Clinical Epilepsy lec 10 Flashcards
Aura
Brief and simple seizure
Prodrome
combination of symptoms
not seizure
Ictal
Clinical feature of seizure
Interictal
Btwn two seizures
Post-ictal
symptoms after seizure is over
Partial (focal)
Start in one area of the brain
Simple partial
no loss of consciousness
Complex partial
impaired consciousness
Do not remember
Secondary Generalized
Partial can spread
Generalized
Usually start in thalamus and project to cortex
Both hemispheres
Convulsive
Repeated motorized activity
Non-convulsive
Firing but no convulsions
Epileptic syndrome
Dz of brain characterized by enduring predisposition to generate epileptic seizures
- idiopathic
- Symptomatic- consequence of a know or suspected disorder of CNS
- cryptogenic
Mutation in Nav1.1
GEFS+
- milder than SMEI
- usually no cognitive impairment
- Loss of fxn of fast inactivation
- gain of fxn of Na channel
- persistent Na current
SMEI (darvent syndrome)
Reduction of Na channel density
Loss of high freq AP
Loss of inhibitory fan of GABAergic Purkinje cells
Cerebellum
Ataxia
Loss of inhibitory GABAergic interneurons
More firing of AP
Seizures
Tigabine
Decrease reuptake of GABA
Benzodiazepines (clonazepam)
Increase in response of post-synaptic GABA Receptors
SMEI clinical manifestation
1st year- seizures associated with elevated temp -progressively prolonged and cluster 2nd year- Psychomotor delay -ataxia -cognitive impairment
Febrile seizures
Seizures occurring after 1 month of age
- associated with febrile illness
- Mutation in Nav1.1 may be cause in many pts
- reduction of peak Na currents
K channelopathies
Missense mutation
LOF
Benign familial neonatal convulsion (BFNC)
resolves by 6 weeks
T-type Ca channelopathies
GOF
Mostly in thalamic cells
Excessive synchronous rhythmic burst firing
idiopathic generalized epilepsy
Cl channelopathies
Cl channels responsible for GABAergic synapse hyperpol
Can lead to idiopathic generalized epilepsy
Antiepileptic Drugs (AED)
Decrease the hyper excitability of neurons
-Na channel blockers
Increasing the inhibitory fxn of neurons
-GABAergic medication
Surgery
May be considered in localization related epilepsy that is medically refractory- fail to respond to 2 meds
