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T2 - Phase 3 - Brain, Mind, and Behavior > BMB 2 - Seizure Disorders > Flashcards

BMB 2 - Seizure Disorders Flashcards

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1
Q

What are seizures?

A

Involuntary episodes of hypersynchronous cerebral discharge

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2
Q

What is another name for a seizure?

A

An ictus

(an ictal event)

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3
Q

The period between multiple seizures is called what?

A

Interictal

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4
Q

The period after a seizure is called what?

A

Postictal

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5
Q

Which forms of seizure present with a postictal state?

A

Complex partial;

tonic-clonic

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6
Q

What is epilepsy?

A

A syndrome of repeating seizures

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7
Q

What percentage of the population has epilepsy?

What percentage will experience a seizure during their lives?

A

1%

10%

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8
Q

Describe the flowchart of seizure classifications.

A
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9
Q

What are the major forms of generalized motor seizure?

A

Tonic-clonic

Tonic

Myoclonic

Atonic

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10
Q

What are the major forms of generalized non-motor seizure?

A

Absence

(also atypical absence)

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11
Q

What is the technical term for a grand mal seizure?

A

Tonic-clonic seizure

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12
Q

What is the technical term for a petit mal seizure?

A

Absence seizure

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13
Q

What type of seizure is also known as a ‘drop’ seizure?

A

Atonic seizure

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14
Q

Name some of the various etiologies of epilepsy.

A

Structural defects,

genetic defects,

toxic or metabolic insults,

infections insults,

autoimmune insults

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15
Q

True/False.

Hypoventilation leads to an increase in CO2, increasing neuronal excitability and sometimes leading to clinical seizures.

A

False.

Hyperventilation leads to a decrease in CO2, increasing neuronal excitability and sometimes leading to clinical seizures.

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16
Q

In simple terms, why can photic (light) stimulation precipitate seizures?

A

It stimulates synchronous neuronal discharge

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17
Q

What medication can be used to induce clinical seizures by increasing brain excitability?

A

Methohexital (a short-acting barbituate)

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18
Q

True/False.

Sleep can sometimes precipitate clinical seizures if neuronal firing becomes synchronous.

A

True.

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19
Q

How do tonic-clonic (grand mal) seizures appear on an EEG?

A

Tonic-phase spikes and clonic-phase spike-and-waves

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20
Q

A patient’s EEG shows synchronous changes in only a few of her EEG leads. What form of seizure is this?

A

A partial seizure

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21
Q

What form of partial seizure involves no change in consciousness?

A

A simple partial seizure

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22
Q

What form of partial seizure involves a loss of consciousness?

A

A complex partial seizure

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23
Q

What term is given to the repetitive movements that are a feature of partial seizures?

A

Automatisms

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24
Q

Automatisms manifest on which side of the body relative to the partial seizure focus(i)?

A

Ipsilateral

(HOWEVER, this is driven by stimulus from the contralateral brain.)

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25
Q

What are some tools that may be useful in determining the focal origin of a seizure?

A

EEG, structural imaging, PET, physical S/Sy

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26
Q

Generalized seizures typically show changes in which EEG leads?

A

All of them

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27
Q

Nonconvulsive generalized seizures (i.e. impaired consciousness with little or no convulsions; e.g., absence seizures) typically occur in which age group(s)?

A

Children

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28
Q

Convulsive generalized seizures (i.e. impaired consciousness with bilateral motor convulsions; e.g., tonic-clonic seizures) typically occur in which age group(s)?

A

All age groups

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29
Q

What are the major causes of seizures in children?

A

Genetic,

infection (febrile),

trauma,

congenital,

metabolic

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30
Q

What are the major causes of seizures in adults?

A

Tumor,

trauma,

stroke,

infection

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31
Q

What are the major causes of seizures in the elderly?

A

Stroke,

tumor,

trauma,

metabolic,

infection

32
Q

True/False.

Generalized convulsive seizures (e.g. tonic-clonic) have a large metabolic cost.

A

True.

ATP-dependent pumps maintain resting potentials; during a seizure, these pumps may be consuming up to 2.5x the normal amount.

33
Q

A 58 year old man presents with two seizures within the past few hours. Do you suspect epilepsy?

A

No.

