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Seizure Disorders

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Meredith Bechtle

on 7 July 2015

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Transcript of Seizure Disorders

Seizure Disorders
Meredith Bechtle, Chloe Colton, Jessica Shoemaker
Risk Factors
Age
Older Adults (66+)
Family History
Inheritance of seizure disorders depends on:
type of seizure disorder in the family
which family members are affected
age when seizure disorder developed

Head Injuries
Dementia
Brain Infections
Infections
: abscess, AIDS, malaria, meningitis, rabies, syphilis, tetanus, toxoplasmosis, viral encephalitis
Stroke & Vascular Diseases
Brain damage caused by a stroke or other vascular disease can trigger a seizure.
Partial Seizures
Generalized Seizures
Unclassified Seizures
Complications
Injuries
Psychological Effects
Status Epilepticus
Aspiration
Aspiration of Secretions
Permanent Brain Damage
Not well understood
Prolonged seizures (Status Epilepticus) do seem to cause some brain damage
Not currently clear whether single seizures cause permanent brain damage
Sudden Unexpected Death in Epilepsy (SUDEP)
Not well understood
No identifiable cause for death
Accounts for 8-17% of all epilepsy related deaths
References
What is a Seizure?
An abrupt and temporary alteration in cerebral activity resulting in changes in electrical discharge from neurons in the cerebral cortex.
Porth, 2011
Retrieved from https://www.google.com/search q=seizures&espv=2&biw=1151&bih=616&site=webhp&source=lnms&sa=X&ei=
tLiOVda0GYKngwSfhYPYBQ&ved=0CAYQ_AUoAA&dpr=1.1
Increased excitatory synaptic neurotransmission
Decreased inhibitory neurotransmission
An alteration in voltage- or ligand-gated ion channels
An alteration of intra- or extra-cellular ion concentrations in favor of membrane depolarization
Decreased uptake of glutamate
Decreased release of GABA
Voltage-gated Na+ channel mutation or injury
Mechanisms of Seizure Development
Excess glutamate remains in synaptic cleft
Neuron Hyperexcitability
High-frequency bursts of action potentials
Hypersynchronization of neuronal activity
Sustained depolarization of neuron membrane
Abnormal accumulation of Ca++ in synaptic knob
Voltage-gated Na+ channels remain open
Continual influx of Na+
Seizure
Retrieved from http://rrapid.leeds.ac.uk/ebook/06-dysfunction-04.html
Retrieved from http://www.nature.com/nrn/journal/v13/n1/fig_tab/nrn3138_F4.html
Continual binding of glutamate to receptors
Sustained depolarization of postsynaptic neuron
Excess excitatory impulses
Increased release of glutamate
Increased uptake of GABA
Review of Nerve Impulses
Retrieved from http://www.aviva.co.uk/health-insurance/home-of-health/medical-centre/medical-encyclopedia/entry/structure-and-function-nerve-cells/
Lack of GABA in synaptic cleft
Decreased inhibition of excitatory impulses
Resurgent Na+ current
Ion channel reopens during repolarization
Increased extracellular K+
K+ unable to move out of cell for repolarization
Enhanced release of excitatory neurotransmitters
Retrieved from https://kin450-neurophysiology.wikispaces.com/Seizure+-+Cortical+Related
Cannot be placed in a category

