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Diagnostics > 6b. Epilepsy > Flashcards

6b. Epilepsy Flashcards

1
Q

What is epilepsy?

Causes?

Incidence?

A

Epilepsy = a neurological CNS disorder in which brain activity becomes abnormal, causing seizures of periods of unusual behavior, sensation, and sometimes loss of awareness.

Causes: it has no identifiable cause in half of the people. In the other half:

  • Strokes (=leading cause of epilepsy in >35y)
  • Genetic influence
  • Head trauma
  • Brain tumor
  • Infectious disease
  • Prenatal injury
  • Developmental disorders (autism)

Incidence: highest in the first few years of life (50% <18y)

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2
Q

Seizures are divided in groups depending on… (3x)

A
  1. Where they start in the brain
  2. Whether or not a person’s awareness is affected
  3. Whether seizures involve other symptoms
    - Motor symptoms like chewing movements, loud cry or screams
    - Non-motor symptoms like a rising feel in the stomach, visual disturbances, smelling an unusual smell
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3
Q

What are focal seizures?

And which 2 focal seizures can be distinguished?

A

Seizures in 1 area of the brain.

  1. Simple partial seizure
  2. Complex partial seizure
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4
Q

Focal seizures

Explain a simple partial seizure, and its symptoms (4x).

A

Seizures without loss of consciousness (symptoms may not be seen from the outside)

Symptoms:

  1. May alter emotions
  2. Change the way things look, smell, feel, taste, or sound
  3. Involuntary jerking of a body part
  4. Sensory symptoms, e.g. tingling, dizziness, and flashing lights
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5
Q

Focal seizures

Explain a complex partial seizure, and its symptoms (3x)

A

With impaired awareness

Symptoms:

  1. Change of loss of consciousness or awareness
  2. Stare into space and not response normally to the environment
  3. Perform repetitive movements
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6
Q

What are generalized seizures?

And which 6 generalized seizures can be distinguished?

A

Seizures in more sites of the brain.

  1. Absence seizures (petite small seizures)
  2. Tonic seizures
  3. Atonic seizures (drop seizures)
  4. Clonic seizures
  5. Myoclinic seizures
  6. Tonic-clonic seizures (grand mall seizures)
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7
Q

Generalized seizures

Explain an absence seizure (petite small seizure)

A

Often occur in children.

o Staring into space or subtle body movements (eye blinking or lip smacking)
o May cause brief loss of consciousness

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8
Q

Generalized seizures

Explain a tonic seizure

A

o Stiffening of muscles (in your back, arms, legs)

o May cause fall

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9
Q

Generalized seizures

Explain an atonic seizure (drop seizure)

A

o Loss of muscle control

o May cause sudden collapse or fall

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10
Q

Generalized seizures

Explain a clonic seizure

A

o Repeated, rhythmic jerking muscle movements (neck, face, arms)

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11
Q

Generalized seizures

Explain a myoclonic seizure

A

o Sudden brief jerks or twitches of arms and legs

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12
Q

Generalized seizures

Explain a tonic-clonic seizure (grand mall seizure)

A

Most dramatic type of epilepsy seizures.

o Abrupt loss of consciousness
o Body stiffening and shaking
o Sometimes loss of bladder control or tongue bite

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13
Q

What are 4 epilepsy triggers/seizure precipitants?

And explain

A
  1. Physiological triggers: menstruation, skipping meals, fatigue, lacking sleep
  2. Emotional triggers: stress, fear, anger, anxiety
  3. Social triggers: little support, overworking
  4. Sensory triggers: flashing lights, certain auditory rhythms
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14
Q

What does the term ‘aura’ mean?

A

Some people use this term to describe the warning they feel before they have a tonic-clonic seizure. It is in fact a focal aware seizure.

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15
Q

ILAE-2014 diagnosis Epilepsy.

Which 3 statements?

