Epilepsy Flashcards
Define a Seizure
Define Epilepsy
Define Status Epilepticus
Seizure: abnormal synchornous firing of neurons that may or may not manifest as physical/neurological symptoms
Epilepsy: recurrent, unprovoked seizures
provoked seizures
- hypoglycemic induced
- acute stroke/brain injury
- drug (lowering threshold)
- alcohol withdrawl
- these are known causes of seizures thus not epilepsy
Status Epilepticus
seizure activity for…
- > 10 continuous minutes (non-convulsive) seen on EEG but no outward symptoms
- a total duration > 20% of a 60 minute interval: so multiple seizures 2-3 minutes but enough during a 60 minute period that its > 20%
- > 5 minutes of a ocontinuous convulsive seizure (bilateral tonic-clonic activity) seizure activity > 5 minutes = brain damage
tonic-clonic = jerking type motions of outward activity
non-convulsive = not outward appearance (absence)
focal = from one area of brain
Focal Seizures
what are they
- focal aware
- focal impaired awareness
- focal to bilateral tonic-clonic
Focal Seizure
- begins in one area of the brain, specific location
- can have focal motor, sensory or autonomic changes
- motor: will begin with jerky movements in one area then spread (jacksonian spread)
Focal Aware = consciousness maintained fully
Focal Impaired Awareness = consciousness impaired
Focal to Bilateral Tonic-Clonic = starts 1 place then spreads to tonic-clonic (jerky)
- starts in one spot, then to the whole body
- tonic = stiffening and continuous muscle activity
- clonic = the flexion stops & becomes “reset”
Focal = different areas of the brain elict different symptoms
Front Lobe: changes in behavior very common
Occipital Lobe: shapes and not weel defined people, dots or lines
Temporal Lobe: most common: aura symptoms (smells and tastes), deja vu, stomach/chest tighetning feeling, sweating or fear (autonomic); involves the imbi system
Parietal Lobe: body sensations
Other Types of Seizures (other than focal and its subtypes)
under the category of Generalized Seizures
Generalized Seizures
- Tonic : stiffening
- Atonic : drop attacks; lost tone throughout whole body, cant hold head up
- Myoclonic: muscle jerking; multiple muscles or just small twitch
- Absence: brief starting; shorter in nature with less post-ictal confuction
- Tonic-Clonic: large jerky outward movements
Seizure Mimickers
- syncope/convulsive
- psychogenicnon-epileptic seiaures (no seizure activity on EEG; psychiatric)
- troke/TIA
- complex migraine (auras!)
- sleep or movement disorders
Seizure Risk Factors
(505 of those with epilepsy have no RF)
Risk Factors
- complicated gestational birth
- TBI
- stroke
- tumor
- meningitis
- febrile seizures as a child
History Taking for Seizures to Dx.
Is there a Warning?: Aura, feeling, trigger? Provoking illness, subsatnce, meds?
Do you loose awareness? or concious?
multiple? how many & how long?
Description of behavior and movement: get from collateral
tongue biting? incontinence?
Streotyped or different every time? (epilepsy = sterotyped)
freqeuncy of occurance?
confusion afterwards?
Symptoms and Specifics of Focal to Bilatera Tonic-Clonic
Focal : at the start just a small localized areas of movement
then…
Tonic: stiffening of the whole body and continuous muscle activity
Clonic: rhythmic jerking
usually
- head lookws towards opposite and so do the eyes
Symptoms and Specifics of Focal unaware Seizures
Focal Unaware: lost consciousness but its a localized not whole body effect
- can have a prodrome: or know its coming/aura
- assocaited symptoms: lips smacking, chewing and motion show the seizure occuring (or other smaller movemtns like these would show)
Symptoms of Absence Seizure
- commonly see in childhood school aged kids
- stops what they’re doing = stare off into space
- usually eye fluttering or other small movement lip smacking
- can be unaware of their activity during the seizure
- loss of awareness without loss of body tone
First Time Seizure
- in untreated pt. with first unprovoked seizure: risk of having another one is 4-50% in the next two years
- thus you should treat them to reduce the risk
- those with abnormal EEG or identifibalt neurological conditions are an even more increased risk
if they have two recurrent unprovoked seizures = epilepsy
After a Seizure occurs
testing & imaging for dx. of Epilepsy
MRI: evalute for
- stroke
- tumor
- vascualr or cortical malformation
- hippocampal sclerosis
EEG
- a normal EEG doesnt rule out a seizure
inpatient EEG in an EMU with the event patured is gold standard diagosis of seizure
EEG wave patterns
- spike, sharp, Spike & wave, sharp and slow wave
- slwo spkie and wave, poly spikeand wave, mutliple sharp and slow wave, poly spike, multiple shapr complexes
Treatment of seizures
treatment = symptoms
2/3 of pt. can become seizure free on medication
Refractory Case: failed 2 medications = epilepsy surgery, resection or ablation of lesion
Palliative Tx.
- implantable devices (VNS, RNS and DBS to nucleus of thalamus)
- diet (ketogenic)
- alternative (CBD oil)
Meds
- Focal epilepsy only: phenytonin, lamotragine, carbamaepine, eslicarbazepine, oxcarbazpine
- Absence Seizure: ethosuximide
Pregnant pt.
- lamotrigine , levetiracetam and oxycarbazepine = lowest rate of transmission to child
