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1、It makes me want to SHAKE!Assessing&Treating the Seizure PatientJason N.CookCaptain/ParamedicLayton City Fire DepartmentCase#1Midvale/Sandy CallCase#29 yr.old febrile seizureIncidenceSeizure disorders are a common neurological problem.In the United States alone,it has been estimated that more than 4
2、 million people have some form of epilepsy.The risk of epilepsy from birth through age 20 is approximately 1 percent.Within this group,the risk is highest during the first year of life and increases somewhat at the onset of puberty.From age 20 to 55 it decreases again,but increases after age 55.The
3、prevalence of epilepsy(defined as the total of the population suffering from a disorder at a particular time)has been estimated to be about 5 to 8 in every 1,000 people.SeizuresSeizures(or convulsions)are temporary abnormal electrophysiologic phenomena of the brain,resulting in abnormal synchronizat
4、ion of electrical neuronal activity.They can manifest as an alteration in mental state,tonic or clonic movements and various other symptoms.The medical syndrome of recurrent,unprovoked seizures is termed epilepsy.SeizuresCauses of provoked seizures include head trauma,intoxication,infection,metaboli
5、c disturbances,withdrawal symptoms(from sedatives such as alcohol,barbiturates and benzodiazepines)and space-occupying processes in the brain(abscesses,tumors).Seizures during(or shortly after)pregnancy can be a sign of eclampsia.SeizuresSeizure is often associated with a sudden and involuntary cont
6、raction of a group of muscles.Seizures can cause involuntary changes in body movement or function,sensation,awareness,or behavior.SeizuresA seizure can also be as subtle as marching numbness of a part of body,a brief loss of memory,sparkling of flashes,sensing an unpleasant odor,a strange epigastric
7、 sensation or a sensation of fear.A seizure can last from a few seconds to status epilepticus,a continuous seizure that will not stop without intervention.SeizuresSometimes seizures may go unnoticed,depending on their presentation,and sometimes seizures may be confused with other events,such as a st
8、roke,which can also cause falls or migraines.SeizuresPersons who have lived with epilepsy for much of their lives may find that their seizures change as they age.The duration of the seizures may become longer or shorter;the intensity of the seizures may worsen or improve;seizure episodes may occur m
9、ore or less frequentlyImportant Facts to RememberAlthough seizures look different,they have certain things in common:During a seizure,a person may stop breathing,generally only for only a few seconds.Although some can last as long as 3-5 minutes,most seizures only last 1-2 minutes.The brain almost a
10、lways stops the seizures safely and naturally.Important Facts to RememberUnless a seizure persists an excessive duration,once a seizure has begun,you cannot stop it-just let it run its course.People dont feel pain during a seizure,although muscles might be sore afterwards.Seizures are usually not li
11、fe threatening,but the risk is increased in seniors by the extra strain on the heart,the possibility of injury,or a reduced intake of oxygen.Diagnosing Seizures&EpilepsyThe doctor usually orders a variety of tests to help make the diagnosis.These include:A brain wave test,also called an EEG(electroe
12、ncephalogram),to look for changes in the brains electrical patterns that are related to seizures Blood tests,to look for certain medical disorders Either a special x-ray of the brain,a CT scan(sometimes called a CAT scan),or an MRI scan(magnetic resonance imaging),to look for abnormal areas such as
13、a tumor or infection.Diagnosing Seizures&Epilepsy Depending on the urgency of the situation,other tests also might be recommended,such as a lumbar puncture(also called a spinal tap),EKG(electrocardiogram,to check the heart),or a sleep test.The results of these tests often appear completely normal in
14、 people with epilepsy.Normal test results do not mean that the seizures are not real Normal test results do not mean that the seizures are not real or that epilepsy is not present.or that epilepsy is not present.Types of SeizuresWhile there are over 40 types of seizure,most are classed within 2 main
15、 categories:Generalized seizures occur when the excessive electrical activity in the brain encompasses the entire organ.The 2 most common forms are generalized absence seizures and tonic-clonic seizures.Types of SeizuresWhile there are over 40 types of seizure,most are classed within 2 main categori
16、es:Partial seizures occur when the excessive electrical activity in the brain is limited to one area.The 2 most common forms are simple partial seizures and complex partial seizures.Generalized SeizuresPrimary Generalized Seizures Absence seizures Myoclonic seizures Atonic seizures Tonic seizures Cl
17、onic seizures Tonic-clonic seizuresAbsence SeizuresAbsence Seizures(aka petit-mal)typically have a sudden onset,present with motor arrest,sometimes eye blinking,and last a few seconds.In an absence seizure,epileptic activity occurs throughout the entire brain.It is a milder type of activity which ca
