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Neurosurgery > Ch. 21 - Epilepsy > Flashcards

Ch. 21 - Epilepsy Flashcards

1
Q

Definition of epilepsy

A

Tendency to have recurrent seizures; transient derangement of nervous system 2/2 sudden, excessive, and disorderly discharge of cerebral neurons

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2
Q

What are the 3 major seizure types?

A

Generalized

Partial

Unclassifiable

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3
Q

Describe the electrical discharges in generalized seizures

A

Bilateral, synchronous and symmetrical, involving BOTH cerebral hemispheres

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4
Q

Describe a tonic-clonic (grand mal) seizure

A

Tonic phase 10-15 sec (LOC, body stiffens, clench teeth, bite tongue, apnea, urinary incontinence)

Clonic phase 1-2 min (rhythmic muscle contractions)

Postictal phase (confusion and drowsiness)

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5
Q

What are the common types of generalized seizures?

A

Tonic-clonic (grand mal), absence (petit mal), myoclonic, tonic, atonic

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6
Q

What are the types of partial (focal) seizures?

A

Simple partial, complex partial

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7
Q

Describe an absence (petit mal) seizure

A

Brief LOC 5-10 sec with starring or blinking but only minimal motor involvement; consciousness regained with amnesia of event

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8
Q

EEG appearance of absence seizure

A

Bilateral synchronous 3-Hz spike and wave activity

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9
Q

What can provoke an absence seizure or its EEG abnormality?

A

Hyperventilation

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10
Q

Describe a myoclonic seizure

A

Brief, usually single, jerking of trunk +/- limbs

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11
Q

EEG appearance of myoclonic seizure

A

Bilateral synchronized spike and wave activity

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12
Q

What differentiates partial from generalized seizures?

A

Electrical activity of partial seizures starts in defined focus

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13
Q

Define simple partial vs. complex partial seizures

A

Simple partial - w/o impairment of consciousness

Complex partial - with impairment of consciousness

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14
Q

Where do most complex partial seizures arise from?

A

Temporal lobe (often begin with an aura - taste, smell, deja vu, fear)

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15
Q

What are automatisms?

A

Lip smacking, chewing movements, repetitive swallowing, upper limb movements

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16
Q

What happens when electrical discharge of a partial seizure generalizes?

A

Can have secondarily generalized tonic-clonic seizure

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17
Q

What are the 3 types of post-traumatic seizures?

A

Immediate, early, and late epilepsy

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18
Q

Describe immediate post-traumatic epilepsy

A

Occurs at the time of, or within minutes, of head injury; usually does not recur; good prognosis; does not predispose to late post-traumatic epilepsy

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19
Q

Describe early post-traumatic epilepsy

A

Occurs within 1 week of head injury; complicates injuries (e.g. intracranial hemorrhage, prolonged amnesia); predisposes to late post-traumatic seizures

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20
Q

Describe late post-traumatic epilepsy

A

Occurs after 1 week following head trauma (can be years later)

21
Q

Factors predisposing to late post-traumatic epilepsy

A

Post-traumatic amnesia >24 hrs, intracranial hemorrhage, early seizures, depressed skull fracture

22
Q

Tx of post-traumatic epilepsy

A

Phenytoin or carbamazepine

23
Q

What is the incidence of seizures following craniotomy?

24
Q

What is the drug of choice for postoperative seizure prophylaxis?

A

Phenytoin for 6 months

25
What is the relationship between the grade of malignancy of a glioma and the seizure risk?
Inverse! Lower grade a/w higher risk of seizure
26
DDx for seizures
Syncope (emotional, cardiac, postural, vasovagal), migraine (aura vs. partial seizure), pseudoseizures, movement disorders (Tourette's vs. myoclonic seizure)
27
What hormone is often elevated after seizures?
Prolactin
28
What is the chance of recurrence in a patient with first seizure?
78% in 3 years
29
Should you start an antiepileptic after 1st seizure?
Controversial; randomized studies say yes (esp. if structural lesion and early life onset)
30
AED after head injuries?
Decreases risk of early seizures (first 7 days) but not thereafter Use phenytoin or carbamazepine
31
AED after craniotomy?
Not shown to make a difference but we use them anyway
32
AED ppx after febrile seizure?
Not shown to make a difference
33
AED in patients with glioma?
Use valproate (1st line); levetiracetam if not controlled
34
AEDs in pregnancy?
Increase risk of fetal abnormalities to 4-8% (vs. 2-3%); risk fo child and mother is greater if mother has uncontrolled seizures AVOID valproate (neural tube defects)
35
What drugs are used for emergent initial therapy in status epilepticus?
Lorazepam IV; can also use midazolam IM or rectal diazepam
36
What therapy is used to maintain control in status epilepticus?
IV phenytoin, valproate, or levetiracetam
37
What should you do if seizure don't stop in status epilepticus?
Intubate, continuous EEG monitoring, general anesthesia (often with propofol to burst suppression)
38
Phenytoin
For partial and generalized motor seizures Tox: Steven-Johnson syndrome Metabolized in liver Half-life 24 hrs + saturation pharmokinetics ("S" shaped) CHEAP
39
Carbamazepine
2 or 3x daily dosage Tox: bonw marrow, rash, lower WBC, hyponatremia Liver metabolism
40
Topiramate
2x daily dosing Tox: major cognitive slowing (esp. speech) Renal clearance
41
Lamotrigine
2x daily dosing Tox: rash, major drug intercation with valproate (doubles VPA levels) Liver metabolism
42
Valproate
For partial and generalized seizures Rapid turnover in brain Tox: weight gain, hair loss, liver, NEURAL TUBE DEFECTS Liver metabolism 2-3x daily dosing EXPENSIVE
43
Levetiracetam
For partial and generalized seizures Well-tolerated with few drug interactions (useful in ELDERLY) Tox: behavioral (hostility, paranoia) 2x daily dosing Kidney clearance
44
Indications for surgery in epilepsy
Seizures persist despite AED therapy Seizure onset in FOCAL area of brain (and area can be removed with low risk of functional deficit)
45
Outcome after temporal lobe resection for epilepsy
75-80% become seizure-free
46
Complications after temporal lobe resection for epilepsy
Often unrecognized 'pie in the sky' visual defect Verbal memory deficit after dominant hemisphere resection ('subtle naming changes')
47
Other surgical therapies available for epilepsy
Vagal nerve stimulator, deep brain stimulation (anterior thalamic nuclei), gamma knife radiosurgery
48
What is medical tx of choice for absence seizures?
Ethosuximide

Neurosurgery (21 decks)

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