Seizures - Seizure Types | Generalized vs Focal Seizures | Causes of Seizures (Mnemonic)

Rhesus Medicine Podcast - Medical Education
23 Nov 202008:08
EducationalLearning
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TLDRSeizures are transient events with symptoms due to abnormal brain activity. They are categorized based on their origin and impact on awareness, with generalized seizures affecting both brain hemispheres and focal seizures starting in one. Seizures can involve motor or non-motor symptoms, and specific types include tonic-clonic, tonic, clonic, myoclonic, absence, and atonic. Diagnosis involves witness accounts and medical tests, while management includes immediate safety measures and pharmacological therapy with benzodiazepines and anti-seizure medications for long-term care.

Takeaways
  • 📖 Seizures are defined as transient occurrences of signs and symptoms due to abnormally excessive or synchronous neuronal activity in the brain.
  • 📌 Generalized seizures involve both hemispheres of the brain and affect awareness, previously known as primary generalized seizures.
  • 👉 Focal seizures originate from an area on one hemisphere and can be with or without impaired awareness, previously known as simple partial or complex partial seizures.
  • ➡️ Focal to bilateral seizures begin on one hemisphere and then involve both sides, formerly called secondary generalized seizures.
  • 💧 Motor seizures involve movement, such as stiffening and jerking, while non-motor seizures may involve changes in sensation, emotion, or awareness.
  • 📚 There are six main types of generalized seizures, including tonic-clonic (grand mal), tonic, clonic, myoclonic, absence (petite mal), and atonic seizures.
  • ⏰ Status epilepticus is a medical emergency where a seizure lasts more than five minutes, requiring immediate treatment including airway management and medications.
  • 💤 The post-ictal phase follows a seizure, characterized by confusion, tiredness, headaches, difficulty speaking, and sometimes amnesia or psychosis.
  • 🖥 Seizures can be categorized as provoked or unprovoked, with causes remembered by the mnemonic VITAMINS, covering vascular, infection, toxins, arterial, metabolic, idiopathic, neoplasms, and stress-related causes.
  • ⚕️ Diagnosis involves history taking, physical exams, and possibly imaging like CT or MRI scans to rule out structural causes, with EEGs often used when an organic cause isn't identified.
  • 💉 Management during a seizure includes removing hazardous objects, ensuring airway safety, and using pharmacological therapies like benzodiazepines, phenytoin, and eventually anti-seizure medications for ongoing treatment.
Q & A

  • What are seizures and what causes them?

    -Seizures are transient occurrences of signs and symptoms due to abnormally excessive or synchronous neuronal activity in the brain. They can be caused by various factors including vascular issues, infections, toxins, structural abnormalities in the brain, metabolic disorders, autoimmune conditions, and sometimes they can be idiopathic or triggered by stress.

  • How are seizures classified?

    -Seizures are classified based on whether they originate from both hemispheres (generalized seizures) or one side of the brain (focal seizures). Generalized seizures were previously known as primary generalized seizures, while focal seizures that spread to both sides are known as focal to bilateral or previously secondary generalized seizures.

  • What is the significance of awareness during a seizure?

    -The level of awareness during a seizure helps in classification. Generalized seizures automatically affect awareness, but the distinction between aware (previously simple partial) and impaired awareness (previously complex partial) applies only to focal seizures.

  • What are the different types of motor and non-motor seizures?

    -Motor seizures involve movement such as twitching, jerking, or stiffening, and can include the Jacksonian march where the abnormal movement spreads to other muscle groups. Non-motor seizures can present as changes in awareness, sensation, emotion, thinking, or experiences, and are often associated with absence seizures.

  • What is the tonic-clonic seizure and how does it manifest?

    -The tonic-clonic seizure, previously known as grand mal, begins with a contraction of the limbs followed by limb extension and arching of the back, usually lasting 10 to 30 seconds. It may involve the Ignell cry due to chest muscle contraction and can last around two to three minutes in total.

  • What are some other types of generalized seizures?

    -Other types of generalized seizures include tonic seizures (sustained muscle contraction), clonic seizures (shaking movements), myoclonic seizures (muscle spasms), and atonic seizures (bilateral loss of muscle activity).

  • What is status epilepticus and why is it a medical emergency?