18、uses unconsciousness without causing convulsions.After the seizure,there is no memory of it.Usually there is no aura,or warning.An absence seizure begins abruptly and without warning,consists of a period of unconsciousness with a blank stare,and ends abruptly.There is no confusion after the seizure,
19、and the person can usually resume full activity immediately.An absence seizure may be accompanied by chewing movements,rapid breathing,or rhythmic blinking.Absence SeizuresAbsence seizures are short,usually lasting only 2-10 seconds.They are very mild,and may go unnoticed by parents and teachers.Bec
20、ause absence seizures may recur frequently during the day,a child who experiences them may have difficulty learning if they are not recognized and treated Simple absence seizures are just stares.Many absence seizures are considered complex absence seizures,which means that they include a change in m
21、uscle activity.The most common movements are eye blinks.Other movements include slight tasting movements of the mouth,hand movements such as rubbing the fingers together,and contraction or relaxation of the muscles.Myoclonic SeizuresThey involve abrupt muscle jerks in part or all the body.A hand may
22、 suddenly fling out,a shoulder may shrug,a foot may kick,or the entire body may jerk.Myoclonic seizures usually cause abnormal movements on both sides of the body at the same time Consciousness and memory are not impaired.A myoclonic seizure may cause a patient to spill or drop what s/he is holding
23、or to fall from his/her chair.Even people without epilepsy can experience myoclonus in hiccups or in a sudden jerk that may wake you up as youre just falling asleep.Atonic SeizuresMuscle tone is the muscles normal tension.Atonic(a-TON-ik)means without tone,so in an atonic seizure,muscles suddenly lo
24、se strength.The eyelids may droop,the head may nod,and the person may drop things and often falls to the ground.These seizures are also called drop attacks or drop seizures.The person may or may not remain conscious.Although there is no convulsion,without warning the patient will collapse and fall t
25、o the floor and may bang their heads as they fall.Recovery occurs after a few seconds.After regaining consciousness,the patient can again stand and walk.Tonic SeizuresIn a tonic seizure,the tone is greatly increased and the body,arms,or legs make sudden stiffening movements.Consciousness is usually
26、preserved.The more prolonged seizures usually are convulsive and may manifest pupillary dilation,tachycardia,apnea,cyanosis,salivation,and the loss of bladder or bowel control.Tonic seizures are often followed by postictal confusion.Tonic seizures most often occur during sleep and usually involve al
27、l or most of the brain,affecting both sides of the body.If the person is standing when the seizure starts,he or she often will fall.Tonic seizures are very uncommon,especially when they occur without clonic jerking.They usually are manifest with Lennox-Gastaut syndrome or,less commonly,with multiple
28、 sclerosis.Tonic seizures most often develop in childhood,although they can occur at any age.Tonic SeizuresTonic seizures are very uncommon,especially when they occur without clonic jerking.They usually are manifest with Lennox-Gastaut syndrome or,less commonly,with multiple sclerosis.Tonic seizures
29、 most often develop in childhood,although they can occur at any age.Clonic SeizuresClonus(KLOH-nus)means rapidly alternating contraction and relaxation of a muscle-in other words,repeated jerking.The movements cannot be stopped by restraining or repositioning the arms or legs.Consciousness may be te
30、mporarily lost and followed by confusion.Clonic(KLON-ik)seizures are rare,however.Much more common are tonic-clonic seizures,in which the jerking is preceded by stiffening(the tonic part).Sometimes tonic-clonic seizures start with jerking alone.These are called clonic-tonic-clonic seizures!Tonic-Clo
31、nic SeizuresThis type is what most people think of when they hear the word seizure.“An older term for them is grand mal.As implied by the name,they combine the characteristics of tonic seizures and clonic seizures.The tonic phase comes first:All the muscles stiffen.Air being forced past the vocal co
32、rds causes a cry or groan.The person loses consciousness and falls to the floor.The tongue or cheek may be bitten,so bloody saliva may come from the mouth.The person may turn a bit blue in the face.After the tonic phase comes the clonic phase:The arms and usually the legs begin to jerk rapidly and r
33、hythmically,bending and relaxing at the elbows,hips,and knees.After a few minutes,the jerking slows and stops.Bladder or bowel control sometimes is lost as the body relaxes.Consciousness returns slowly,and the person may be drowsy,confused,agitated,or depressed.Tonic-Clonic SeizuresDrooling,biting o
