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Epilepsy > Continuum Epilepsy > Flashcards

Continuum Epilepsy Flashcards

1
Q

How long can post-ictal Todd’s last?

A

can last minutes to hours BUT can also last up to 36 hours (sometimes up to a 1 week)

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2
Q

What is Epilepsia Partialis Continua?

A
  • ongoing activity of 1 speific body part - can continue for months wihtout interruption in consciousness, years even
  • DDX
    • Rasmussens encephalitis
    • HONK
    • Focal cortical dysplasia
    • MERRF
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3
Q

What can Insular seizures present with?

A
  • they can present with tightening of throat, suffocation sense, warmth
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4
Q

How do visual seizures from primary visual cortex present?

A
  • flashes of lights, color patterns incontralateral VF or straight ahead
  • can get postictal blindness or darkness
  • can also get complex visual hallucinations like people or scenes
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5
Q

What are symptoms of auditory seizures with heschl’s gyrus involvement?

A
  1. hypoacusis
  2. hyperacusis
  3. buzzing sounds
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6
Q

Where can the fencing posture be localized to?

A

Tonic seizure from SMA contraleterally

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7
Q

Clinical complaints in patients with olfactory seizures from mesial temporal or superior temporal or uncinate gyrus

A

sulphur or burnt rubber smell

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8
Q

Where can you localize seizures that present with metallic or bitter taste?

A

Gustatory seizures from the insula

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9
Q

What are examples of psychic auras from medial temporal lobe?

A
  • Deja vu: an illusion of a familiar memory
  • Jamais vu: a familiar visual experience becomes unfamiliar
  • Deja entendu: an auditory illusion of something familiar
  • Jamais entendu: a familiar auditory experience becomes unfamiliar
  • Autoscopy: seeing oneself in external space, as it the mind has left the body
  • depersonalization - a feeling of unreality in one’s sense of self; feeling as if in a dream or watching oneself act
  • macropsia/micropsia - objects appear larger or smaller than usual
  • macracusia/micracusia: sounds are louder or softer than usual
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10
Q

What are the five subtypes of generalized abscence seizures?

A

Absence seizures with

  • atonic
  • with tonic
  • with impaired LOC only
  • mild clonic
  • automatisms
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11
Q

What are some differential diagnoses for JME?

A
  • IGE like JME
  • lafora body disease or PME
  • myoclonic Astatic
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12
Q

What are characteristics of Atonic seizures?

A
  1. Sudden loss of muscle tone
  2. last less than 5 seconds followed by minimal post-ictal confusion
  3. usually seen in symptomatic idiopathic generalized epilepsies like Lennox-Gestaut syndrome
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13
Q

How do you differentiate between MESIAL (LIMBIC) and LATERAL (NEOCORTICAL) foci?

A

MESIAL TEMPORAL LOBE versus LATERAL TEMPORAL LOBE

Mesial temporal lobe:

  • automatisms and oroalimentary automatisms and rising epigastric fullness more common

Lateral temporal lobe:

  • visual or auditory hallucinations and spreads rapidly to hemisphere or generalizes quickly
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14
Q

What is the second most common epilepsy? And what are it’s characteristics?

A
  • Frontal lobe epilepsies (30%)
  • Quick Stereotyped
  • orbitofrontal seizures characterized by mydriasis, flushing, tachycardia
  • multiple times per day with no post ictal confusion
  • FRONTAL SEIZURES - FIGURE OF 8, tonic posturing and other semiologies
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15
Q

For the following clinical seizures, please indicate the localization or lateralization.

  • HEAD TURN
    • early nonforced
    • forced
    • late forced
  • ocular version
  • focal clonic
  • dystonic limb
  • unilateral tonic limb
  • M2e sign (fencing posture)
  • Figure 4
  • ictal paresis
  • todd paresis
  • unilateral blinking
  • unilateral limb automatism
  • postictal nose rubbing
  • postictal cough
  • bipedal automatisms
  • hypermotor
  • ictal splitting
  • automatisms with reserved responsiveness
  • gelastic
  • ictal vomitting/retching
  • ictal urinary urge
  • loud vocalization
  • ictal speech arrest
  • postictal aphasia
    *
A
  • HEAD TURN
    • early nonforced –> ipsilateral temporal
    • forced –> frontal
    • late forced –> contralateral temporal
  • ocular version .–> CL occipital
  • focal clonic –> CL perirolandic or temporal
  • dystonic limb –> CL temporal > frontal
  • unilateral tonic limb –> CL hemisphere
  • M2e sign (fencing posture) –> CL frontal > temporal
  • Figure 4 –> CL hemisphere
  • ictal paresis –> CL hemisphere
  • todd paresis –> CL hemisphere (extratemporal > temporal)
  • unilateral blinking –> ipslateral hemisphere
  • unilateral limb automatism –> ipsilateral hemishere
  • postictal nose rubbing –> ipsilateral temporal >frontal
  • postictal cough –> CL temporal
  • bipedal automatisms –> frontal > temporal
  • hypermotor supplementary motor area
  • ictal splitting –> right temporal
  • automatisms with reserved responsiveness –> right temporal
  • gelastic - hypothalamic hamartoma, mesial temporal
  • ictal vomitting/retching –> right temporal
  • ictal urinary urge –> nondominant temporal
  • loud vocalization –> frontal > temporal
  • ictal speech arrest –> temporal
  • postictal aphasia –> language-dominant hemisphere
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16
Q