    -Status epilepticus is a condition where a seizure lasts for more than five minutes. It is considered a medical emergency because it can lead to severe health complications if not treated promptly, usually involving airway management and medications like benzodiazepines, phenetoin, and phenobarbital.

  • What is the post-ictal phase and what symptoms does it present?

    -The post-ictal phase follows a seizure and precedes a return to normal consciousness. It can last from minutes to hours and often features symptoms like confusion, tiredness, headaches, difficulty in speaking, and in some cases, psychosis or amnesia.

  • How can seizures be categorized based on their cause?

    -Seizures can be divided into provoked (caused by a known factor) and unprovoked (no identifiable cause). The pneumonic 'VITAMINS' can help remember the causes: V for vascular, I for infections, T for toxins, A for arterial venous malformations and structural abnormalities, M for autoimmune conditions, I for metabolic causes, N for neoplasms, and S for stress.

  • What are the steps in diagnosing a seizure?

    -Diagnosis involves taking a detailed history of the seizure from any witnesses, considering the post-ictal state, and any history of drug or alcohol use. Physical examination may reveal signs like tongue lesions or injuries sustained during the seizure. If a provoked seizure is suspected, investigations may include blood tests for hypoglycemia or metabolic causes, CT or MRI scans of the head, and sometimes a lumbar puncture if infection is suspected. Electroencephalogram (EEG) is often used when an organic cause is not identified.

  • What are the initial management steps for a seizure?

    -During a seizure, hazardous objects should be removed to prevent injury. After the seizure, the individual should be placed in the recovery position to prevent choking, and appropriate airway management should be ensured if the airway is compromised.

  • What is the first-line pharmacological therapy for seizures?

    -The first-line pharmacological therapy for seizures is a benzodiazepine, often lorazepam or diazepam. A second dose may be given after 10 minutes if the seizure has not resolved, and if necessary, barbiturates or propofol may be used. Second-line treatment may involve phenytoin, which requires a loading dose followed by a maintenance dose.

Outlines
00:00
🧠 Understanding Seizures and Their Types

This paragraph discusses the definition of seizures as transient signs and symptoms due to abnormal neuronal activity in the brain. It delves into the classification of seizures, highlighting the difference between generalized and focal seizures, and further subdivides them based on whether they affect awareness and motor functions. The paragraph also explains the phenomenon of the jacksonian march and describes the six main types of generalized seizures, including tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. It concludes with information on status epilepticus, a medical emergency when a seizure lasts over five minutes, and the post-ictal phase symptoms.

05:00
🩺 Causes and Diagnosis of Seizures

This paragraph explores the various causes of seizures, categorized using the pneumonic 'Vitamins' to remember vascular, infectious, toxic, arterial venous malformations, autoimmune conditions, metabolic, idiopathic, and neoplasms. It emphasizes the importance of a detailed history and physical examination in diagnosing seizures, including the use of investigations like blood tests, CT, MRI, lumbar puncture, and electroencephalogram (EEG). The management of seizures is also discussed, focusing on the removal of hazards during a seizure, appropriate positioning after a seizure, and the use of benzodiazepines as first-line pharmacological therapy. It mentions the potential need for referral to specialist clinics and the initiation of anti-seizure medications.

