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Neuropsychiatric Disorders > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What are the two main definitions for diagnosis of epilepsy?

A

▪️At least 2 unprovoked seizures >24 hours apart
OR
▪️One unprovoked seizure and probability of further seizures similar to recurrence after two

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2
Q

When is epilepsy considered resolved?

A

▪️Past the applicable age if age-dependent
OR
▪️Seizure-free for last 10 years and no medicines for last 5 years

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3
Q

What are the three main types of seizure?

A

▪️Focal onset
▪️Generalised onset
▪️Unknown onset

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4
Q

How can you further classify focal onset seizures?

A

▪️Aware vs impaired awareness
▪️Motor onset vs nonmotor onset

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5
Q

What is an absence seizure?

A

▪️Generalised onset
▪️Nonmotor
▪️Brief, sudden lapses of consciousness
▪️Impaired awareness/behavioural arrest

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6
Q

What is a tonic-clonic seizure?

A

▪️Typically generalised
▪️Body goes stiff (tonic)
▪️Followed by twitching (clonic)

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7
Q

How might a focal onset nonmotor seizure present?

A

▪️Autonomic
▪️Behaviour arrest
▪️Cognitive
▪️Emotional
▪️Sensory

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8
Q

Which is a clonic seizure?

A

Rhythmic jerking of arms and legs of one or both sides

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9
Q

What is a tonic seizure?

A

Sudden stiffness or tension in muscles

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10
Q

What is a myoclonic seizure?

A

Brief shock-like jerks of a muscle or group of muscles

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11
Q

What is a ‘grand mal’ seizure?

A

Old name for generalised tonic-clonic seizure

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12
Q

What are the 4 main stages of a tonic-clonic seizure (‘grand mal’)?

A
  1. Myoclonic
  2. Tonic
  3. Intermediate vibratory phase
  4. Clonic
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13
Q

Are tonic-clonic seizures symmetrical or asymmetrical?

A

Can be either

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14
Q

What can head deviation in a seizure tell us?

A

Can indicate the location of the seizure onset as the head turns to the side that it is on

(pushing motion from muscle)

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15
Q

What can asymmetric arm straightening tell us about the seizure?

A

Might indicate the location of the seizure - straightened arm is often contralateral to the side of the seizure onset

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16
Q

Lots of seizures start __________ then quickly ___________

A

▪️Focally
▪️Generalise

Can be hard then to differentiate!

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17
Q

Who is more likely to have focal epilepsy?

A

▪️Following injury to head
▪️Older (younger people more likely generalised)

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18
Q

What is JME?

A

▪️Juvenile myoclonic epilepsy
▪️Absence + myoclonic events in childhood
▪️May develop early morning tonic-clonic seizures as teenagers
▪️Generalised but short events
▪️Typically early morning

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19
Q

If someone talks throughout the seizure, what does this suggest?

A

Focal onset in the right temporal lobe

Might last longer and associate with an aura

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20
Q

What are the two main types of absence seizures?

A

▪️Limbic complex partial seizure (mesial temporal lobe epilepsy)
▪️Typical absences (idiopathic generalised epilepsy)

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21
Q

What might awareness during a seizure suggest?

A

Focal onset

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22
Q

What are the main signs of a typical generalised absence seizure?

A

▪️Often young children
▪️Short and uncomplicated
▪️No aura
▪️Most commonly in the morning
▪️Distinct focal spikes but normal between seizures
▪️~40% have a relative with them

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23
Q

What are the main signs of a TLE absence seizure?

A

▪️Prolonged and complicated
▪️Often begin with aura
▪️More frequent
▪️Focal onset
▪️Automatisms
▪️More often maintain awareness

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23
Q

What are the main differential diagnoses for epilepsy?

A

▪️Syncope (reflex, vasovagal, cardiac, orthostatic hypertension)
▪️Psychogenic/dissociative seizures
▪️Other (e.g. stroke, cataplexy, migraine, “drop attacks”)

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24
Q

What are the

A
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25
Q

What is a syncope?

A

▪️Transient loss of consciousness and postural tone
▪️Caused by cerebral hypoperfusion ▪️Spontaneous recovery

26
Q

What is a vasovagal syncope?

A

▪️Reflex syncope
▪️Sudden drop in blood pressure
▪️Often associated with situational triggers (e.g. Long time standing up, warm environment, physiological stress, acute pain, venepuncture)
▪️Facilitated by dehydration or anxiety
▪️Very common!

27
Q

How can you tell if someone had a syncope?

A

▪️Describe aura (lightheaded, neuasea, sweaty, blurry vision)
▪️Witness accounts (sweaty, sudden floppy, collapse, spontaneous recovery)

28
Q

What might memory of the syncope event and aura suggest?

A

Pseudo-syncope - aura but doesn’t actually faint

29
Q

How long do syncopes usually last and what might a prolonged event indicate?

A

▪️LoC < 20 seconds
▪️Prolonged = reflect anoxic seizure

30
Q

What might post-ictal confusion indicate?

A

Seizure rather than syncope/faint

31
Q

What are some of the issues with differentiating between seizure and syncope?

A

▪️First episode
▪️No clear trigger
▪️Rapid evolution
▪️No recall of typical symptoms
▪️Eyes open
▪️Post-ictal confusion?
▪️Incontinence

32
Q

What are the main signs of non-organic syncope (PNES) ?

