Adult Seizure Disorder

Question 1

Seizure

Answer 1

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

Question 2

Epilepsy

Answer 2

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

Question 3

WHat are some conditions that may provoke seizures

Answer 3

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

Question 4

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

Answer 4

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

Question 5

Epilepsy incidence peaks?

Answer 5

Children and the elderly

Question 6

causes of adult onset epileptic seizures

Answer 6

• cerebrovascular disease
• Trauma
• Tumors
• Infection
• Cerebral degeneration

Question 7

What are partial seizures

Answer 7

• 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

Question 8

Generalized seizures

Answer 8

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

Question 9

Simple partial seizure

Answer 9

consciousness intact

Question 10

Complex Partial

Answer 10

Impaired consciousness

Question 11

So what are the two types of partial seizures

Answer 11

simple and complex

Question 12

Partial seizure with secondary generalization

Answer 12

consciousness lost + bilateral cerebral involvement

Question 13

Simple partial seizures emanating from the motor cortex may demonstrate what

Answer 13

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

Question 14

Simple partial seizures involving the sensory cortex involve what

Answer 14

tingling or numbness of an extremity or side of face

Question 15

Simple partial seizures involving autonomic

Answer 15

Rising epigastric sensations, nausea,

Question 16

Simple partial seizures that are psychic involve

Answer 16

Fear, deja vu, jamais vu

Question 17

Complex partial seizures

Answer 17

impaired consciousness

• Remmeber that partial is interchangeable with focal in seizure talk

Question 18

Complex partial seizures typically emanate from the temporal or frontal lobe

Answer 18

ok

Question 19

Complex partial seizures last how long

Answer 19

about 1 minute

Question 20

Features of complex partial seizures

Answer 20

• 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

Question 21

What are the 6 types of Primary Generalized seizures

Answer 21

• Absence
• Tonic-clonic
• Clonic
• Tonic
• Myoclonic
• Atonic

Question 22

Absence Seizure

Answer 22

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

Question 23

Tonic-Conic Seizure

Answer 23

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

Question 24

Myoclonic seizure

Answer 24

• 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

Question 25

Atonic

Answer 25

- Impaired consciousness - loss of muscle tone - head drop - fall - brief duration - injury common

Question 26

Seizure diagnosis

Answer 26

- 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

Question 27

Serial EEGs reveal epileptiform discharges in what percent of patients

Answer 27

80-90....way better than inital EEG

Question 28

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

Answer 28

studies with sleep deprivation and extended recording times

Question 29

Sharp waves, spikes, sharp and slow wave discharges?

Answer 29

All examples of epileptiform abnormalities

Question 30

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

Answer 30

Absence seizure

Question 31

Receont onset epilepsy in adults requires

Answer 31

MRI

Question 32

Causes of tumors in adults

Answer 32

tumors, trauma, stroke, infection

Question 33

Epilepsy MRI protocol

Answer 33

- 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

Question 34

Video- EEG monitoring

Answer 34

simultaneously records EEG and seizure. - Useful in differentiating epleptic seizures from non - Essential for pre-surgical localization of seizure focus

Question 35

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

Answer 35

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

Question 36

Two types of remission when fighting epilepsy

Answer 36

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

Question 37

Intractable epilepsy

Answer 37

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

Question 38

Status epilepticus

Answer 38

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