030515 epilepsy

Question 1

pathophysiology of seizure

Answer 1

trigger:

• genetic predisposition
• trauma, ischemia, stroke, malformation of cortical development
• febrile illness, sleep deprivation

Excitation/inhibition:

• GABA, K and Cl, basal ganglia
• NMDA, AMPA, alteration of voltage gated channels

synchronization:

• recurrent excitatory connections, coupling of gap jxns
• networks-electrical field effects

Question 2

seizure types

Answer 2

partial vs generalized

partial: simple, complex
generalized: absence, tonic, atonic, GTC, myoclonic

Question 3

diagnosis of epilepsy is based primarily on

Answer 3

history

EEG, MRI, labs support

Question 4

definition of epilepsy

Answer 4

tendency to have recurrent, UNPROVOKED seizures

Question 5

simple partial seizures

Answer 5

• consciousness NOT impaired
• signs and symptoms depend on localization (clonic movement of face/arm/leg, somatosensory, autonomic, psychic symptoms of deja vu/hallucinations/illusions)
• brief
• no post ictal symptoms

Question 6

complex partial seizures

Answer 6

• consciousness impaired
• “temporal lobe” or “psychomotor seizures”
• staring, automatisms (facial grimacing, gestures, chewing, lip smacking, finger snapping, reptitive speech. continuation of activity)
• w/o recall
• 30 sec to a minute
• postictal impairment (lethargy, confusion)
• symptoms depend on where the seizure is

Question 7

temporal lobe origin complex partial seizure

Answer 7

preceded by aura
often w autonomic symptoms
post ictal phase

Question 8

frontal lobe origin complex partial seizures

Answer 8

motor manifestations
blank stare
brief on and off attacks

Question 9

types of generalized seizures

Answer 9

tonic-clonic
absence
clonic
tonic
atonic
myoclonic

Question 10

tonic-clonic seizure

Answer 10

loss of consciousness w stiffening of limbs (tonic phase)

evolution to generalizaed jerking of muscles (clonic phase)

deep sleep post ictal

Question 11

absence seizures

Answer 11

abrupt cessation of activity and
change in facial expression (blank stare)

less than 30 seconds
no aura
behavioral change-motor, behavioral, autonomic

clonic eye movements (nystagmus, eye blinking)
head nodding or dropping of object

Question 12

clonic seizures

Answer 12

focal, multifocal, rarely generalized

Question 13

tonic seizures

Answer 13

brief
sudden onset of increased extensor tone
impaired consciousness

Question 14

atonic seizures

Answer 14

“drop attack”
sudden loss of tone
usually only brief loss of consciousness
rare seizures

Question 15

myoclonic seizures

Answer 15

shock-like

generalized or confined to face, trunk

Question 16

status epilepticus

Answer 16

30 minutes of sustained seizure activity or

two or more seizures w/o full recovery of consciouness btwn seizures