Epilepsy typically begins at a young age. Look for other causes.

34
Q

Describe the features of a tonic-clonic (grand mal) seizure in terms of age of onset, generalized vs. partial, duration, and frequency of seizures.

A

Any age

Generalized

Duration is variable (but usually 2 – 5 minutes)

Frequency is variable

35
Q

How do tonic-clonic (grand mal) seizures typically present?

A

Tonic phase: increased maximal tone of muscles

Clonic phase: muscle jerks

Tongue biting and incontinence are common

Sleepiness and confusion postictally

36
Q

Describe the EEG findings in an individual undergoing a tonic-clonic (grand mal) seizure.

A

Tonic-phase spikes and clonic-phase spike-and-waves

Flattening of the wave postictally

Interictal paroxysmal sharp wave

(NOTE: ~15% have normal EEG findings.)

37
Q

Describe the features of an absence (petit mal) seizure in terms of age of onset, generalized vs. partial, duration, and frequency of seizures.

A

4 – 12 years

Generalized

5 – 20 seconds

As many as 50+ per day

38
Q

How do absence (petit mal) seizures typically present?

A

Lapse of consciousness; blank stare

3-per-second eye blinks

Abrupt start and stop of the seizure

39
Q

Describe the EEG findings in an individual undergoing an absence (petit mal) seizure.

A

3 counts per second spike-and-wave

Abrupt start and stop

40
Q

Absence (petit mal) seizures typically present with an EEG pattern of 3 spikes and then a slow wave. How do atypical absence seizures present on EEG?

A

Slow spike, then wave

41
Q

Absence (petit mal) seizures usually arise from a(n) ___________ etiology and can be activated by _________________.

A

Absence (petit mal) seizures usually arise from a genetic etiology and can be activated by hyperventilation.

42
Q

Pediatric patients with genetic predisposition to absence (petit mal) seizures typically gain remission by their _______ or _______ decade of life. As many as _______% may develop tonic-clonic (grand mal) seizures.

A

Pediatric patients with genetic predisposition to absence (petit mal) seizures typically gain remission by their 2nd or 3rd decade of life. As many as 50% may develop tonic-clonic (grand mal) seizures.

43
Q

___________ seizures are a form of generalized seizured which most commonly appear in children ages 3 – 7 as flexor or extensor muscle spasms, akinesis, and myoclonic extremity activity.

A

Minor motor seizures are a form of generalized seizured which most commonly appear in children ages 3 – 7 as flexor or extensor muscle spasms, akinesis, and myoclonic extremity activity.

44
Q

How long do minor motor seizures typically last?

How frequent are they?

A

Seconds;

multiple daily

45
Q

What are the typical EEG findings during a minor motor seizure?

A

Slow spike-and-waves or polyspike-and-waves

46
Q

True/False.

Children with minor motor seizures typically have a poor prognosis due to increased risk of injury to the head during the multiple daily seizures.

A

True.

47
Q

Describe the classical presentation of a patient with juvenile myoclonic epilepsy.

A

A young adult presents with 4 – 5 Hz spikes on EEG the morning after a night of heavy drinking and little sleep (carbamazepine worsens these seizures)

48
Q

What is here described?

A young adult presents with 4 – 5 Hz spikes on EEG the morning after a night of heavy drinking and little sleep (carbamazepine worsens these seizures).

A

Juvenile myoclonic epilepsy

49
Q

What term refers to a medical emergency in which one experiences repetitive seizures (≥5 minutes of seizures) with incomplete recovery between seizures?

A

Status epilepticus

50
Q

Why is status epilepticus considered a medical emergency?

A

It is associated with brain injury and death

(NOTE: as well as cardiac arrest, arrhythmias hypotension, pulmonary edema, lactic acidosis, rhabdomyolysis, DIC, multiple organ failure, etc.)

51
Q

What is the typical age of onset for focal cerebral epilepsy?

A

Any age

52
Q

True/False.

Focal cerebral epilepsy is a form of generalized seizure which typically lasts seconds or minutes and may progress to absence (petit mal) seizures.

A

False.

Focal cerebral epilepsy is a form of partial seizure which typically lasts seconds or minutes and may progress to tonic-clonic (grand mal) seizures.

