Bloch: Epilepsy

Question 1

What is a seizure?

Answer 1

paroxysmal, excessive and disorderly discharge of neurons

Question 2

What are the components of a seizure?

Answer 2

aura
ictus *during seizure
post-ictal *immediately after seizure

Question 3

Epilepsy is defined as a syndrome of (blank) seizures

Answer 3

recurrent

Question 4

Is epilepsy a benign disease?

Answer 4

no

• psychosocial factors
• hospitalization, medications, lost work

Question 5

Just because you have one seizure, does this mean you have epilepsy?

Answer 5

No…

Question 6

What age groups are most likely to have epilepsy?

Answer 6

60+ *trauma, stroke, general damage to axons

0-9 *children can be genetically predisposed, but outgrow it as they myelinate their axons

Question 7

What are some classifications of seizures?

Answer 7

partial
generalized
status epilepticus
non-epileptic seizures

Question 8

Two types of partial seizures?

Answer 8

simple

complex *impairment of consciousness

Question 9

T/F: Partial seizures can evolve to secondarily generalized seizures

Answer 9

True

Question 10

What are some types of generalized seizures?

Answer 10

typical absence seizures *brief period of staring
myoclonic *brief shock-like jerks
clonic *flexed limbs
tonic *extended limbs
tonic-clonic
atonic *loss of all muscle tone

Question 11

What are some causes of localization-related epilepsy?

Answer 11

vascular *stroke, venous thrombosis
infectious *meningitis
tumor
degenerative *MS
trauma
congenital

Question 12

80% of seizures begin in the (blank) lobe

Answer 12

temporal

Question 13

What factors can help you identify the type of epileptic syndrome?

Answer 13

history
EEG
etiology
inheritance
response to anti-epileptic meds

Question 14

What do these clues favor?
Pt never witnessed having a seizure
Provoked by emotional stress
Variable presentation from one event to the next
Screaming or vocalizing through the whole event
Prolonged event (greater than a few minutes)
Sudden termination of event
No post-ictal confusion
Induced by suggestions
Responsive during event

Answer 14

non-epileptic event or syndrome

Question 15

What are some things that can provoke seizures?

Answer 15

massive sleep deprivation
excessive use of stimulants
withdrawal from sedatives or alcohol
high fever
hypoglycemia
electrolyte imbalance
hypoxia
hormonal variations
trauma
stress

Question 16

What happens to the eyes during a real seizure? What about during a non-epileptic seizure?

Answer 16

eyes open; eyes closed

Question 17

What are some lab tests you might perform after an unprovoked single seizure?

Answer 17

routine lab tests: electrolytes, CBC, glucose
toxicology screen *pts aren’t always honest
CT *if urgent or MRI *preferable
EEG
lumbar puncture *ONLY if you suspect infection (fever, AIDS)

Question 18

What are bed rail seizures? What type of pt do they usually occur in?

Answer 18

seizures that occur when a child’s body temp increases and their under-myelinated axons cannot respond appropriately; occur in young children *usu grow out of these

Question 19

What is mesial sclerosis?

Answer 19

sclerosis of hypocampus (didn’t develop normally or damaged from infection, etc) *provokes seizures

Question 20

After a single seizure, when would you want to start a pt on meds?

Answer 20

structural lesion on MRI
infection of CNS or meninges
history of epilepsy in sibling
childhood seizures
head trauma
age over 60 when first seizure occured
todd's paralysis
status epilepticus

Question 21

What is status epilepticus?

Answer 21

any seizure type that does not stop w/i 5 minutes or continuous pattern of seizing and recovering for 10min *likely to cause perma brain damage

Question 22

When would you NOT use meds after a single seizure?

Answer 22

alcohol withdrawal
drug abuse
seizure from hypoglycemia
provoked by sleep deprivation
post-impact seizure

Question 23

When to stop using seizure meds?

Answer 23

If seizure free for 2yrs
**over 60, keep em on it
If easily controlled on one drug at low dose
Normal EEG and neuro exam
No previous unsuccessful attempts at withdrawal

Question 24

Implantable device, like a pacemaker, for seizures. It stimulates left peripheral vagus nerve.

Answer 24

vagus nerve stimulator

Question 25

When might you consider surgery for epilepsy?

Answer 25

unresponsive to medical managements