Epilepsy

Question 1

what is a seizure

Answer 1

an abnormal electrical network

Question 2

What is the difference between and focal and general seizure

Answer 2

focal seizure: It firing in one network, and stays in one area of the brain

general seizure: cross-corpus colosseum, and affect the other hemisphere

Question 3

Describe a focal seizure

Answer 3

• focal was known as partial
  
  • focal gives you an idea of the network model
  • someone knows a seizure is happening
  • and do not lose awareness
  • so seizure is short around 5 seconds
  • treatable but associated with a high rate of morbidity
  • in adult world you see focal

Question 4

Describe a generalised seizure

Answer 4

• you can get absences (might stare, eyelid flicker) → lasts around 15 seconds
• ages 6-10
• seizure can affect both arms, trunk and limbs
• happens if sleep-deprived

Question 5

symptoms of generalised seizures

What is meant by tonic

Answer 5

• limbs may stiffen
• increase muscle tone
• can happen in sleep
• easy to miss

Question 6

symptoms of generalised seizures

What is meant by atonic

Answer 6

• body flops
• decrease in muscle tone
• usually have intellectual disabilities
• if sitting heading may go and then come up

Question 7

symptoms of generalised seizures

What is meant by tonic clonic

Answer 7

tonic stiffening followed by a jerking phase

Question 8

symptoms of generalised seizures

What is meant by myoclonic jerks

Answer 8

Sudden jerking of both upper limbs so arms twitch

usually occurs if the patient is sleep deprived

Question 9

symptoms of seizures

What are the symptoms of seziures

Answer 9

• sensory symptoms-> tingling on one side of body
• motor phase: jerking on affected side of body (if prolonged can expereince todd paresis which causes weakness on affected side)

other symptoms
* sweating, flushing, pallor, tightness in thorat
* changes in hearing or vision
* can see coloured shapes

can differenate with migrane because seizure has visual or auditory disturbance is vivid
whilst with migraine it is a black and white visual disturbance

Question 10

How do we test for seizures

Answer 10

• MRI – essential in adults, unless strong suspicion of genetic generalised epilepsy
• CT can be used for A&E→ but will tell you about bleeding or if something else is happening
• EEG – useful for establishing focality
  
  • useful to work out where discharge is coming from
  • Focal abnormalities increase recurrence risk
  • 30% ‘hit rate’ on initial EEG, may need sleep deprived and/or ambulatory recordings

Question 11

What is the cause of generalised seizure

typically

Answer 11

genetic

Question 12

What is refractory epilepsy?

Answer 12

Ongoing seizures (≥ 1/ month) despite two adequate trials of antiepileptic drugs

1/3 patients refractory following a single AED

Question 13

Who is usually offered surgery for seizures

Answer 13

• someone having seizures
  
  • 1 a month, or 7 seizures a a week
• depends on the lesson
• needs a focal history of seizures
• need to be healthy and at a good age

Question 14

Who are the ideal surgical candidates

Answer 14

• Young, prior febrile seizures, recent seizure onset
• Primarily focal seizures
• Typical mesial temporal lobe symptoms
• Hippocampal sclerosis on MRI

those who come in with hippocampal sclerosis are more likely to get seizure free

• easy respectable tumors can be seizure free
• can do hemispherectomy usually for kids

Question 15

Before resective surgery what would you need to do