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MD1 Neuroscience > Cellular Basis of Epilepsy > Flashcards

Cellular Basis of Epilepsy Flashcards

1
Q

What is epilepsy?

A

Large range of conditions characterised by recurrent unprovoked epileptic seizures

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2
Q

What does the clinical presentation of epilepsy result from?

A

Paroxysmal excessive, synchronous, abnormal firing patterns of neurons

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3
Q

What does the specific presentation of epilepsy depend on?

A

Which part of brain affected

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4
Q

What is the most common serious chronic neurological condition?

A

Epilepsy

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5
Q

What is the epidemiology of epilepsy?

A

Affects all societies and strata, globally

Increased in underdeveloped countries and lower SE groups

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6
Q

Why is the prevalence of epilepsy higher in underdeveloped countries and lower SE groups?

A

Primarily because people in this group develop more conditions that injure their brain > seizures

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7
Q

What are the significant adverse consequences of epilepsy?

A 
Physical morbidity
Psychiatric morbidity
Social morbidity
Medication side effects
Mortality
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8
Q

What is an epileptic seizure?

A

Transient occurrence of clinical signs and/or symptoms due to excessive and hyper-synchronous activity of populations of neurons in brain

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9
Q

Does everyone have the same sort of seizure?

A

No, seizures vary from person-person and type-type

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10
Q

What are the different categories of epilepsy?

A 
Genetic = idiopathic/primary
Structural/metabolic = symptomatic/secondary
Unknown = cryptogenic
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11
Q

What is the classification of the type of epilepsy based on?

A

Similar

  • Signs
  • Symptoms
  • Prognosis
  • Response to treatment
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12
Q

Why is it important to classify the type of epilepsy a person has?

A 
Choosing treatment options
Counselling patients regarding
- Aetiology
- Genetics
- Likely prognosis
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13
Q

What is a partial (focal) seizure?

A

Arise in limited number of cortical neurons in one hemisphere

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14
Q

What is usually the cause of a focal seizure?

A

Focal brain lesion

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15
Q

Are focal seizures easy to control?

A

No, tend to be more difficult to control

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16
Q

What is a generalised seizure?

A

Arise simultaneously in both hemispheres

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17
Q

What is usually the cause of a generalised seizure?

A

Genetic

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18
Q

What is genetic (idiopathic) epilepsy?

A

Underlying brain structurally and functionally normal

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19
Q

When is the usual onset in genetic epilepsy?

A

Childhood/teenage

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20
Q

Can genetic epilepsy remit?

A

Possible

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21
Q

Does genetic epilepsy respond well to medication?

A

Yes

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22
Q

What is structural/metabolic (symptomatic) epilepsy?

A

Seizures result from identifiable structural/functional brain abnormality

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23
Q

Does structural/metabolic epilepsy remit?

A

Not commonly, because brain injury doesn’t go away

24
Q

Does structural/metabolic epilepsy respond well to medication?

A

Incompletely controlled

25
Q

What causes epilepsy?

A

Disturbance in balance between inhibition and excitation of cortical neurons and neuronal networks

26
Q

What does the imbalance between excitation and inhibition of neurons cause?

A

Neuronal networks fire in uncontrolled, hyper-synchronous, self-sustained way

27
Q

What are the possible causes of the imbalance between excitation and inhibition of neurons?

A 
Genetic
Congenital/developmental
Traumatic
Infectious
Metabolic
Drugs
28
Q

What can alter in neuronal network components to produce epileptic neuronal networks?

A

Loss of inhibitory neurons
Gain of excitatory neurons via neurogenesis - often happens after brain injury
Aberrant sprouting - can often sprout back on themselves creating auto-excitation

29
Q

What are the mechanisms by which epileptic neuronal networks are generated?

A

Alterations in neuronal network parts
Alterations in intrinsic neuronal cellular excitability
Alterations in synaptic transmission
Alterations in extra-neuronal environment

30
Q

What is the most sensitive structure to induce seizure activity?

A

Hippocampus

31
Q

What is the epileptic remodelling that takes place in the hippocampus?

A

Cell loss
Mossy fibre sprouting
Gliosis

32
Q

What is the relationship between epileptogenesis and disease progression?

A

Seizures beget seizures

33
Q

What is the disease progression of epilepsy?

A 
Drug resistance
Neuronal loss
Synaptic reorganisation
Neurocognitive changes
Psychiatric changes
34
Q

When is the onset of epilepsy?

A

Common at all ages

Peaks in young and old

35
Q

What is the aetiology of new onset epilepsy in infancy and early childhood?

A

Most commonly congenital or perinatal CNS insults

36
Q

What is the aetiology of new onset epilepsy in late childhood and early adulthood?

A

Most commonly idiopathic/genetic

37
Q

What is the aetiology of new onset epilepsy in adulthood and the elderly?

A

Most symptomatic

  • Trauma
  • Ischaemia
  • Tumours
  • Haemorrhange
  • Degenerative diseases
38
Q

What is the cause of genetic epilepsies?

A

5-10% Mendelian monogenic inheritance pattern

Most have complex inheritance patterns

39
Q

How are pathologies of the brain identified in focal epilepsy?

A

MRI

40
Q

What is the most common pathology in adults with partial epilepsy?

A

Mesial temporal sclerosis

41
Q

What is the prognosis of epilepsy when the pathology is mesial temporal sclerosis?

A

Most patients continue to have seizures despite medication

Good prognosis with surgery

42
Q

What are the MRI features of partial epilepsy with a pathology of mesial temporal sclerosis?

A

Unilateral hippocampal atrophy
Increased T2 signal
Decreased T1 signal
Loss of internal architecture

43
Q

What is focal cortical dysplasia?

A

Focal regions of disturbed cortical development and architecture

44
Q

What is the aetiology of focal cortical dysplasia?

A

Uncertain

45
Q

What are the MIR features of focal cortical dysplasia?

A

Focal thickening of cerebral cortex
Blurring of grey/white interface
Gyral abnormalities
May be associated with region of increased T2 signal

46
Q

What is the prognosis of focal cortical dysplasia?

A

Almost always drug resistant

If focal, respond well to surgery

47
Q

What is periventricular nodular heterotopia?

A

Generalised malformation due to abnormal neuronal migration
Nodular masses of grey matter diffusely lining ventricular walls
- Bilateral or focal

48
Q

What is the cortical and neurological functioning like in periventricular nodular heterotopia?

A

Normal

49
Q

What proportion of people with partial epilepsy have low grade tumours?

A

15%

50
Q

What proportion of people with chronic drug resistant partial epilepsy have vascular lesions?

A

10%

51
Q

What is focal encephalomalacia?

A

Focal lesion from previous destructive insult, especially

  • Trauma
  • Stroke
  • Infection
52
Q

What are the MRI features of focal encephalomalacia?

A

Irregular area of atrophy of cerebral cortex and underlying white matter
Surrounding region of increased T2 signal
May be associated with large cystic region

53
Q

What are anti-epileptic drugs?

A

Decrease frequency and/or severity of seizures in people with epilepsy

54
Q

Do anti-epileptic drugs treat the underlying epileptic condition?

A

No, treat symptoms; ie: seizures

55
Q

What proportion of people have drug resistant epilepsy?

A

30%

56
Q

What are non-medical treatments for epilepsy?

A

Often adjunct to medications
Surgery
Neurostimulators
Dietary

57
Q

What kinds of epilepsy can be treated with surgery?

A

Focal epilepsy where origin of seizures can be localised to brain region that can be resected with low risk of significant damage afterwards

MD1 Neuroscience (55 decks)

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