Mindmap
Keywords
💡Seizures
Seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, and levels of consciousness. In the context of the video, seizures are categorized based on their origin and impact on awareness, with examples like generalized and focal seizures being discussed.
💡Generalized Seizures
Generalized seizures involve both hemispheres of the brain and are characterized by a loss of awareness. They were previously known as primary generalized seizures. The video mentions different types of generalized seizures, including tonic-clonic, tonic, and clonic seizures, each with distinct symptoms and manifestations.
💡Focal Seizures
Focal seizures, previously known as partial seizures, originate from a specific area in one hemisphere of the brain. They can be aware (simple partial) or impaired awareness (complex partial). The video explains that these seizures can sometimes spread to involve both sides of the brain, becoming focal to bilateral seizures, also known as secondary generalized seizures.
💡Awareness
In the context of seizures, awareness refers to whether a patient maintains consciousness during a seizure. The video clarifies that generalized seizures automatically affect awareness, while the distinction between aware and impaired awareness applies only to focal seizures, impacting the patient's experience and behavior during the seizure.
💡Motor and Non-Motor Seizures
Motor seizures involve muscle movement, such as twitching or jerking, while non-motor seizures do not. The video provides examples of both types, noting that generalized seizures may feature stiffening and jerking, whereas focal seizures can also include automatic movements like licking lips or rubbing hands, and may involve the Jacksonian march, where the abnormal movement spreads to other muscle groups.
💡Status Epilepticus
Status epilepticus is a medical emergency characterized by a seizure that lasts for more than five minutes or by a series of seizures without recovery in between. The video emphasizes the importance of prompt treatment, which may involve airway management and medications like benzodiazepines, phenetoin, and phenobarbital.
💡Post-ictal Phase
The post-ictal phase refers to the period following a seizure when the individual transitions back to normal consciousness. The video describes this phase as potentially featuring confusion, tiredness, headaches, and difficulty in speaking, with some individuals experiencing psychosis or amnesia. This phase is crucial for understanding the aftermath of a seizure and the patient's recovery process.
💡Pneumonic VITAMINS
VITAMINS is a mnemonic used to remember the common causes of seizures, including Vascular causes, Infections, Toxins, Autoimmune conditions, Metabolic causes, Idiopathic seizures, Neoplasms (tumors), and Stress. The video uses this mnemonic to illustrate the diverse range of factors that can provoke seizures, aiding in the identification of potential underlying causes during diagnosis.
💡Diagnosis
Diagnosis of seizures involves a thorough patient history, witness accounts, physical examination, and possibly further investigations like blood tests, imaging scans (CT or MRI), lumbar puncture, and electroencephalogram (EEG). The video highlights the importance of a comprehensive approach to diagnosing seizures to identify the type, potential triggers, and underlying causes.
💡Management
Management of seizures includes immediate safety measures during a seizure, such as removing hazards and placing the individual in recovery position, as well as pharmacological therapy with benzodiazepines, phenytoin, and other anti-seizure medications. The video emphasizes the importance of appropriate management to prevent injury and ensure the patient's well-being.
💡Tonic-Clonic Seizures
Tonic-clonic seizures, previously known as grand mal seizures, are one of the main types of generalized seizures. They involve a contraction of the limbs followed by limb extension and arching of the back, often accompanied by a cry due to chest muscle contraction. The video describes the process and duration of tonic-clonic seizures, which typically last around two to three minutes.
Highlights

Seizures are defined as transient occurrences of signs and symptoms due to abnormal neuronal activity in the brain.

Seizures are classified into several types based on their origin and the level of awareness they affect.

Generalized seizures involve both hemispheres of the brain and were previously known as primary generalized seizures.

Focal seizures originate from an area on one hemisphere and are also known as partial seizures.

Focal to bilateral seizures, previously called secondary generalized seizures, start on one hemisphere and then involve both sides.

The awareness of the patient during a seizure is a key factor in distinguishing between focal aware and focal impaired awareness seizures.

Motor seizures involve movement during the seizure, such as twitching, jerking, and stiffening.

Non-motor seizures can present with changes in sensation, emotion, thinking, or experiences, and were previously known as auras.

The Jacksonian march describes the spread of abnormal movement from one group of muscles to other muscle groups during a focal seizure.

Generalized non-motor seizures, or absence seizures, primarily involve changes in awareness.

Tonic seizures present with increased tonicity, or sustained contraction, and may result in cyanosis if breathing is affected.

Clonic seizures are characterized by shaking movements, while myoclonic seizures feature muscle spasms.

Atonic seizures involve bilateral loss of muscle activity for more than one second.

Status epilepticus is a medical emergency where a seizure lasts for more than five minutes.

The post-ictal phase follows a seizure and can last from minutes to hours, featuring confusion, tiredness, headaches, and difficulty in speaking.

Seizures can be divided into provoked and unprovoked types, with the mnemonic 'VITAMINS' used to remember their causes.

Diagnosis of seizures involves a history of the seizure, physical examination, and investigations such as blood tests and imaging.

Management during a seizure includes removing hazardous objects, placing the individual in recovery position, and appropriate airway management.

Benzodiazepines are the first line pharmacological therapy for seizures, followed by phenytoin and other anti-seizure medications.

Transcripts

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