53
Q

Which form of epilepsy is associated with a ‘Jacksonian march’ of synchronous activity spreading throughout the sensorimotor cortex?

A

Focal cerebral epilepsy

54
Q

The seizures of focal cerebral epilepsy are associated with auras which precede most of the symptoms. Are these auras precedent or part of the seizures?

A

Part of

(the intial part, not just a warning sign of the impending seizure)

55
Q

What are the typical EEG findings for a seizure due to focal cerebral epilepsy?

A

Focal spike or sharp wave with phase reversal

56
Q

What is it called when focal seizures progress to generalized tonic-clonic (grand mal) seizures?

A

Secondary generalization

57
Q

What is it called when the secondary foci of a partial seizure become independent foci?

A

Kindling

58
Q

Fill in the following for psychomotor temporal lobe epilepsy:

Age of onset:

Type:

Duration:

EEG findings:

Fill in the following for psychomotor temporal lobe epilepsy:

A

Fill in the following for psychomotor temporal lobe epilepsy:

Age of onset: any

Type: partial

Duration: 1 – 2 minutes

EEG findings: variable (may be normal), discharge from anterior temporal lobe

59
Q

A patient presents with exaggerated lip smacking, chewing, and staring. She had reported an aura before lapsing into this state. What form of seizure is here described?

A

Psychomotor temporal lobe seizure

60
Q

What form of seizure-like activity is represented in this EEG?

A

Spreading depression (spreading depolarization)

(NOTE: spreads via gap junctions and elevations in extracellular K+ and glutamate)

61
Q

True/False.

Spreading depolarizations (depressions) are due to massive, transient, and nonselective increases in membrane permeatbility.

A

True.

62
Q

In what order does recovery from a spreading depolzarization occur?

A

Assuming adequate blood/nutrient supply, recovery occurs in the order in which the depression occurred (ATP pumps restore normal membrane potentials)

63
Q

What term is given to the condition in which a patient has a seizure in their temporal lobe and has violent contralateral turning of the head away from the seizure side?

A

Force head versions

64
Q

How do frontal lobe seizures typically present?

A

Jerking of extremities, outstretched tonic limbs, bicycling of legs

65
Q

What is the sequence of physiological events seen in migraines?

A

Hypoperfusion, aura, headache, hyperperfusion

66
Q

A completely conscious female patient presents with bilateral motor activity. You suspect some sort of seizure, but three repeat EEGs are normal and her motor activity is refractory to high dose benzodiazepines and multiple anti-epileptic medications. What is the likely diagnosis?

A

Psychogenic non-epileptiform seizures

67
Q

What are the major indicators for diagnosis of psychogenic non-epileptiform seizures?

A

Bilateral motor activity,

preserved consciousness,

≥2 normal EEGs

68
Q

What is the rule of 2s associated with non-epileptiform seizures?

A

≥ 2 normal EEGs

≥ 2 seizures per week

≥ 2 anti-epileptic drugs failed

69
Q

How are psychogenic non-epileptiform seizures treated?

A

Anti-depressants (typically SSRIs)

70
Q

Most patients with psychogenic non-epileptiform seizures have what comorbidities or associated medical history?

A

Epilepsy, psychiatric issues;

a history of childhood trauma

71
Q

Stiff person syndrome is a condition in which the patient experiences a progressive stiffening of their body which begins in the trunk, often as a reaction to some emotional stimulus.

It is due to what etiology?

A

Anti-GAD65 antibodies (which cause a loss of GABA)

72
Q

What is the etiology behind type 1 narcolepsy (in which emotional stimuli produce a sudden-onset REM atonia)?

A

Auto-antibodies against orexinogenic cells

(orexin promotes sleep and suppresses REM)

73
Q

Motor seizures involving bicycling of the legs are most likely to be originating in what portion(s) of the brain?

A

Frontal lobes

74
Q

Mainly sensory seizures are most likely to be originating in what portion(s) of the brain?

A

The parietal lobes

75
Q

Seizures that are characterized by strong emotional components are most likely to be originating in what portion(s) of the brain?

A

The temporal lobes

76
Q

Seizures involving visual changes are most likely to be originating in what portion(s) of the brain?

A

The occipital lobes

T2 - Phase 3 - Brain, Mind, and Behavior (43 decks)

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