NBCOT-CH5-Neurological System Disorders

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Sympathetic (thoracolumbar) division of ANS

Prepares body for fight or flight; raises heart rate and BP, constricts peripheral blood vessels and redistributes blood, inhibits peristalsis

Parasympathetic (craniosacral) division of ANS

Conserves and restores homeostasis; slows heart rate and reduces BP, increases peristalsis and glandular activity

Meninges (3 membranes that envelop the brain)

1) Dura mater: outer, tough fibrous memb. attached to inner surface of cranium; forms falx and tentorium
2) Arachnoid: delicate, vascular memb.
3) Pia mater: thin, vascular memb. that covers the brain surface; forms tela choroidea of ventricles

Ventricles

- Lateral ventricles: large, irreg. shaped; ant. (frontal), post. (occipital) and inf. (temporal) horns; commun. w/ 3rd ventricle through foramen of Monro
- 3rd ventricle: post. and deep b/t two thalami; cerebral aqued. communicates 3rd w/4th ventricle
- 4th ventricle: pyramid-shaped cavity in pons and medulla; foramina of Luschka and Magendie communicate 4th venticle w/subarach. space

Cerebrospinal fluid function

- Cushions brain, ctrls brain excitability by regulating ionic composition, aids in exch. of nutrients and waste products
- Produced in choroid plexus in ventricles

Carotid system

- Internal carotid arteries arise off common carotids and branch to form ant. and mid. cerebral arteries
- Supplies lg. area of brain and many deep struct.

Vertebrobasilar system

- Verteb. arteries arise off subclav. arteries and unite to form basilar artery (divides into two post. cerebral arteries)
- Supplies brain stem, cerebellum, occ. lobe, parts of thalamus

Circle of Willis

Formed by ant. commun. artery connecting the two ant. cereb. arteries and the post. commun. artery connecting each post. and mid. cereb. artery

Nerve fiber types (A, B and C fibers)

- A: large, myelinated, fast-conduction (Alpha= prop., somatic motor; Beta= touch/pressure; Gamma= motor to muscle spindles; Delta= pain, temp., touch)
- B: small, myelinated, conduct less rapidly; preganglionic autonomic
- C: smallest, unmyelinated, slowest conducting (dorsal root= pain, reflex responses; sympathetic= post-ganglionic sympathetics)

Ventral (anterior) root and dorsal (posterior) root

- Ventral: efferent (motor) fibers to volun. muscles (alpha mn, gamma mn), viscera, glands and smooth muscles (preganglionic ANS fibers)
- Dorsal: afferent (sensory) fibers from sensory receptors from skin, joints and muscles; each dorsal root has DRG (cell bodies of sensory neurons); no dorsal root for C1

Dermatome and myotome

- Dermatome: a specific segmental skin area innerv. by sensory spinal axons
- Myotome: the skeletal muscles innerv. by motor axons in a given spinal root

Stretch (myotatic) reflexes

- Stimulus: muscle stretch
- Reflex arc: afferent Ia fiber from muscle spindle to alpha mn projecting back to muscle of origin (monosynaptic)
- Function: maintain muscle tone, support agonist muscle contraction, provide feedback about muscle length

Inverse stretch (myotatic) reflex

- Stimulus: muscle contraction
- Reflex arc: afferent Ib fiber from Golgi tendon organ via inhib. interneuron to muscle of origin (polysynaptic)
- Function: to provide agonist inhib., dec. force of agonist contraction

Gamma reflex loop

- Stretch reflex forms part of loop
- Allows muscle tension to come under ctrl of desc. pathways

Flexor (withdrawal) reflex

- Stimulus: cutaneous sensory stimuli
- Reflex arc: cutaneous receptors via interneurons to flexor muscles; multi-segmental response (polysynaptic)
- Function: protective withdrawal mechanism to remove body part from harmful stimuli

Crossed extension reflex

- Stimulus: noxious stimuli and reciprocal action of antagonists; flexors of one side excite causing extensors on same side to be inhibited, opp. responses in opp. limb
- Reflex arc: cutaneous and muscle receptors diverging to many sc motoneurons on same and opposite side (polysyn.)
- Function: coordinates reciprocal limb activ. such as gait

Middle cerebral artery (MCA) stroke

Results in contralateral hemiplegia, hemianesthesia, homonymous hemianopsia, aphasia and/or apraxia
INTERNAL CAROTID ARTERY STROKE results in similar symptoms.

