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Block 9 - Neuro > CM: Epilepsy > Flashcards

CM: Epilepsy Flashcards

1
Q

What is an epileptic seizure?

A

temporary, relatively sudden alteration of behavior or cognition, resulting from an abnormally excessive or hypersynchronous discharge of cerebral neurons (usually in cortex)

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2
Q

What is epilepsy?

A

dz associated with having recurrent epileptic seizures (2 or more nonprovoked seizures)

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3
Q

What are the three factors that the generation of an epileptic focus depends upon?

A

intrinsic properties of neuronal hyperexcitability (membrane properties)
exposure to inhibitory or excitatory NTs
manner in which neuronal populations interconnected

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4
Q

What EEG finding is important in the diagnosis of epilepsy?

A

spike (PDS) and slow wave (AHP) = interictal phenomenon, serves as indication of seizure disorder

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5
Q

What is the neurophysiological basis of epileptic seizures?

A

paroxysmal depolarization shift: prolonged depolarization with superimposed bursts of APs followed by prolonged after hyperpolarization
temporal and spatial summation produces large enough EC electric field to be recorded at scalp of animal

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6
Q

What is a provoked vs. non-provoked epileptic seizure?

A

provoked - when normal cortex exposed to extreme, theoretically avoidable conditions (hypoglycemia, hyponatremia, inf, alcohol withdrawal, drug intox) - not epileptic

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7
Q

What are major risk factors for the dev of epileptic seizures?

A

military gunshot wound, head injury, stroke, encephalitis, Alzheimers

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8
Q

What is ictal, interictal, and post-ictal?

A

what occurs during a seizure, between seizures, or immediately after a seizure

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9
Q

What are the two most common mimics of an epileptic seizure?

A

psychiatric = nonepileptic psychogenic attacks

convulsive syncopy: cardiac (arrhythmias), non-cardiac (orthostatic), neurocardiogenic (vasovagal)

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10
Q

What is Todd’s paralysis?

A

after focal seizure pt may develop hemiparesis contralateral to site of seizure origin

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11
Q

What is the difference between focal and generalized seizures? why is this important?

A

focal - arising from one region of the brain
generalized - arising from both hemispheres at once
affects med choice, focal can raise possibility of lesion that may pose additional risks/be amenable to surgical cure

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12
Q

What is the ABCs of focal epileptic seizures?

A

aura, blackout (amnesia), convulsion

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13
Q

What is a simple partial seizure?

A

begins w one hemisphere, does not cause alteration of consciousness (amnesia) - should remember word or phrase given during seizure
may have aura = odor, lights, tingling, deja vu, fear or sadness, butterflies, jerking limb
EEG may be normal or abnormal

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14
Q

What is a complex partial seizure?

A

does involve loss of consciousness - implies spread of epileptic activity to bilateral memory systems
pt unresponsive, repetitive movements of no purpose (chewing, lip smacking), amnestic for event
lack of aura - dangerous!, post-ictal confusion
EEG - rhythmic sharp discharges in one area of brain becoming more diffuse

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15
Q

What is a secondarily generalized seizure?

A

progression from simple or complex partial
overlapping tonic and clonic phases
tonic phase - begins with ictal cry, limbs extend and become rigid, forceful jaw closure, bladder empties
clonic - limb and facial muscles contract rhythmically (jerking)
entire seizure lasts less than two minutes

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16
Q

What is an absence seizure?

A

<30 sec starting spell with or without minor automatisms, but always w amnesia
abrupt onset and offset, no post-ictal confusion, induced by hyperventilation

17
Q

What are myoclonic seizures?

A

sudden, rapid muscle jerk typically involving both arms and trunk in bilaterally synchronous fashion
brief, but has EEG discharge, can build to tonic-clonic

18
Q

What is a clonic seizure?

A

repetitive jerking of all limbs without clear tonic phase

19
Q

What are tonic seizures?

A

sudden increase in body tone (clenching)

usually <1 min

20
Q

What is an atonic seizure?

A

sudden loss of muscle tone - can collapse to ground - most dangerous!

21
Q

What are the four main epilepsy syndromes?

A 
localization related syndromes (focal)
generalized syndromes
undetermined
special syndromes
further divided in each group into idiopathic or symptomatic
22
Q

What is idiopathic?

A

only abnormality is intrinsic neuronal hyperexcitability

23
Q

What is symptomatic?

A

distinct, acquired brain injury causing epilepsy

24
Q

What is cryptogenic?

A

thought to be acquired injury, but no specific lesion identified

25
Q

What is an example of focal idiopathic epilepsy and focal cryptogenic epilepsy?

A 
idiopathic = benign rolandic epilepsy - children otherwise normal, remits after adolescence
cryptogenic = mesial temporal lobe epilepsy
26
Q

What is an example of generalized idiopathic and generalized cryptogenic epilepsy?

A

Juvenile myoclonic epilepsy - starts in adolescence and persists throughout life
Lennox-Gestaut (symptomatic or cryptogenic) - mental retardation, hard to control

27
Q

How is an EEG performed?

A

metal electrodes applied to scalp w conductive paste, placed in “international 10-20” system arrangement, a montage is how they are connected
letter is cortical region, even #s on right side, odd #s on left
electrode inputs compared in pairs

28
Q

What are the two basic types of epileptiform discharges?

A

focal and generalized

29
Q

What are the 2 basic features of a seizure on an EEG?

A

rhythmycity and evolution

30
Q

What are the 5 types of treatment for epilepsy?

A

behavioral modification
medications
vagal nerve stimulator - pulses to L vagal nerve
resective or disconnective surgery
ketogenic diet - high fat, no carb - restricted to children w severe forms of epilepsy

31
Q

What is the most common type of epilepsy surgery?

A

anteromesial temporal lobe resection for mesial temporal lobe epilepsy - takes a few cm of ant and lateral temporal neocortex and hippocampus

32
Q

What exactly is the PDS?

A

a giant EPSP, correlate of epileptic focus of neurons

Block 9 - Neuro (26 decks)

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