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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)