A

▪️Frequent episodes
▪️Emotional triggers
▪️Memory of losing consciousness
▪️Partly aware, may move to space place to fall
▪️Long events, on and off
▪️Subtle eyelid flutter

33
Q

What might cause cardiac syncope?

A

▪️Bradycardia
▪️Arrest
▪️Bradycardia-tachycardia syndrome
▪️Atrial fibrillation (irregular)
▪️Structural obstruction (e.g. narrowing of valves, swelling o muscle)

IMPORTANT TO DO ECG!

34
Q

What is cataplexy?

A

Sudden muscle weakness (atonic) in response to strong emotions such as anger or laughter

35
Q

What might cataplexy be confused with?

A

▪️Atonic seizure
▪️Narcolepsy
▪️Syncope
▪️PNES

36
Q

What signs might indicate cataplexy?

A

▪️Partial atonia spreading gradually
▪️No LoC
▪️No “postictal” clouding
▪️Depressed reflexes during
▪️Emotional trigger

37
Q

What is the main demographic of PNES?

A

▪️Women
▪️Late adolescencr/early adulthood
▪️10% also have epilepsy (~20% PwE also have PNES)

38
Q

What can you use to differentially diagnose epilepsy from PNES?

A

▪️History
▪️Video EEG

39
Q

What signs outside of seizure presentation are suggestive of PNES instead of epilepsy?

A

▪️Inconsistent response to AED
▪️More likely in presence of witness
▪️6x more likely to have witnessed a seizure
▪️History of sexual abuse

40
Q

What ictal presentations may be suggestive of PNES instead of epilepsy?

A

▪️Lack of event stereotypes - changing ictal symptoms and types
▪️Longer, fluctuating events
▪️Eyes closed, resistent to opening (but open on command)
▪️Pelvic thrusting/rocking
▪️Emotional response
▪️Stay seated

41
Q

If someone has a seizure whilst asleep, what might this suggest?

A

Epileptic event as oppose to PNES

42
Q

What signs are not very indicative of the nature of a seizure?

A

▪️Tongue biting
▪️Urinary incontinence
▪️Flailing and trashing movements

43
Q

What is photic stimulation?

A

A technique whereby lights are flashed at the patient to try and evoke a seizure

44
Q

How can you differentiate a panic attack from a focal seizure?

A

▪️Could be gradual
▪️Triggers?
▪️Longer duration
▪️Other symptoms (e.g. chest pain, nausea, sweating)
▪️No “postictal” confusion

45
Q

Sleep ____________ epilepsy

A

promotes

increases risk of

46
Q

When conducting an EEG, patients are often asked to be ________________

A

Sleep deprived

47
Q

What sleep disorders may present with movements similar to epilepsy?

A

▪️Hypnic jerks (benign hypnagogic myoclonus)
▪️Excessive daytime sleepiness
▪️Arousal parasomnias
▪️REM parasomnias

48
Q

What seizures might most commonly be mistaken for abnormal parasomnias?

A

Nocturnal frontal lobe seizures

49
Q

How might sleep influence seizures?

A

▪️Increase in transitional phases
▪️More prevalent when tired
▪️Decrease during REM

50
Q

What focal seizures are seen most commonly in sleep?

A

Frontal (as oppose to temporal)

51
Q

What stage of sleep are you most likely to see seizures such as generalised tonic or focal frontal?

A

NREM

52
Q

How might seizures influence sleep?

A

▪️Increased REM latency
▪️Interictal generalised spike wave discharge may lead to epileptic arousals and sleep disruption
▪️Viscious cycle (sleep disrupted = more tired = more likely to have seizure)

53
Q

What is the relationship between OSA and epilepsy?

A

▪️More common in PwE
▪️Can make epilepsy worse - disordered sleep architecture?

54
Q

What is the most common site of focal onset epilepsy?

A

Temporal lobes

55
Q

How might frontal lobe seizure present?

A

▪️Hyperkinetic
▪️Early motor manifestations
▪️Bizarre automatisms
▪️Strange, ballistic movements, can be asynchronous
▪️Pelvic thrusting and turning
▪️Partial awareness
▪️Brief and often in sleep
▪️Vocal and have little confusion afterwards

56
Q

How might orbitofrontal seizures present?

A

▪️Hyperkinetic
▪️Emotional

57
Q

How might medial temporal lobe epilepsy present?

A

▪️Auras (epigastric?)
▪️Automatisms (e.g. hand movements)
▪️Orofacial automatisms (e.g. lip smacking, chewing)
▪️Contralateral dystonia posturing

58
Q

How might lateral temporal lobe epilepsy present?

A

▪️Auras (dysphasia, auditory hallucinations)
▪️Motionless staring
▪️Contralateral clonic jerking
▪️Slower ictal activity than mTLE and wider field

59
Q

How might occipital seizures present?

A

▪️Visual phenomena
▪️Mixed degree of recall depending on onset location (calcarine vs occipitotemporal)
▪️Can spread to involve motor symptoms

60
Q

How does OLE aura differ from migraine auras?

A

▪️Multicoloured
▪️Rounded patterns
▪️Rapid onset and disappearance
▪️Association with other seizure symptoms

61
Q

How might EEG look after and inbetween seizures?

A

Often abnormal activity, can take a while to normalise if at all

62
Q

What is the difference between a tonic movement and a spasm?

A

Tonic = shorter, more brief contractions

Neuropsychiatric Disorders (30 decks)

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