Occur in neonates and infants

Difficult to control with meds
Simple/Focal
Complex
Secondary Generalized
Abnormal electrical activity in one hemisphere
Recruitment of surrounding neurons
Loss of surround inhibition
Seizure Propogation
: spread of seizure activity into contiguous areas
Repetitive neuron firing
Increase in extracellular K+
Accumulation of Ca++ in synaptic knob
Depolarization-induced activation of excitatory neurotransmitter receptors
Abnormal activity in both hemispheres
Motor Symptoms:
Contralateral aberrant movement
Jerking
Stiffening
Sensory Symptoms:
Somatic sensory disturbances (e.g., tingling)
Special sensory disturbances (e.g., visual or olfactory phenomena)
Aura
Autonomic Symptoms:
Flushing
Tachycardia
Diaphoresis
Hypo- or hypertension
Impairment of consciousness
Automatisms
Déjà vu
Jamais vu
Overwhelming fear
Uncontrolled forced thinking
Flood of ideas
Depersonalization
Postictal confusion
Symptoms:
Involves deeper structures of brain (e.g., thalamus)
Symptoms:
Tonic-clonic seizure activity
Aura possible
Psychological Symptoms:
Memory impairment
Emotional disturbances
Absence
Atonic
Tonic-Clonic
Abnormal electrical activity in brainstem
Disrupts functions of medulla, pons, and midbrain
Tonic Phase
:
Loss of consciousness
Altered ANS (tachycardia, HTN)
Apnea & cyanosis
Sharp contraction of muscles
Extension of extremities
Clenched jaw
Epileptic cry
Bowel & bladder incontinence
Inhibitory impulse arises from the thalamus and interrupts the tonic phase
Clonic Phase
:
Alternating contraction and relaxation of extremities
Eyes roll back
Froth at mouth
Hyperventilation
Postictal Phase
:
Gradually regain consciousness
Headache & muscle aches
Drowsy & groggy
Often amnesia to event
Seizure propogation into both hemispheres
Discontinuous bursts of electrical activity
60-90 seconds
Retrieved from http://www.tonicclonicseizure.com/
Retrieved from http://www.tonicclonicseizure.com/
Retrieved from www.tonicclonicseizure.com
Hyperpolarization of cell membrane of thalamic neurons
Activation of low-threshold calcium currents (T-channels)
Activation of GABA receptors
Synchronous thalamic discharges
Symptoms:
Blank stare
Motionlessness
Unresponsiveness
Possible automatisms
Brief in duration, resume normal activity immediatly
Myoclonic
Abnormal electrical activity in area of brain that decreases muscle tone
Abnormal electrical activity in area of brain that increases muscle tone
Sudden, split-second loss of muscle tone
Symptoms:
Slackening of jaw
Drooping of limbs
Falling to ground
Brief involuntary muscle contractions
Symptoms:
Bilateral jerking of muscles, often of the head, trunk, or extremities
Age
Family History
Head Injuries
Stroke and other vascular diseases
Dementia
Brain infections
"The nature of seizures varies, because the lobes of the brain control different behaviors, movements, and experiences."
Mayo Clinic, 2015
Onset of a seizure can occur at any age!
Febrile Seizures in Children
Cytokine network is activated & triggers the seizure
Low seizure threshold
Greater risk for developing a upper respiratory tract infection, otitis media, viral syndromes, and response to high temperatures
Medscape, 2015
Cryptogenic (50%): no identifiable cause
Physical changes in the brain caused by stoke, heart disease, Alzheimer's disease, or brain tumors
Lazare, 2015
Some types of seizure disorders have a higher risk of being inherited than other types.

Some people don’t inherit seizure disorders itself, but they do inherit a low seizure threshold.

Between two and five in every 100 children born to parents with epilepsy will inherit epilepsy.
Epilepsy.org, 2012
Retrieved from www.epilepsy.org
Risks of Inheriting Epilepsy
Causes
Mild Head Trauma
: loss of consciousness for less than 30 seconds, associated with a slight increase in the risk of developing reoccurring seizures

Severe Head Trauma
: loss of consciousness or amnesia for more than a day or bleeding around the brain, associated with a greater increase in the risk of seizures

Early Seizure:
occurs in first week after a head injury
Typically not treated
Late Seizure:
occurs later than a week; considered epilepsy
Typically treated with medications
Fisher, 2015
To reduce the risk of these diseases you can:
limit alcohol intake
avoid cigarettes
eat a healthy diet
exercise regularly
Protein beta amyloid builds up and forms a plaque in the brain
Plaque causes nerve damange in the brain
Decline in cognitive and motor function
Increase risk for developing a seizure
Shouri, 2014
Retrieved from http://www.dementiatoday.com/clinical-decline-in-alzheimers-requires-plaque-and-proteins/
Retrieved from http://www.epilepsy.com/learn/triggers-seizures
Mayo Clinic, 2015
Mayo Clinic, 2015
Infection develops in the brain
Toxins cause damage to brain tissue and the blood brain barrier
Increased vascular permeability
Increased intercranial pressure resulting in decreased cerebral perfusion and hypoxia
Increased risk of a seizure occuring
Agamanolis, 2014
Genetic Influence
Head Trauma
Brain Conditions
Infectious Diseases
Prenatal Injury
Prenatal Injury
A fetus is sensitive to brain damage that could be caused by:
There is no identifiable cause in about 50% of those with the condition, but it can be traced to various factors
Mayo Clinic, 2015
maternal infection
poor nutrition
oxygen deficiencies
If brain damage does occur, the newborn may experience seizures or epilepsy
Retrieved from http://www.families.com/blog/childhood-seizures-what-parents-should-know
Injuries
Psychological Problems
Status Epilepticus
Sudden Unexpected Death from Epilepsy
Aspiration
Permanent Brain Damage
Retrieved from http://images.medicinenet.com/images/slideshow/epilepsy-s1-illustration-of-seizure.jpg
Seizure
Unresponsiveness
Drowning
Car Accident
Fall
Injury
Seizure Disorder
Depression
Suicidal Ideation
Brain Injury
Medication
Side Effects
Chronic Illness
Seizure lasting longer than five minutes OR more than one seizure occurring within five minutes without returning to normal between them
Convulsive
: Tonic-Clonic

