21. Epilepsy

Question 1

What is epilepsy?

Answer 1

An abnor. hypersynchronous electrical discgharge of neurons.

Question 2

Diagnosis

Answer 2

Often diagnosed after having to episodes. EEG

Question 3

Classifications

Answer 3

Partial
- Simple
- Complex
Generalized
- Tonic-clonic
- Absence
- Atonic
- Tonic
- Myoclonic

Question 4

Causes

Answer 4

Head trauma, stroke, brain tumors, hypoxia, hypoglycemia, fever, chronic alcohol withdrawal

Question 5

Partial (focal) seizures

Answer 5

Arise in one cerebra hemisphere

• Simple partial seizure: No alteration of consciousness
• Complex partial seizure: Altered consciousness, automatisms (repetitive behaviours), behavioral changes
• Secondarily generalized seizure: Focal seizure becomes generalized & is accompanied by loss of consciousness

Question 6

Generalized seizure

Answer 6

Arise in both cerebral hemispheres & are accompanied by loss of consciousness
- Tonic-clonic (grand mal) seizure: ↑mus. tone –> spasms & relaxation. Drowsiness, confusion and glazed eyes
o Status epilepticus: Recurrent episodes of tonic-clonic seizures w/o regaining consciousness or normal mus. move. between episodes

• Tonic seizure: ↑mus. tone
• Clonic seizure: Spasms of contraction & relaxation
• Myoclonic seizure: Rhythmic, jerking spasms
• Atonic seizure: Sudden loss of all muscle tone
• Absence (petit mal) seizure: Brief loss of consciousness, w/minor mus. twitches & eye blinking
  o May incl. a mild clonic component, automatisms and autonomic effects

Question 7

Jacksonian epilepsy/march

Answer 7

First involves e.g. fingers, then hand, then arm

Question 8

Lennox-Gastaut syndrome

Answer 8

Multiple different types of seizures, particularly tonic & atonic seizures. Intellectual devel. is usually impaired

Question 9

Treatment

Answer 9

Antiepileptics; Carbamazepine, Phenytoin
Lennox: Valproate
Absence: Ethosuximide

Vagus nerve stim., surgery

Question 10

Diagnosis

Answer 10

Lab. test: Metabolic abnor. (hyponatremia or hypocalcemia, lactic acidosis, decreased bicarbonate)
Lumbar puncture
CT/MRI
EEG