Seizures Overview

Pathophysiology

• Sudden, excessive, and uncontrolled discharge of neurons in the brain.

Causes

• Idiopathic factors, PTSD, hypoglycemia, drug withdrawal, febrile conditions, tumors, electrolyte imbalances, alkalosis.
• Family history and triggers such as bright lights, loud noises, and stress.

Types

• Generalized: Originates in deep brain structures, causes loss of consciousness.
• Partial: Originates often in the cerebral cortex, may affect consciousness.

Specific Seizure Types

• Myoclonic: Muscle jerking movements for 1-2 seconds.
• Tonic-Clonic (Grand-mal): Muscle contraction and flexion followed by limb extension; includes prodromal, aura, and postictal phases.
• Atonic: Sudden limb stiffness causing falls.
• Absence (Petit mal): Brief loss of awareness.
• Simple Partial: Repeated motor activity; consciousness maintained.
• Complex Partial: Bizarre behavior, potential hallucinations, unresponsiveness.

Management

• Monitor “ABCs” (airway, breathing, circulation) during seizures to prevent hypoxia.
• Diagnostics: EEG, MRI to detect structural abnormalities.

Treatment

• Seizure precautions, quiet and dim environment, monitor vital signs.
• During seizures, roll patient on side, avoid putting anything in their mouth, time the seizure.
• Medications: Benzodiazepines, Anticonvulsants (Phenytoin, Phenobarbital, Levetiracetam, etc.).

Education

• Educate on seizure triggers, medication compliance, keeping a seizure journal.

Epilepsy

Overview

• Chronic disorder with recurrent seizures; involves CNS dysfunction.
• Therapy aims to control seizures and maintain quality of life.

Medications

• Antiepileptic Drugs (AEDs) like Phenytoin, Phenobarbital, Carbamazepine, etc.
• Start with one medication before adding more.
• Regular monitoring of serum drug levels.

Phenytoin

• MOA: Selective inhibition of sodium channels.
• Uses: Partial and tonic-clonic seizures.
• Adverse Effects: Sedation, nystagmus, gingival hyperplasia.
• Monitor oral health closely.

Valproic Acid

• Uses: Epilepsy, bipolar disorder, migraines.
• Adverse Effects: Dizziness, weight gain, hepatotoxicity.

Parkinson’s Disease

Overview

• Chronic, progressive neurodegenerative disorder.
• Imbalance of dopamine and acetylcholine.

Symptoms

• Bradykinesia, postural instability, rigidity, tremors, shuffled gait.

Treatment

• Therapy: Physical, occupational, speech therapy.
• Medications: Carbidopa-Levodopa, Amantadine, Pramipexole, Entacapone, Selegiline.

Medication Details

Carbidopa-Levodopa

• MOA: Inhibits levodopa decarboxylation to increase CNS availability.
• Uses: Essential for Parkinson's management.
• Adverse Effects: Cardiac arrhythmias, muscle cramps.

Amantadine

• MOA: Releases dopamine, blocks reuptake.
• Uses: Influenza, mild Parkinson’s symptoms.

Entacapone

• MOA: Blocks catecholamine breakdown.
• Uses: Reduces levodopa wear-off effects.

Education

• Educate on symptoms, treatment adherence, and lifestyle modifications.