Retrieved from http://www.cambrianfirstaid.co.uk/mediafiles/epilepsy.jpg
Retrieved from http://static.wixstatic.com/media/0b9b20_c733a61dcd5e4510bf7982a089007785.jpg_srz_226_95_75_22_0.50_1.20_0.00_jpg_srz
Tonic-Clonic Seizure
Aspiration Pneumonia
Asphyxia
Retrieved from http://i.ytimg.com/vi/yp5mi9gTg2A/maxresdefault.jpg
Retrieved from http://adc.bmj.com/content/78/1/78.full
Retrieved from https://www.boundless.com/biology/textbooks/boundless-biology-textbook/the-nervous-system-35/how-neurons-communicate-200/nerve-impulse-transmission-within-a-neuron-resting-potential-761-11994/
Agamanolis, D. (2014). Infections of the nervous system.
Neuropathy
(pp. 1-5). Akron, OH.

Al-Mufti, F., Claassen, J. (2014). Status epilepticus review. Retrieved from http://www.sciencedirect.com/science/article/pii/S0749070414000529

Bromfield, E. B., Cavazos, J. E., Sirven, J. I. (2006). An introduction to epilepsy. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK2510/

Cunha, J. P. (2014) Epilepsy. Retrieved from http://www.medicinenet.com/seizure/article.htm

Danbolt, N. C. (2001). Glutamate as a neurotransmitter. Retrieved from http://neurotransporter.org/glutamate.html

Epilepsy Action. (2012). Epilepsy and inheritance. Retrieved from https://www.epilepsy.org.uk/info/inheriting-epilepsy

Epilepsy Foundations. (n.d.) About the sudep institute. Retrived from http://www.epilepsy.com/sudep-institute

Fisher, R. (2015). Seizures from head trauma. Retrieved from http://neurology.stanford.edu/epilepsy/patientcare/videos/e_12.html

Fuller, J. (2013) 9 complications of epilepsy. Retrieved from http://www.healthgrades.com/conditions/9-complications-of-epilepsy

Jackson, M.J., Turkington, D. Depression and anxiety in epilepsy. Reterieved from http://jnnp.bmj.com/content/76/suppl_1/i45.full

Jarecki, B. W., Piekarz, A. D., Jackson II, J. O., & Cummins, T. R. (2010). Human voltage-gated sodium channel mutations that cause inherited neuronal and muscle channelopathies increase resurgent sodium currents. J Clin Invest, 120(1): 369–378

Hopkins Medicine (n.d.) Status epilepticus. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/status_epilepticus_134,42/

Kelley, G. R. (2014). Epilepsy complications. Retrieved from http://www.healthcommunities.com/epilepsy-seizures/complications.shtml

Ko, Y. D. (2013). Generalized tonic-clonic seizures. Retrieved from http://emedicine.medscape.com/article/1184608-overview#a3

Ko, Y. D. (2014). Epilepsy and seizures. Retreived from http://emedicine.medscape.com/article/1184846-overview#a3

Krucik, G. T. (2014). The epilepsy depression connection. Retrieved from http://www.healthline.com/health/epilepsy-depression-connection#Epilepsy1

Lazare, J. (2011). Seizures in older adults. Retrieved from http://www.todaysgeriatricmedicine.com/archive/spring2011_p30.shtml

Massachusetts General Hospital. (2006). Seizure types and syndromes. Retrieved from http://www2.massgeneral.org/childhoodepilepsy/overview/seizure_types.htm

Mayo Clinic. (2014). Epilepsy. Retrieved from http://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/dxc-20117207

McPhee, S. J., & Hammer, G. D. (2010).
Pathophysiology of disease: An introduction to clinical medicine
(6th ed.). New York: McGraw-Hill

Porth, C., & Gaspard, K. J. (2011).
Essentials of pathophysiology: Concepts of altered health states
. Philadelphia: Wolters Kluwer

Richards, C. K. (2004). The risk of fatal car crashes in people with epilepsy. Retrieved from http://www.neurology.org/content/63/6/E12.full

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Anatomy & physiology: The unity of form and function
(6th ed.). New York: McGraw-Hill

Shouri, R. (2014). Alzheimer's disease: Causes of seizures. Retrieved from http://epilepsy.about.com/od/symptomsandcauses/a/alzheimers.htm

Tejani, N. (2015). Febrile seizures. Retrieved from http://emedicine.medscape.com/article/801500-overview#a5
Non-Convulsive
: Absence or Complex Partial
Epilepsy
: two or more unprovoked seizures separated by at least 24 hours
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