Anterior cerebral artery (ACA) stroke

Results in contralateral hemiplegia, grasp reflex, incontinence, confusion, apathy and/or mutism (unable/willing to speak)

Posterior cerebral artery (PCA) stroke

Results in homonymous hemianopsia, thalamic pain, hemi-sensory loss and/or alexia (inabil. to understand written lang.)

Left brain hemisphere specialization

Mvmt of rt side, processing of sensory info. from rt side, visual reception from rt field, visual verbal processing, bilateral motor praxis, verbal memory, bilateral aud. reception, speech, processing of verbal aud. info.

Right brain hemisphere specialization

Mvmt of left side, processing of sensory info. from left side, visual recep. from left field, visual spatial processing, left motor praxis, nonverbal memory, attn. to incoming stimuli, emotion, processing of nonverbal aud. info., interp. of abstract info., interp. of tonal inflections

Glascow Coma Scale scoring

- Eye: 4= open spontaneously; 3= open to speech; 2= open to pain; 1= no opening
- Verbal: 5= oriented; 4= confused; 3= inapprop. words/random; 2= incomprehensible sounds; 1= no response
- Motor: 6= obeys commands; 5= localizes to pain; 4= withdraws from pain (pulls away); 3= flex. in response to pain (decorticate); 2= ext. in response to pain (decerebrate); 1= no response

Rancho Level I

No Response: Total Assist
- Complete absence of observable change in behav. when presented with all types of stimuli.

Rancho Level II

Generalized Response: Total Assist
- Generalized reflex response to painful stim.
- Responds to repeated aud. stim.
- Responds to external stim. w/ physio. changes generalized, gross body mvmt, maybe non-purposeful vocalization
- Responses may be delayed and/or always the same

Rancho Level III

Localized Response: Total Assist
- Withdrawal or vocaliz. to painful stim.
- Turns to/away from aud. stim.
- Blinks to strong light/follows moving object crossing visual field
- Responds to discomfort
- Responds inconsistently to simple commands
- Responses directly related to type of stimulus
- May respond to some persons but not to others

Rancho Level IV

Confused/Agitated: Max Assist
- Alert/heightened state of activ.
- Attempts to remove restraints/tubes/crawl OOB
- May try to sit/reach/walk with no purpose
- Absent STM
- Cry out, scream, aggression, mood swings, uncooperative
- Verbalizations incoherent/inapp. to activ./enviro.

Rancho Level V

Confused, Inapprop. Non-Agitated: Max Assist
- Alert, not agitated
- Not oriented x3
- Freq., brief periods of non-purp. sustained attn.
- Severely impaired recent memory
- No goal-directed, prob. solving, self-monitoring behavior
- Inapprop. use of objects w/out external direction
- Unable to learn new info.
- Able to respond to simple commands with external structure/cues
- Able to converse on social, automatic level (brief)

Rancho Level VI

Confused, Approp.: Mod Assist
- Inconsis. oriented x3
- Able to attend to highly familiar task ~30 min. in non-distracting environ. with mod redirection
- Remote mem. has more depth/detail than recent
- Able to use assistive memory aide w/max A
- Mod A to prob. solve barriers to task completion
- Superv. for old learning; max A for new learning
- Unaware of impairments/disabil./safety risks
- Consistently follows simple directions
- Verbal expressions approp. in familiar situations

