92. Epilepsy Flashcards
Definition of Epilepsy and difference between a focal and generalized seizure
Epilepsy: recurrent (>2) unprovoked seizures
Focal: seizure starts on one side/region
General: seizure starts on both sides and produces LOC
List the three types of focal seizures and 5 types of general seizures
- w/o impairment of consciousness/awareness
- w/ impairment of consciousness/awareness
- Evolving into bilateral convulsive seizure
I. Absence II. Tonic III. Atonic IV. Tonic-Clonic V. Myoclonic
Focal Seizures w/ and w/o impairment of consciousness/awareness
- signs of each
- origin
- duration
w/o impairment:
person remains alert, can answer questions, remembers what happened, may have post-ictal focal weakness
w/ impairment:
- LOC cannot follow commands, no memory
- originate in TEMPORAL LOBE
- w/ aura, automatisms (lip smacking, fumbling, repeating phrases), motor activity
- duration <2min
- post-ictal confusion <15min
Focal seizures evolving into bilateral, convulsive seizure
- signs
- duration
- differences from primary generalized seizure
Signs:
- motor activity on both sides of body, begins focally +/- neuro sx
- variable symmetry, intensity, duration of tonic (stiffening) or clonic (jerking) phases
- postictal confusion +/- transient focal deficits
Duration: 1-3 min
Differences:
- +aura or prior focal seizure
- EEG shows unilateral origin
- neuro exam: greater weakness on side seizure started
- CT/MRI: focal lesion (tumor/stroke)
Absence Seizures
- signs, duration
- trigger
- EEG signs
- brief staring spells w/impairment of consciousness/awareness
- no warning, 3-20s long (sudden onset, resolution)
trigger: hyperventilation
EEG: Generalized 3Hz spike-wave discharges!!
Tonic Seizures
- signs
- duration
- EEG
- symmetric muscle contraction of extremities w/tonic flexion of waist and neck
- 2-20s long
- EEG: sudden attenuation w/ generalized low V fast activity OR generalized poly spike-wave
Atonic Seizures
- signs
- duration
- EEG
- sudden loss of postural tone = falls or head/jaw drops
- duration: seconds (<1 min)
- EEG: sudden diffuse attenuation or generalized poly-spike wave
Tonic-Clonic Discharges
- signs
- duration
- EEG
- LOC, post-ictal confusion/lethargy (min-hrs)
- tonic: stiffening, fall, ictal cry
- clonic: rhythmic extremity jerking
- drooling/foaming at mouth, lip/tongue biting, incontinence
- duration: 30-120s
- EEG: generalized polyspikes then diffuse slowing
Myoclonic Seizures
- signs
- EEG
- brief shock-like jerks of muscles/groups of muscles (NOT RHYTHMIC
- bilateral, synchronous jerks of neck, shoulders, upper arms, body, upper legs
- does NOT impair consciousness
- EEG: generalized 4-6Hz polyspike-wave
Childhood Absence Epilepsy (CAE)
- age
- sx
- EEG
- tx/prognosis
- age 4-8
- dozens of Absence seizures per day, provoked by hyperventilation
- may also have generalized tonic-clonic seizures, but normal intellectual fx
- EEG: generalized 3Hz spike and wave
- tx: respond easily to meds, resolve by puberty
Juvenile Myoclonic Epilepsy
- age
- signs
- EEG
- tx/prognosis
- around puberty (age 12-18)
- seizures during awakening in AM (bad days: clusters of myoclonic seizures culminating in generalized tonic-clonic)
- can have Absence seizures
- EEG: 4-4.5 Hz generalized spike and wave
- all respond easily to tx but usually lifelong
Mesial Temporal Lobe Epilepsy
- onset
- cause
- signs
- origin of seizures
- begins in childhood/adolescence
- hx of predisposing hit (head trauma, CNS infection)
- few focal seizures evolving to bilateral convulsive seizures (becomes typical focal seizures +/- awareness over time)
- origin: hippocampus/amygdala
Temporal Lobe Epilepsy
- signs for location
- EEG
- tx/prognosis
AURA
- insula: epigastric/nausea, autonomic sx
- temporal neocortex: deja vu
- uncus: foul smell
- amygdala: intense emotion/fear
- association areas: perception disorders
Auras occur alone or progress to focal seizures w/impaired consciousness and automatisms (RARE To evolve to bilateral)
EEG: focal temporal spikes
tx: cannot be medically controlled, need surgical tx (anteromesial temporal lobectomy)