What are characteristics of parietal lobe?

A
  • less than 10%
  • clinically silent areas as generators but manifest once other areas are spread to
  • DOMINANT hemisphere: language deficits
  • NONDOMINANT hemisphere: neglect
17
Q

What are characteristics of occipital lobe seizures?

A
  • visual hallucinations, auras, transiently, followed by field defect as part of Todds phenomenon

Account for less than 10% of focal seizures.

  • White or coloured lights in contralateral VF and spread to the rest of VF.
  • If spreads to posterior temporal region- complex visual hallucinations form.
  • Tend to have contralateral eye deviation and repetitive blinks.
  • On top of all positive phenomena
  • Eyes can blink rapidly and deviate contralaterally.
18
Q

What is ADNFLE?

A
  • Autosomal dominant nocturnal frontal lobe epilepsy
  • clusters of brief 5- 30 seconds during N2 or NREM sleep
  • misdiagnosed as parasomnias or nightmares
  • mean age is 12
  • brief motor attacks, often shouting, bimanual or bipedal automatisms, sometimes violent behaviour.
19
Q

what childhood seizure disorder is MTE with hippocampal sclerosis associated with?

A

Strongly associated with prolonged febrile seizure in childhood.

  • other characteristics of MTE with hippocampal sclerosis
    • most report auras
    • often prior febrile seizures
    • later head turn prior to secondary generalziation.
20
Q

What are characterisitics of Myoclonic Epilepsies?

A
  • STIMULUS-INDUCED versus JME
  • remember DDx
    • massive myoclonus leading to falls
    • EPS, cerebellar dysfunction also noted
    • DDx (mostly AR)
      • lafora body (a fatal autosomal recessive genetic disorder characterized by the presence of inclusion bodies, known as Lafora bodies, within the cytoplasm of the cells of the heart, liver, muscle, and skin)
      • ceroid lipofuscinosis (lysosomal storage disorder)
      • Gaucher (sphingolipid storage disease) and sialidoses
      • MERRF (mitochondrial diease)
      • Baltic myoclonus or Uverricht Lundborg
21
Q

Can a frontal lobe seizure diagnosis be missed on EEG with scalp electrodes?

A

YES

22
Q

Name five things about clinical history which correlate well with PNES?

A
  • Stuffed animal sign
  • fibromyalgia
  • history of abuse or PTSD4
  • pseudosleep
  • seizure while in clinic
23
Q

what percent of syncopal events have convulsive features?

A
  1. 40 - 90%
  2. vasovagal in young, arrhythmia in old.
24
Q

What medications can make epilepsy worse?

A
  • Quinolones
  • B-lactams
  • anti-psychotics, opiates
  • In younger populations: acute concussive injury may predominate with trauma and infection in the young.
  • CVA and neoplastic in the elderly
25
Q

Is there any evidence that early AED prevents future Sz in post-trauma patients?

A

NO

26
Q

What tests should you order for a first time seizure ?

A
  1. MRI or CT of brain with contrast
  2. EEG (preferably including a sleep recording)
  3. routine blood laboraory test
  4. Labs (Na, potassium, magnesium, ionized calcium, creatinine, liver enzymes, CBC with differential)
  5. consider CSF
  6. EKG (screen for QT prolongation)
  7. Urine Tox screen
27
Q

What is recurrence rate of FES unprovoked?

A
  • 33-50% after 1 seizure at 2-5 year follow-up
  • 73% after second
  • and 76% after third

MOST RECUR IN FIRST YEAR

28
Q

How much do AEDs help with seizure risk managment?

A

After initiation of therapy 86% achieve a 3 year and 68% a 5 year remission.

29
Q

What are risk factors for favourable and unfavorable discontinuation of AEDS?

A

See image.

  • risk factor for recurrence includes SZ onset between 10-12 years

Epilepsy (1 decks)

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