Rancho Level VII

Automatic, Approp.: Min A for Daily Living Skills
- Consis. oriented (person, place); mod A (time)
- Able to attend to highly familiar task ~30 min. in non-distracting environ. with min A
- Min sup. new learning; demo. carry over
- Carries out steps to complete familiar routine (shallow recall of what he/she has been doing, min A safety)
- Superficial awareness of condition but unaware of specific impair./disabilities
- Unrealistic planning for future (overestim. abil.)
- Oppositional/uncooperative; unable to recog. inapp. social interaction behavior

Rancho Level VIII

Purposeful, Approp.: SBA
- Consistently oriented x3
- Indep. attends to and completes familiar tasks for 1 hr. in distracting environ.
- Initiates and carries out familiar tasks w/ SBA
- Aware of impair. and ackn. when they interfere w/task completion; SBA to take corrective action
- Thinks about conseq. of decision w/min A
- Ackn. others' feelings/needs; responds w/min A
- Depressed, irritable, low frustration tol., argumentative, self-centered
- Able to recog. inapp. social interaction while occurring and correct w/min A

Rancho Level IX

Purposeful, Approp.: SBA on Request
- Indep. shifts back and forth b/t tasks
- Assis. memory devices to recall daily schedule
- Initiates/carries out familiar tasks; A when requested
- SBA to anticipate problem before it occurs and take action to avoid it
- Accurately estimates abilities
- Ackn. others' needs/feelings; responds w/ SBA
- Depression may cont., less irritable, low frustration tol., able to self-monitor approp. of social interaction w/ SBA

Rancho Level X

Purposeful, Approp.: Modified Independent (compensatory strategies/more time)
- Able to handle mult. tasks simultaneously
- Indep. procure/maintain assistive memory device
- Indep. w/fam. and unfam. tasks; may take longer
- Anticipates problems before they occur, takes action to avoid; may take longer
- Indep. think about consequences of decisions.; may take longer
- Automatically respond to others' feelings/needs
- Periodic periods of depression, irritable/frustrated when sick
- Social interaction consistently appropriate

ASIA Impairment Scale

- A: complete, no sensory/motor func. preserved in sacral segments S4-S5
- B: incom., sensory but no motor func. preserved below neuro level and extends through S segments
- C: incom., motor func. preserved below neuro level, majority of key muscle grps below neuro level have muscle grade less than 3/5
- D: same as above but muscle grade >or = 3/5
- E: normal, sensory and motor func. normal

Central cord syndrome

Resulting from hyperext. injuries and presenting as more UE deficits than LE deficits

Brown-Sequard syndrome

Hemi-section of the cord resulting in ipsilateral spastic paralysis and loss of position sense; contralateral loss of pain and thermal sense

Anterior cord syndrome

Caused by flexion injuries; motor func., pain and temp. sensation are lost bilaterally below lesion

Conus medullaris syndrome

Injury of the sacral cord and lumbar nerve roots resulting in LE motor and sensory loss and a reflexic bowel and bladder

Cauda equina syndrome

Injury at the L1 level and below resulting in a LMN lesion; flaccid paralysis w/no spinal reflex activity

Possible characteristics of CP

Primitive reflexes and automatic reactions, hyperresponsive reflexes, clonus, variable tone, asymmetry, invol. mvmts., feeding diff., cog. and other dev. delays

Location of lesion and type of CP

- Motor cortex: spasticity w/flex. and ext. imbalance
- BG: fluctuations in muscle tone causing dyskinesia, dystonia or athetosis; char. by choreoathetosis w/jerky invol. mvmts. more proximal than distal and lack of cocontrations; or writhing mvmts. more distal than proximal
- Cerebellum: ataxic mvmts., char. by lack of stability- coactivation is diff. resulting in more primitive total patterns of mvmt.

Tremor

Rhythmic, alternating, oscillatory mvmts. produced by repetitive patterns of muscle contraction and relaxation.

Dyskinesias

Involuntary, nonrepetitive, but occasionally stereotyped mvmts. affecting distal, proximal and axial musculature in varying combinations. Most dyskinesias representative of BG disorders.

