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Neurology > Adult Seizure Disorder > Flashcards

Adult Seizure Disorder Flashcards

1
Q

Seizure

A

Episode of abnormally synchronized and high frequency firing of neurons resulting in abnormal behavior or experience.

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2
Q

Epilepsy

A

Chronic brain disorder of various etiologies characterized by RECURRENT, UNPROVOKED seizures

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3
Q

WHat are some conditions that may provoke seizures

A

fever, acute head trauma, metabolic disorders such as hypo or hyperglycemia, electrolyte disturbances such as hyponatremia

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4
Q

Increase in rate of epileptic seizures in pts over 60. WHy?

A

High rate of strokes in that age group and strokes predispose to epileptic seizures

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5
Q

Epilepsy incidence peaks?

A

Children and the elderly

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6
Q

causes of adult onset epileptic seizures

A
  • cerebrovascular disease
  • Trauma
  • Tumors
  • Infection
  • Cerebral degeneration
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7
Q

What are partial seizures

A
  • Focal onset seizures that emanate from a specific cortical region. They affect 1 area of the brain and most commonly originate in the median temporal lobe. May spread to become generalized
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8
Q

Generalized seizures

A

no focal onset, thought to originate from brainstem structures; with spread to both hemispheres at the same time.

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9
Q

Simple partial seizure

A

consciousness intact

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10
Q

Complex Partial

A

Impaired consciousness

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11
Q

So what are the two types of partial seizures

A

simple and complex

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12
Q

Partial seizure with secondary generalization

A

consciousness lost + bilateral cerebral involvement

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13
Q

Simple partial seizures emanating from the motor cortex may demonstrate what

A

Jacksonian March. That is, they start at the hand and march up to involve the arm and face on the same side.

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14
Q

Simple partial seizures involving the sensory cortex involve what

A

tingling or numbness of an extremity or side of face

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15
Q

Simple partial seizures involving autonomic

A

Rising epigastric sensations, nausea,

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16
Q

Simple partial seizures that are psychic involve

A

Fear, deja vu, jamais vu

17
Q

Complex partial seizures

A

impaired consciousness

  • Remmeber that partial is interchangeable with focal in seizure talk
18
Q

Complex partial seizures typically emanate from the temporal or frontal lobe

A

ok

19
Q

Complex partial seizures last how long

A

about 1 minute

20
Q

Features of complex partial seizures

A
  • Blank stare
  • Oral automatisms: chewing and lip smacking movements
  • Typical hand automatisms are hand rubbing or picking movements
  • contralateral dystonic posturing- sustained muscle contractions on one side of the body cause twitching. A result of a spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia.
  • Post-ictal amnesia and confusion
  • Focal abnormality of EEG
21
Q

What are the 6 types of Primary Generalized seizures

A
  • Absence
  • Tonic-clonic
  • Clonic
  • Tonic
  • Myoclonic
  • Atonic
22
Q

Absence Seizure

A
  • Brief Loss of consciousness
  • Staring spell
  • No post-ictal confusion
  • Subtle myoclonic
23
Q

Tonic-Conic Seizure

A
  • loss of consciousness
  • muscular rigidity (tonic)
  • jerking movements (clonic)
  • tongue-biting/ injury common
  • bladder/ bowel incontinence
  • post-ictal confusion/ sleep
24
Q

Myoclonic seizure

A
  • Brief muscle contractions (clonic) of the head and upper extremities
  • Usually symmetrical and bilateral
  • consciousness preserved
  • precipitated by awakening or falling asleep
  • may progress into tonic-clonic seizures
25
Q

Atonic

A
  • Impaired consciousness
  • loss of muscle tone
  • head drop
  • fall
  • brief duration
  • injury common
26
Q

Seizure diagnosis

A
  • history from patient and witness (very important)
  • Physical and neurological exam
  • CBC, metabbolic panel (CMP), AED (anti-epileptic drug levels…helps determine whether pt has not been taking meds or screwed up the dose)
  • inter-ictal EEG
  • Epilepsy protocol MRI
  • Video-EEG monitoring
27
Q

Serial EEGs reveal epileptiform discharges in what percent of patients

A

80-90….way better than inital EEG

28
Q

Outside of Serial EEGs, what are some good ways to detect epileptiform changes

A

studies with sleep deprivation and extended recording times

29
Q

Sharp waves, spikes, sharp and slow wave discharges?

A

All examples of epileptiform abnormalities

30
Q

Bilateral and symmetrical spke and wave activity occuring at a frequency of 3 per second (3 hz) is classic EEG for

A

Absence seizure

31
Q

Receont onset epilepsy in adults requires

A

MRI

32
Q

Causes of tumors in adults

A

tumors, trauma, stroke, infection

33
Q

Epilepsy MRI protocol

A
  • You want high res T1 weighted volume set, coronal slices, through the whole brain
  • ALso a coronal T2 weighted sequence, using 3mm thin sections, should also be done to detec hippocampal sclerosis
34
Q

Video- EEG monitoring

A

simultaneously records EEG and seizure.

  • Useful in differentiating epleptic seizures from non
  • Essential for pre-surgical localization of seizure focus
35
Q

In most neuronal circuits, GABA inhibition exerts a powerful suppression of excitability

A

This inhibition is overcome during the development of a focal seizure.

  • A seizure results when excitation significantly exceeds inhibition. Know that most antiepileptic medications work by attempting to restore the excitation inhibition balance by reducing glutamate-mediated excitation or by increasing GABA mediated inhibition
36
Q

Two types of remission when fighting epilepsy

A

Medical remission: seizure free with no side-effects on 1 or 2 AEDs

Disease Remission: Seizure free off all AEDs…generally a result of surgery

37
Q

Intractable epilepsy

A

Disabling seizures- seizures causing impaired quality of ife, limited educational or occupational apportunities, physical injuries, or social compromise.

38
Q

Status epilepticus

A

continuous, generalized, convulsive seizure lasting more than 5 minutes or two or more sequetial seizures occurring without full recovery of consciousness

Neurology (38 decks)

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