34、f the tongue,and incontinence of urine may occur.After a seizure,the person may feel fatigue,confusion and disorientation.This may last from 5 minutes to several hours or even days.Rarely,this disorientation may last up to 2 weeks.The person may fall asleep,or gradually become less confused until fu
35、ll consciousness is regained.The patients may experience prolonged weakness after the event;this is termed Todds paralysis.Partial SeizuresPartial Seizures Simple partial seizures Complex partial seizures Simple partial seizures result from epileptic activity which is localized in one part of the br
36、ain,usually the cortex or limbic system.Consciousness is not impaired:people experiencing a simple partial seizure can talk and answer questions.They will remember what went on during the seizure.Simple partial seizures usually last just a few seconds,although they may be longer.If there are no conv
37、ulsions,they may not be obvious to the onlooker.In some children,simple partial seizures lead to complex partial seizures,or to tonic-clonic convulsions.Simple Partial Seizures(Jacksonian Seizures,Focal Cortical Seizures)Simple Partial SeizuresSimple partial seizures take different forms in differen
38、t people.They are further classified according to their symptoms:Autonomic Seizures-These seizures are accompanied by autonomic symptoms or signs,such as abdominal discomfort or nausea which may rise into the throat(epigastric rising),stomach pain,the rumbling sounds of gas moving in the intestines(
39、borborygmi),belching,flatulence and vomiting.This has sometimes been referred to as abdominal epilepsy.Other symptoms may include pallor,flushing,sweating,hair standing on end(piloerection),dilation of the pupils,alterations in heart rate and respiration,and urination.A few people may experience sex
40、ual arousal,penile erection,and orgasm.Simple Partial SeizuresEmotional and Other-Simple partial seizures which arise in or near the temporal lobes often take the form of an odd experience.One may see or hear things that are not there.One feels emotions,often fear,but sometimes sadness,anger,or joy.
41、There may be a bad smell or a bad taste,a funny feeling in the pit of the stomach or a choking sensation.These seizures are sometimes called simple partial seizures of temporal lobe origin or temporal lobe auras.Simple Partial SeizuresMotor-Other simple partial seizures include(clonic,jerking)convul
42、sive movements.Jerking typically begins in one area of the body-the face,arm,leg,or trunk-and may spread to other parts of the body.These seizures are sometimes called Jacksonian motor seizures;their spread is called a Jacksonian march.It cannot be stopped.Sensory Seizures-Some simple partial seizur
43、es consist of a sensory experience.The person may see lights,hear a buzzing sound,or feel tingling or numbness in a part of the body.These seizures are sometimes called Jacksonian sensory seizures.Simple Partial SeizuresWhen motor symptoms spread slowly from one part of the body to another,this epil
44、eptic march has been termed jacksonian epilepsy(first described by Hughlings Jackson).Complex Partial Seizures(Psychomotor/Temporal Lobe Seizures)A complex partial seizure occurs when epileptic activity spreads to both temporal lobes in the brain.A complex partial seizure often occurs after a simple
45、 partial seizure of temporal lobe origin.A complex partial seizure does not involve convulsions,but consciousness is impaired.Someone experiencing one will no longer respond to questions after the seizure starts.A complex partial seizure often begins with a blank look or empty stare.They will appear
46、 unaware of their surroundings and may seem dazed.The seizure may progress to include chewing movements,uncoordinated activity,or sometimes performing meaningless bits of behaviour which appear random and clumsy.These automatisms may include actions such as picking at their clothes,trying to remove
47、them,walking about aimlessly,picking up things,or mumbling.Often accompanying these symptoms are the presence of unusual thoughts,such as the feeling of deja vu(having been someplace before),uncontrollable laughing,fear,visual hallucinations,and experiencing unusual unpleasant odors.These interestin
48、g symptoms are thought to be caused by abnormal discharges in the temporal lobe.Someone experiencing a complex partial seizure may become frightened and try to run and struggle.Following the seizure,there will be no memory of it.A complex partial seizure usually lasts about 2 to 4 minutes.It may be
49、followed by a state of confusion lasting longer.Complex partial seizures sometimes resist anticonvulsant medication.Complex Partial Seizures(Psychomotor/Temporal Lobe Seizures)Complex Partial SeizureSome people can have seizures of this kind without realizing that anything has happened.Because the s
50、eizure can wipe out memories of events just before or after it,however,memory lapses can be a problem.Complex partial seizures starting in the frontal lobe tend to be shorter than the ones from the temporal lobe.The seizures that start in the frontal lobe are also more likely to include automatisms