Myoclonus

Brief and rapid contraction of a muscle or group of muscles.

Chorea

Brief, purposeless, invol. mvmts. of distal extremities and face. Usually considered manifestation of dopaminergic overactivity in BG.

Dystonia

Results in sustained abnormal postures and disruptions of ongoing mvmt. resulting from alterations of muscle tone. May be generalized or focal.

Parkinson's disease definition

Hypokinetic CNS mvmt. disorder that is idiopathic, slowly progressive and degenerative.

Parkinson's symptoms

- Begins w/resting, pill-rolling tremor of one hand
- Cardinal signs: tremor, rigidity, resistance to passive motion, akinesia, postural instab., festinating gait, falling backwards or forwards, mask face, micrographia

Hoehn and Yahr's 5 stage scale to diagnose Parkinson's progression

- 1: unilat. tremor, rigidity, akinesia, min./no functional impairment
- 2: bilat. tremor, rigidity or akinesia, w/or w/out axial signs, indep. w/ADL, no balance impair.
- 3: worsening, first signs of impair. righting reflexes, onset of disabil. in ADL perf., can lead indep. life
- 4: requires A with some or all ADL, unable to live alone w/out some A, able to walk/stand indep.
- 5: confined to w/c or bed, max A

Medical management of Parkinson's

- Surgical: thalamotomy, pallidotomy, fetal tissue transplant, deep brain stim.
- Pharmacology: Levodopa (metabolic precursor of dopamine) , Sinemet (Ldopa/Carbidopa), dopamine agonists, anticholinergics (Benadryl, Artane, Cogentin) for rigidity tremors, dopamine releasers (Amantadine)

Spina bifida

Genetic, intrauterine, and/or environ. factors contribute to the neural tube defect involving the vertebral arches and the spinal column.

Spina bifida occulta (occult spinal dysraphism and spina bifida cystica)

A bony malformation w/separation of vertebral arches of one or more vertebrae w/no external manifestations.
- Occult spinal dysraphism (OSD): when external manifestations are present (red birthmark, patch of hair, opening in skin, fatty benign tumor, dimple covering site)
- Spina bifida cystica: exposed pouch

Spina bifida w/meningocele and w/myelogemingocele

- Meningocele: protrusion of a sac through the spine, containing CSF and meninges; however, does not include spinal cord
- Mye: same as above but incl. sc or nerve roots

Spina bifida symptoms

- Occulta: usually none
- OSD: may result in sc being split or tied down and tethered->neuro damage and devel abnormality as child grows
- Menin.: occ. instability and neuromuscular impair. such as mild gait involve. or bowel/bladder prob.
- Mye: sensory and motor deficits occurring below level of lesion, may result in LE paralysis and.or deform., bowel/bladder incont.

Medical management of Spina bifida

- Prevent sac from rupturing during neonatal
- Shunt if hydrocephalus occurs
- Urological manage. and cath is indicated
- Ortho manage. for motor deficits

Arnold-Chiari Syndrome

Portion of the cerebellum and medulla oblongata slip down through the foramen magnum to the cervical spinal cord

Tethered Cord Syndrome

Tail end of sc is stretched from compression, being trapped w/fatty mass or a devel. abnormality
- Surgery required
- Symp.: hairy patch of skin, hemangioma, dimple of lower spine; diff. w/bowel and bladder, gait disturb. and/or feet deformities

Duchenne's muscular dystrophy

- Most common form, detected b/t 2-6 yrs.
- Inherited, sex-linked and recessive; males
- Symp.: enlarged calves, forearm and thigh muscles (due to fibrosis, adipose tissue formation)
- Weakness of prox. joints; crawl up thighs w/hands to stand (Gower's sign)
- Weakness in all vol. muscles (incl. heart/diaphr.)
- Rarely survive beyond 20's (resp. prob., infection and/or cardiovascular prob.)

