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Neurobiology of Disease > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

goals of managing epilepsy

A

no seizures
no side effects
manage comorbidities
optimize quality of life
prevent major complications like status epilepticus and SUDEP

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2
Q

challenges in managing epilepsy

A

variety of seizure types, causes, epilepsy syndromes
complex underlying mechanisms
high rate of medication failure

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3
Q

psychological consequences of epilepsy

A

loss of driving
underemployment
under-education
social isolation

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4
Q

morbidity consequences of epilepsy

A

increased risk of falls, lacerations, burns, fractures
increased rate of anxiety, depression, suicide

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5
Q

reasons for mortality in epilepsy

A

SUDEP
status epilepticus: mortality rate 20%

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6
Q

seizures

A

paroxysmal hyperexcitability of population of neurons
10% of people will have at least one seizure, 4% will have 2+

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7
Q

provoked seizure

A

occuring in the setting of transient CNS or systemic insult

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8
Q

unprovoked seizure

A

no apparent acute provoking cause

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9
Q

epilepsy

A

2+ unprovoked seizures 24 hours apart or single unprovoked seizure with >60% likelihood of reoccurrence
3% of people will have epilepsy at some time in their life

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10
Q

diagnosis of epilepsy: history

A

conducted with patient and witness
discuss risk factors: head injury, CNS infection, stroke, tumor, febrile seizures, autoimmune disease, family history
precipitants: sleep deprivation, stress, illness, alcohol, flashing lights
seizure description

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11
Q

diagnosis of epilepsy: examination

A

signs of global brain development
signs of focal dysfunction
interictal EEG: in between seizure states
MRI
diagnostic study

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12
Q

epilepsy and genetics

A

each year the number of known epilepsy genes increases
genes are associated with ion channel function, NT receptors, synaptic complexes, intracellular pathways, metabolism

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13
Q

epilepsy and neurochemistry

A

seizure initiators include low sodium or high potassium concentrations extracellularly, GABA antagonists, glutamate agonists

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14
Q

How does epilepsy change inflammatory response?

A

increases

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15
Q

absence seizure hypothesis

A

hyperexcitable cortex and thalamus produce an excessive reverberating loop
generalized spike wave is recorded from cortex

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16
Q

dormant basket cell hypothesis

A

in the hippocampus dormant basket cells become inactive
excitation is unopposed creating prolonged depolarization

17
Q

mossy fiber sprouting hypothesis

A

mossy fibers synapse back on themselves, producing a positive feedback loop
CA3 cells undergo sustained depolarization

18
Q

epilepsy treatment strategies: absence

A

inhibit excitation: calcium channels
neurostimulation
gene therapy

19
Q

epilepsy treatment strategies: focal/impaired

A

inhibit excitation: calcium channels, voltage dependent sodium channels
promote inhibition
neurostimulation
surgical resection or ablation
gene or cellular therapy

20
Q

What is drug resistant epilepsy?

A

failure to control seizures despite trials of two seizure medications
occurs in about one-third of patients

21
Q

neurostimulation

A

electrical current delivered by internalized pulse generator
specific target in CNS/PNS
continuous, intermittent, or on-demand stimulation

22
Q

types of neurostimulation

A

closed loop: responds to patient seizure
open loop: programmed

23
Q

mechanism of neurostimulation

A

not fully understood
low frequency: enhance neuronal activity
high frequency: reversibly simulate “lesion” of targeted structure

24
Q

device therapy: VNS

A

indicated in refractory epilepsy
minimally invasive
HR detection of biomarker for seizures
long battery life
better at reducing seizures than stopping them
side effect: hoarseness or voice change

25
Q

device therapy: RNS

A

indicated in refractory epilepsy
closed loop device: potential to abort seizures
long term ECoG
invasive
limited battery life
usually requires invasive video EEG to place electrodes

26
Q

Is it beneficial to add VNS to RNS?

A

yes: many patients improve, seems to have an additive effect

27
Q

device therapy: DBS

A

indicated in refractory or generalized epilepsy
familiar technology
appropriate for multifocal or poorly localized epilepsy
invasive
not closed loop
no long term ECoG

28
Q

indications for epilepsy surgery

A

drug resistant
localized seizures
resection can be performed safely and effectively
informed and willing patient
referral to surgical epilepsy center

29
Q

epilepsy surgical evaluation

A

phase 1: noninvasive - video EEG, MRI, neuropsychological testing
phase 2: invasive - implanting electrode arrays, stereo EEGs
phase 3: Wada test, resection surgery

30
Q

What is the outcome one year after epilepsy surgery?

A

about 60% of people are seizure free

Neurobiology of Disease (9 decks)

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