A
  1. At least 2 unprovoked seizures occuring >24h apart.
  2. There should be 1 unprovoked seizure and a probability of further seizures (at least 60%) after 2 unprovoked seizures occuring over the next 10 years.
  3. Diagnosis of epilepsy syndrome, such as Dravet.
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16
Q

What is Davet-syndrome?

A

An autosomal dominant genetic disorder which causes a catastrophic form of epilepsy with prolonged seizures that are often triggered by hot temperatures or fever.

17
Q

When is epilepsy resolved? (2x)

A
  1. For individuals who had age dependend epilepsy syndrome, and are past that age.
  2. For those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.
18
Q

Assessment of diagnosis of epilepsy.

Why neurological exam?

A

For anamnesis, neurological tests, testing of mental functions

19
Q

Assessment of diagnosis of epilepsy.

Why physical/blood examination?

A

To exclude other possible conditions

20
Q

Assessment of diagnosis of epilepsy.

Why EEG?

A

To see typical 3 per seconds spike-and-wave discharges that typically occur during an absence seizure

21
Q

Assessment of diagnosis of epilepsy.

Why MRI?

A

May help to find the cause of the seizures, such as sclerosis, scar tissue, tumors, or stroke.

22
Q

What is the most common cause of epilepsy? (besides stroke)

A

Mesial temporal sclerosis.

Its refractory to medical therapy, so in these cases surgery offers the greatest changes of cure.

23
Q

Which 2 neuropsychiatric disorders are common in epilepsy? Explain.

A
  1. Anxiety: unpredictability and severity of seizures and the loss of control play a major role here. Most commonly in refractory epilepsy.
  2. More common in focal epilepsy, when limbic structures are involved.
24
Q

Which 3 effects does epilepsy has on daily life?

A
  1. Physical risks: including injuries due to falls (contusions, wounds, fractures)
  2. Treatment side-effects: dizziness, fatigue, concentration, depression, liver failure.
  3. Stigma: leading to social exclusion and isolation, difficulties obtaining employment.
25
Q

What are the 3 most frequently reported cognitive problems in epilepsy?

A
  1. Memory impairment
  2. Mental slowing
  3. Attentional deficits
26
Q

Which 3 factors influence the cognitive impact of epilepsy?

A
  1. Seizures: repeated seziures are associated with increased intellectual impairment. Less severe disorders are seen when the cause is unknown (idopathic epilepsy).
  2. Age of onset: the younger the child at seizure onset, the higher effect on IQ.
  3. Treatment-related factors: type of anti-epileptics/dosis.
27
Q

What are psychogenic non-epileptic attacks? (differential diagnosis of epilepsy)

A

These attacks have no neurological, but psychogenic origin

28
Q

Which 3 factors influence a neuropsychological test profile in epilepsy?

A
  1. Fixed factors: such as the underlying brain damage, age of onset, premorbid intellectual capacity.
  2. Factors related to the course of the disease: did the person have a status epilepticus (=meaning that they had multiple seizures in a row without gaining consciousness > this will have a bad effect on cognition), have they had a head injury due to a fall?
  3. Remediable factors: like medication, whether the seizures are under control, mood, quality of sleep.
29
Q

Which 3 indirect treatments for the cognitive problems in MS can be distinguished?

A
  1. Epilepsy surgery: to reduce seizures.
  2. Anti-epileptics: with limited cognitive side-effects.
  3. Treatment of comorbid conditions: like depression.
30
Q

Which 4 direct treatments for the cognitive problems in MS can be distinguished?

A
  1. Vagal nerve stimulation: some evidence for improved memory function
  2. Cholinergic replacement: some evidence for improvement in certain aspects of memory in memory-impaired individuals with partial (focal) epilepsy
  3. Stimulants: like Methylphenidate (improvement in concentration and memory), or Modafinil
  4. Memory rehabilitation strategies: psychoeducation or strategy training

Diagnostics (21 decks)

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