Arthrogryposis multiplex congenita

- Detected at birth; assoc. w/loss of ant. horn cells
- Weakness, deformities and joint contrac. (UE inter. rot. of shoulders, ext. of elbows, flex. of wrists; LE flex. and inter. rot. of hips and clubfeet)
- Related prob.: congen. heart defects, spinal defects, torticollis, involv. of diaphragm

Limb-girdle muscular dystrophy

- Onset b/t 1st and 3rd decades of life
- Prox. muscles of pelvis and shoulder initially afffected
- Slowly progressive

Fascioscapulohumeral muscular dystrophy

- Early adolescence
- Involves face, upper arms and scapular region; masking and dec. mobility of face and inabil. to lift arms above shoulder level

Spinal muscular atrophy

- Infantile form known as Werdnig-Hoffman disease (life expec. of 2 yrs.)
- Intermediate form is detected 6 mo.-3 yrs. and progresses rapidly w/life expec. of early childhood

Congenital myasthenia gravis

- Disorder involving transmission of impulses in the neuromuscular junction
- Onset starting near birth; occurs more in males

Charcot-Marie-Tooth disease

- Disease involving peripheral nerves marked by progressive weakness, primarily inperoneal (fibular) and distal leg muscles
- Occurs teenage years or earlier

Medical management for muscular dystrophy

- Meds to dec. pulmonary complications
- Nutritional manage. for feeding diff. and tendency to gain weight
- Prevent skin breakdown/ulcers
- Steriods to help delay/reverse muscle weakness (questionable due to undesirable side effects)

Progressive Supranuclear Palsy

- Eti.: manifested by loss of voluntary, but preservation of reflexive eye mvmts., bradykinesia, rigidity, axial dystonia, pseudobulbar palsy and dementia
- Occurs later middle life; death approx. 15 yrs. after onset

Huntington's Chorea

- Eti.: autosomal dominant disorder
- Begins mid age; onset process insidious
- Char. by choreiform mvmts. and progressive intellectual deterioration
- Psych. disturbance may precede onset of mvmt. disorder

Cerebellar/Spinocerebellar Disorders

- Eti.: char. by ataxia, dysmetria, dysdiadochokinesis, hypotonia, mvmt. decomposition tremor, dysarthria and nystagmus

Structural Cerebellar Lesions

- Eti.: includes vascular lesions (stroke) and tumor deposits, producing symp. and signs approp. to their locus w/in the cerebellum
- Demyelinating plaques of MS may also arise in cerebellum white matter and give rise to cerebellar symp.
- Alcoholism/nutritional depriv. can cause degen. of vermis and ant. cerebellum

Spinocerebellar Degenerations

- Eti.: group of degen. d/o, char. by progressive ataxia due to degen. of cerebellum, brain stem, sc, peripheral nerves and the BG
- Grouped as spinal ataxias, cerebellar ataxias and multiple system degeneration

Friedrich's ataxia

- Eti.: autosomal recessive inheritance
- Onset in childhood, early adolescence
- Symp.: gait unstead., UE ataxia, dysarthria, tremor (may be minor), areflexia and loss of large fiber sensory modalities, scoliosis and cardiomyopathy (as disease progresses)

Cerebellar cortical degeneration

- Eti.: pathologic changes seen in cerebellum and inf. olives
- Onset b/t 30 and 50
- Symp.: cerebellar symp. only signs detectable

Multiple systems degeneration

- Eti.: char. by spasticity, extrapyramidal, sensory, LMN and autonomic dys.
- Onset young to middle life

Amyotrophic Lateral Sclerosis (ALS)

- Eti.: motor neuron disease of unknown eti. char. by progressive degen. of corticospinal tracts and ant. horn cells or bulbar efferent neurons
- Symp.: muscle weakness/atrophy, cramps and fasciculations precede weakness, signs usually begin in hands, LMN signs soon accompanied by spasticity, hyperactive DTR, evi. of corticosp. tract involve., dysarthria and dysphagia

