6b. Epilepsy Flashcards
What is epilepsy?
Causes?
Incidence?
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)
Seizures are divided in groups depending on… (3x)
- Where they start in the brain
- Whether or not a person’s awareness is affected
- 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
What are focal seizures?
And which 2 focal seizures can be distinguished?
Seizures in 1 area of the brain.
- Simple partial seizure
- Complex partial seizure
Focal seizures
Explain a simple partial seizure, and its symptoms (4x).
Seizures without loss of consciousness (symptoms may not be seen from the outside)
Symptoms:
- May alter emotions
- Change the way things look, smell, feel, taste, or sound
- Involuntary jerking of a body part
- Sensory symptoms, e.g. tingling, dizziness, and flashing lights
Focal seizures
Explain a complex partial seizure, and its symptoms (3x)
With impaired awareness
Symptoms:
- Change of loss of consciousness or awareness
- Stare into space and not response normally to the environment
- Perform repetitive movements
What are generalized seizures?
And which 6 generalized seizures can be distinguished?
Seizures in more sites of the brain.
- Absence seizures (petite small seizures)
- Tonic seizures
- Atonic seizures (drop seizures)
- Clonic seizures
- Myoclinic seizures
- Tonic-clonic seizures (grand mall seizures)
Generalized seizures
Explain an absence seizure (petite small seizure)
Often occur in children.
o Staring into space or subtle body movements (eye blinking or lip smacking)
o May cause brief loss of consciousness
Generalized seizures
Explain a tonic seizure
o Stiffening of muscles (in your back, arms, legs)
o May cause fall
Generalized seizures
Explain an atonic seizure (drop seizure)
o Loss of muscle control
o May cause sudden collapse or fall
Generalized seizures
Explain a clonic seizure
o Repeated, rhythmic jerking muscle movements (neck, face, arms)
Generalized seizures
Explain a myoclonic seizure
o Sudden brief jerks or twitches of arms and legs
Generalized seizures
Explain a tonic-clonic seizure (grand mall seizure)
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
What are 4 epilepsy triggers/seizure precipitants?
And explain
- Physiological triggers: menstruation, skipping meals, fatigue, lacking sleep
- Emotional triggers: stress, fear, anger, anxiety
- Social triggers: little support, overworking
- Sensory triggers: flashing lights, certain auditory rhythms
What does the term ‘aura’ mean?
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.
ILAE-2014 diagnosis Epilepsy.
Which 3 statements?
- At least 2 unprovoked seizures occuring >24h apart.
- 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.
- Diagnosis of epilepsy syndrome, such as Dravet.
What is Davet-syndrome?
An autosomal dominant genetic disorder which causes a catastrophic form of epilepsy with prolonged seizures that are often triggered by hot temperatures or fever.
When is epilepsy resolved? (2x)
- For individuals who had age dependend epilepsy syndrome, and are past that age.
- For those who have remained seizure-free for the last 10 years, with no seizure medicines for the last 5 years.
Assessment of diagnosis of epilepsy.
Why neurological exam?
For anamnesis, neurological tests, testing of mental functions
Assessment of diagnosis of epilepsy.
Why physical/blood examination?
To exclude other possible conditions
Assessment of diagnosis of epilepsy.
Why EEG?
To see typical 3 per seconds spike-and-wave discharges that typically occur during an absence seizure
Assessment of diagnosis of epilepsy.
Why MRI?
May help to find the cause of the seizures, such as sclerosis, scar tissue, tumors, or stroke.
What is the most common cause of epilepsy? (besides stroke)
Mesial temporal sclerosis.
Its refractory to medical therapy, so in these cases surgery offers the greatest changes of cure.
Which 2 neuropsychiatric disorders are common in epilepsy? Explain.
- Anxiety: unpredictability and severity of seizures and the loss of control play a major role here. Most commonly in refractory epilepsy.
- More common in focal epilepsy, when limbic structures are involved.
Which 3 effects does epilepsy has on daily life?
- Physical risks: including injuries due to falls (contusions, wounds, fractures)
- Treatment side-effects: dizziness, fatigue, concentration, depression, liver failure.
- Stigma: leading to social exclusion and isolation, difficulties obtaining employment.
What are the 3 most frequently reported cognitive problems in epilepsy?
- Memory impairment
- Mental slowing
- Attentional deficits
Which 3 factors influence the cognitive impact of epilepsy?
- Seizures: repeated seziures are associated with increased intellectual impairment. Less severe disorders are seen when the cause is unknown (idopathic epilepsy).
- Age of onset: the younger the child at seizure onset, the higher effect on IQ.
- Treatment-related factors: type of anti-epileptics/dosis.
What are psychogenic non-epileptic attacks? (differential diagnosis of epilepsy)
These attacks have no neurological, but psychogenic origin
Which 3 factors influence a neuropsychological test profile in epilepsy?
- Fixed factors: such as the underlying brain damage, age of onset, premorbid intellectual capacity.
- 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?
- Remediable factors: like medication, whether the seizures are under control, mood, quality of sleep.
Which 3 indirect treatments for the cognitive problems in MS can be distinguished?
- Epilepsy surgery: to reduce seizures.
- Anti-epileptics: with limited cognitive side-effects.
- Treatment of comorbid conditions: like depression.
Which 4 direct treatments for the cognitive problems in MS can be distinguished?
- Vagal nerve stimulation: some evidence for improved memory function
- Cholinergic replacement: some evidence for improvement in certain aspects of memory in memory-impaired individuals with partial (focal) epilepsy
- Stimulants: like Methylphenidate (improvement in concentration and memory), or Modafinil
- Memory rehabilitation strategies: psychoeducation or strategy training
