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Disease in the brain > Epilepsy > Flashcards

Epilepsy Flashcards

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1
Q

When was epilepsy first described?

A

In Babylon 1500 BCE

Was known as Miqtu (the falling sickness)

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2
Q

Who identified symptoms of epilepsy in 450-350 BCE?

A

Hippocrates

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3
Q

Who started a definition for epilepsy based on physiology?

A

Huhglings Jackson 1870

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4
Q

What did Hughlings Jackson identify in epilepsy?

A

He noticed the focal nature of it

& realised damage than area of the brain could cause epileptic seizures

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5
Q

Who was the first to record electrical activity on the scalp of epilepsy?

A

Hans Berger performed the first EEG in absence epilepsy 1931

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6
Q

What did Hans Berger notice in his EEG?

A

He noticed sudden changes in electrical rhythms in the brain

These would now be recognised as absence seizures

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7
Q

What did Wilder Penfield do to study epilepsy?

A

He used neurosurgery & brain stimulation to study epilepsy

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8
Q

What was a focus of Wilder Penfield’s studies & what did he discover

A
  • He did lots of work on temporal lobe epilepsy
  • He could stimulate temporal lobe & this could evoke memories in a patient (e.g. familiar memory to patient & they feel like they are apt to have an attack)
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9
Q

Define a seizure:

A

A transient occurence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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10
Q

Define epilepsy:

A

“A pathologic & during tendency to have recurrent seizures”

AND

“by the neuro-biologic, cognitive, psychological & social consequences of this condition”

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11
Q

What do all seizure types share?

A

Abnormal neuronal firing in a particular brain network which trigger clinical symptoms:

  • May alter consciousness
  • May have external signs
  • Will often have an EEG signature
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12
Q

How do the types of seizures differ?

A
  • Brain networks involved
  • Signs & symptoms
  • Causes
  • Drug therapy (need to be specific to type of seizure)
  • Prognosis (final outcome)
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13
Q

What are the 2 main types of seizures?

A
  • Generalised seizures
  • Focal seizures
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14
Q

What is a generalised seizure:

A

A seizure that starts simultaneously in both hemispheres

It spreads from there

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15
Q

What is a focal seizure:

A

Seizure starts in a focus (on one side of the brain) & then spreads across the brain

(Can spread from one hemisphere to another)

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16
Q

How can a focal onset seizure be classified?

A
  • Does the patient have awareness?
  • Is there motor onset or not?
  • If it progresses from focal to bilateral tonic-clonic (not all will do this but it is good to classify with)
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17
Q

How can generalised onset seizures be classified?

A

Motor and non-motor symptoms

Is there tonic-clonic or other motor symptoms present

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18
Q

What is the definition of a generalised seizure?

A

“Originating at some point within, and rapidly engaging, bilaterally distributed networks”

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19
Q

What are the 3 types of generalised seizures?

A
  • Typical absence
  • Myoclonic
  • Tonic-clonic
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20
Q

What is the usual onset of typical absence seizures?

A

Mainly childhood in onset

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21
Q

How long do typical absence seizures last?

A

Frequent brief attacks (1-30s)

(In video patient was briefly unaware w little face movements but quickly comes back around)

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22
Q

What happens during an typical absence seizure to the patient?

A
  • Sudden loss & return of consciousness
  • No aura (warning signs) & no post-ictal state (period after seizure where brain is recovering)
  • Some involuntary movements
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23
Q

When an EEG is taken of an absence seizure, what does it look like?

A

There is a 3Hz spike and wave (electroclinical syndrome)

(Pretty sure this is seen at the start of the seizure)

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24
Q

What are the physical symptoms of a patient suffering a myoclonic seizure?

A
  • Sudden, brief, shock-like muscle contractions
  • Usually bilateral arm jerks (can also be legs)
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25
Q

What factors can affect myoclonic seizures?

A
  • Time of day (often worse in mornings)
  • Precipitated (induced) by sleep deprivation & alcohol
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26
Q
A
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26
Q
A
27
Q

How can myoclonic seizure be controlled?

A

There are Lon-term treatments involved in this

28
Q

What are the physical symptoms of a patient suffering a tonic-conic seizure?

A
  • Sudden onset, gasp, fall
  • Tonic phase w cyanosis (blush tint to skin & lips - shows circulation issues)
  • Clonic phase
  • Post-ictal phase
29
Q

What happens in the tonic and clonic phases of a tonic-clonic seizure?

A

Tonic = Body becomes stiff

Clonic = Rhythmic jerking on muscles

These happen in this order (hence the name)

30
Q

What is the post-ictal phase of a seizure?

A

Period of time after a seizure / recovery phase

31
Q

Patient usually has no memory of a tonic-clonic seizure, so what can a clinician observe?

A

Can ask the patient about:

  • Tongue bitten & incontinence
  • Noisy breathing
  • Headache & muscle pain afterwards
32
Q

What is the generalised onset of tonic-clonic seizures?