Treatment for ALS

- No specific tx to slow disease process
- Aimed at tx of secondary complic. such as spasticity and prevention of aspiration

Brachial Plexus Disorder

- Eti.: secondary to traction during birth, invasion of metastatic cancer, after radiation secondary to fibrosis or traction injury
- Symp.: mixed motor/sensory d/o of corres. limb, rostral injuries produce shoulder dysf. while caudal injuries produce dysf. in hand

Erb's Palsy

Paralysis of the upper plexus incl. 5th and 6th cervical nerves; C7 may be invol. in some cases
- Muscles most often paralyzed: supra / infraspinatus, deltoid, biceps, brachialis, subscap.
- Arm cannot be raised, elbow flex. weak, pro/retraction of scapula weak ("waiter's tip" arm)
- After 6 mo., contrac. may devel. (add., int. rot.)
- Positioning and ROM necessary to retain ext. rot., abd. and flex. at shoulder as well as distal flexibility

Klumpke's Palsy

Paralysis of lower plexus incl. 7th and 8th cervical and 1st thoracic nerves
- Relatively rare compared to Erb's
- Results in paralysis of wrist/hand; hand limp and fingers do not move

Peripheral Neuropathies etiology

- Peripheral neuropathy of single nerve may be result of trauma, pressure paralysis, forcible overext. of joint, hemorrhage into nerve, exposure to cold or radiation, ischemic paralysis
- Mult. nerves may be affected in cases of collagen vascular disease, metabolic diseases (DM) or infectious agents (Lyme disease)
- Other causes: nutri. deficiency, malignancy, microorganisms, exposure to toxic agents, chronic alcohol abuse

Symptoms/medical management of peripheral neuropathies

- Symp.: sensory, motor, reflex and vasomotor; pain, weakness and parasthesias in distribution of affected nerve
- Tx of underlying systemic d/o (DM, tumor, multiple myeloma) may slow progression although recovery is slow

Guillain- Barre Syndrome

- Eti. unknown; may occur after infectious d/o, surgery, immunization
- Symp.: acute, rapidly progress. form of polyneuropathy char. by symmetric muscular weakness and mild distal sensory loss/ parasthesias (stocking-glove distrib.), DTR lost
- Tx: IV IG, plasmapheresis to slow symp.

Myasthenia Gravis

- Eti.: caused by autoimm. attack on acetylcholine receptor of the postsynaptic neuromus. junction
- Symp.: ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia, prox. limb weakness; fluctuate over course of day; life threatening resp. muscle involv. may occur; sensation and DTR intact

Tx of Myasthenia Gravis

- Cholinesterase inhibitors, corticosteroids, immunosuppressive agents and plasmapheresis
- Anticholinergics and plasmaphereis treat current symp.
- Corticoster. and immunosup. may alter disease course by interfering w/autoimm. pathogenesis

Post-Polio Syndrome (PPS)

- Eti.: some motor neurons infected w/polio virus die (leaving paralyzed muscle cells); others survive and devel. new terminal axon sprouts that reinnerv. muscle cells. After yrs. of stability, these motor units break down and cause new mus. weak.
- Symp.: new onset weakness, easily fatigued, muscle pain, jt pain, cold intoler., atrophy, loss of func. skills

Tx of PPS

- Bracing with orthoses and pace daily activ.
- Stretching and exercise programs
- Low doses tricyclic antidepressants to relieve muscle pain
- Pyridostigmine to dec. fatigue/improve strength

Multiple Sclerosis (MS) etiology

- Eti.: unknown; possibly infection by slow or latent virus or contributing environ. factors
- Slowly progress. CNS disease char. by patches of demyelination in brain and spinal cord
- Either exacerbations and remissions, relapse and remission or chronic and progressive

MS symptoms

- Multiple/varied neuro symptoms usually w/remissions and exacerbations, paresthesias in one or more extrem., on trunk or in face; weakness or clumsiness in leg or hand, visual disturb., emotional disturb., vertigo, bladder dys., cog. features (lack of judg., inattention, loss of memory, apathy), sensorimotor findings: spasticity, inc. reflexes, ataxia, weakness, gait instab., easy fatigue, hemi or quadriplegia

