

Morbidity is more likely with individuals with

severe CNS pathology

Convulsive disorders treatment

treat and remove causes anticonvulsant drugs Sterotactic surgery - electrical stimulation to locate and reset (destroy) epileptogenic focus

Tremor

unintentional, rhythmic muscle movement involving to-and-fro movements (oscillations) of one or more parts of the body

The increase in O2 consumption and cerebral blood flow lead to

◦Hypoxic ischemic brain injury ◦Metabolic brain injury ◦Structural brain injury