A

The tonic & clonic phases appear

Some with have myoclonic involved too –> a cluster of symptoms known as generalised epilepsy –> Brain lesions not usually found as likely genetic

33
Q

What is the generalised onset of atonic seizures?

A

Tends to occur in children w intellectual disability & bad epilepsy

34
Q

What is an atonic seizure?

A

AKA a drop seizure

You get a little jerk then sudden total body atonia for a split second

35
Q

Where do focal seizures start?

A

They originate in networks limited to one hemisphere –> may propagate to the other

36
Q

As focal seizures propagate, what happens to the patient?

A

The symptoms they experience will evolve

Symptoms vary in beginning & change throughout the seizure

37
Q

What is a focal with awareness seizure?

A

This is where the patient does not lose awareness

(Old terminology = simple partial)

38
Q

What is a focal without awareness seizure?

A

This is where the patient loses awareness

(Old terminology = complex partial)

39
Q

What is the most common type of focal epilepsy & why?

A

Temporal lobe seizures

Bc this is the most common area where lesions form

40
Q

How common is a warning (aura) in a focal seizure?

A

2/3 of patients get this warning that a seizure is coming

41
Q

What are the types of warnings (aura) that ppl get b4 a focal seizure?

A
  • Epigastric rising sensation (butterflies)
  • Olfactory & gustatory symptoms
  • Deja vu (strong feeling of familiarity)

(May also feel fearful & autonomic symptoms)

42
Q

What does it mean is a focal seizure stops after the warning (aura)?

A

Some seizure can stop after this as it does not spread to the other lobe

These are known as focal seizure with awareness

43
Q

What happens if a focal seizure spreads to both lobes?

A

Loss of awareness will happen

44
Q

What happens to a patient during loss of awareness in a focal seizure?

A
  • Arrest reaction & blank stare
  • Oral automatisms (lip-smacking)
  • Manual automatisms
45
Q

What often happens after a focal seizure (loss of awareness)?

A

Often experience post-ictal phase

These take a while to regain consciousness from

46
Q

What are the 3 key steps in a focal seizure?

A
  • Aura (warning phase)
  • Loss of awareness
  • Post-ictal phase
47
Q

What are the 3 methods used to study seizures experimentally?

A
  • Hippocampal slices exposed to stimuli, provoking acute seizures
  • Animals with CNS injury causing seizures
  • Rodent genetic models
48
Q

How do you prepare a hippocampal slice for testing?

A
  • Slice about 400 microns thick
  • Kept alive for many hours in warm oxygenated bath
49
Q

What stimuli can be applied to the prepared hippocampal slice?

A
  • Electrical stimulus

OR

  • Various convulsive stimuli (transmitter based or channel based)

Depending on which one is used - results will differ

50
Q

What are the limitations of hippocampal slice to test epilepsy?

A
  • A reduced model - not all network connections present
  • Model of acute seizures only, not recurrent seizures
  • Typically non-physiological triggers are needed
51
Q

What are the advantages of hippocampal slice to test epilepsy?

A
  • Realistic epileptic discharges can be created
  • V detailed neurophysiology & neuropharmacology
  • More humane than animals models
52
Q

What are the 4 things we study from the hippocampal set up?

A
  • Local field potentials LFPs
  • Spikes
  • Inter-ictal spikes
  • Seizure
53
Q

What is a local field potential?

A

An EEG but done in the brain (micro EEG)

54
Q

What does a Local field potential measure?

A

The summed synaptic activity from thousands of neurons (it is a summary event)

Using a micro EEG

55
Q

How do you measure a spike?

A

Impale or patch clamp an individual neurone

56
Q

What does a spike show?

A

Shows a single neutron firing (can see spiking activity)

57
Q

What is an inter-ictal spike?

A

A marker of epileptic activity in a cortex

Is a long event= 200ms –> indicates an area of cortex prone to seizures

58
Q

What are the 3 types of stimuli used to trigger the hippocampal slice?

A
  • Bath medium
  • Drugs
  • Electrical stimulation
59
Q

What are the bath mediums that can be used to induce seizures in the hippocampal slice?

A
  • Low Mg++
  • Low Calcium
60
Q

What are the drugs that can be used to induce seizures in the hippocampal slice?

A
  • 4 Aminopyridine (K+ blocker)
  • Bicuccilline (GABA blockers)
60
Q

What is the action of the drug 4 Aminopyridine?

A

It blocks potassium channels that repolarise cells

A K+ blocker

61
Q

What is the action of the drug Bicucculline?

A

It is a GABA blocker –> blocks inhibitory networks

62
Q

What are the 2 things we have learned from acute slice models?

A

1 - Mechanisms are dependent on the model used

2 - Epileptiform discharges due to combination of effects

63
Q

Finish from what have we learned in acute slice models

A

Disease in the brain (22 decks)

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