MS medical management

- During acute exacerbation, anti-inflamm. drugs
- Antispasmodics to counteract spasticity
- Manage. of bowel/bladder dys. may req. pharmacologic interv. or cath

Slow pain vs. fast pain

- Slow: transmitted over C fibers; functions for diffuse arousal (protective/aversive reactions), affective and motivational aspects of pain
- Fast: transmitted over A delta fibers; functions for localization and discrimination of pain

Gate control theory and descending analgesic systems

- GCT: Transmission of sensation at spinal cord level is controlled by balance between large fibers (A alpha, A beta) and small fibers (A delta, C)
- Descending pathways: endogenous opiates produced t/o CNS can depress pain transmission at various sites through mechanisms of presynaptic inhib.

Thalamic pain

Continuous and intense; occurring on the contralateral hemiplegic side as result of stroke invol. the ventral posterolateral thalamus; poor rehab potential

Complex Regional Pain Syndrome Type I and Type II

I (formerly RSD): pain maintained by efferent activ. of symp. nervous system; char. by abnor. burning pain, hypersens. to light touch and sympathetic hyperfunction (coldness, sweating, etc.); usually assoc. w/traumatic inj.
II (formerly neuralgia): pain occurring along branches of nerve; freq. paroxysmal

Herpes Zoster (shingles)

An acute, painful mono-neuropathy caused by the varicella-zoster virus.
- Char. by vesicular eruption and inflamm. of post. root ganglion of affected spinal nerve or sensory ganglion of cranial nerve
- Infection can last 10 days- 5 weeks; pain may persist for months

Seizure disorder etiology

- Eti.: usually idiopathic; often assoc. w/conditions that involve scarring in brain (severe BI or hemorrhage, CP, hydroceph., metabolic d/o, infections, rubella)

Tonic-clonic seizures/grand mal seizures

- Most common type of seizure d/o in children
- Tonic phase: loss of consciousness, stiffness of body, heavy/irreg. breathing, drooling and skin pallor
- Clonic phase: alternating rigidity and relaxation of muscles
- Postictal state follows clonic phase and includes period of drowsiness, disorien., fatigue

Myoclonic-akinetic seizure

- Brief, invol. jerking of extremities; w/ or w/out loss of consciousness
- Akinetic seizures include loss of tone; myoclonic-akinetic seizures diff. to control

Absence seizures or petit mal seizures

- Typically occur b/t ages 4 and 12
- Loss of consciousness w/out loss of muscle tone
- Child does not fall down; does not recall episode

Simple partial seizures

- Abnormal electrical impulses occur in localized area of brain (often motor strip of frontal lobe)
- Invol., repetitive jerking of L hand and arm occurs, but indiv. can maintain interaction w/envir.

Complex partial or psychomotor seizures

- Symp. vary
- Alterations in consciousness/unresponsiveness
- Automatic motions such as lip smacking, chewing/swallowing, nervous mvmt. hands/fingers
- Vis. or aud. sensations occur just before seizure

Infantile spasms or West syndrome, infantile myoclonic seizures or jackknife epilepsy

- Begins at 3-9 mo. of age
- Dropping of head and flex. of arms
- May occur hundreds of times/day; prog. poor
- Spasms sometimes dec. after several yrs., but usually replaced by other seizure d/o

Lennax-Gastaut syndrome

- Children w/severe seizures, MR and a specific EEG pattern
- Seizures of diff. types begin during first 3 yrs. of life and diff. to control
- Assoc. w/various brain d/o

Simple febrile seizures

- MOST COMMON type of seizure, occuring in 5-10% of children under 5, precipitated by fever
- Lasts about 10 min., loss of consc. and invol., generalized jerking
- Usually do not cause damage, do not lead to epilepsy

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