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Neuropsychiatric disorders > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the most common localisation related epilepsy syndrome?

A

Temporal lobe epilepsy

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2
Q

What is semiology?

A

Clincial signs and symptoms

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3
Q

What does a classification of epileptic syndromes take into account?

A
  • classification of seizures
  • patterns and signs of symptoms
  • age at onset
  • electrophysiology
  • background and family history
  • natural history
  • potential aetiology
  • pathology
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4
Q

ILAE

A

International League Against Epilepsy

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5
Q

Partial seizures

A

Seizures that arise from epileptic discharges beginning in a specific brain region

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6
Q

Generalised seizures

A

Seizures that have no detectable focal onset and involve the cortex bilaterally from onset

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7
Q

Which seizure types are classified as partial (or focal) seizures?

A
  1. Simple partial seizures
  2. Complex partial seizures
  3. Partial seizures which evolve to secondary generalised seizures
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8
Q

Which seizure types are classified as generalised seizures?

A
  1. Absence seizures
  2. Atypical absence seizures
  3. Myoclonic seizures
  4. Clonic seizures
  5. Tonic seizures
  6. Tonic-clonic seizures
  7. Atonic seizures

unclassified epileptic seizures

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9
Q

What are the two main manifestations of epilepsy?

A

Focal seizures and generalised seizures

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10
Q

Define focal seizures

A

Focal seizures (partial seizures) originate from a localised region of a single cerebral hemisphere.

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11
Q

What is the main characteristic features of simple partial seizures?

A
  • Consiousness is fully retained
  • Motor signs
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12
Q

What is the most common form of simple partial seizures?

A

Motor seizures localised in the primary motor cortex.

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13
Q

What is the main characterisitc feature of complex partial seizures?

A

Conciousness is imparied during the seizure

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14
Q

Define

Clonic

A

Regular, rhythmical jerking movements

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15
Q

Which motor signs are common in complex partial seizures?

A
  • dystonic posturing
  • complex behavioural automatisms
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16
Q

What are the characteristic features of seizures localised in the primary sensory cortex?

A

Elementary sensory symptoms

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17
Q

What are the characteristic features of seizures localised in neocortical regions with a higher-order integrating sesnory function e.g., tempoparietal areas

A

Complex illusions and hallucinations

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18
Q

What are the characteristic features of seizures localised in the postcentral gyrus?

A
  • tingling
  • pins and needles
  • electrical sensations
  • numbness
  • unusual smell/ tastes
  • hallucinations
  • visual disturbances e.g. flashing lights nad simple patterns

Somatosensory symptoms

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19
Q

How long do simple partial seizures typically last?

A

A few seconds

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20
Q

EEG during a simple partial seizure is…

A

usually normal

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21
Q

Which type of seizure is associated with aura?

A

Complex partial seizures

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22
Q
A
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23
Q

Generalised tonic clónica

A

Started focal then generalise
Tonic phase - stiffening
Clonic phase - jerking
Figure of 4 sign

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24
Q

Children are more likely to have generalised seizures. True or false

A

True

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25
Absence seizures ‘classic’ EEG
3 to 5 Hz spike and wave activity Starts and ends abruptly
26
Ictal speech
Focal seizure localised in the non dominant hemisphere (right) temporal lobe. Tonic in left side of body
27
28
PNES
Psychogenic non epileptic seizures
29
What is the incidence of PNES
1-4-4.9/ 100,000/ year
30
What is the prevalence of PNES
2-33/ 100,000
31
What percentage of patients with epilepsy also have PNES?
Approximately 20%
32
When during the lifetime do PNES typically occur?
Late adolescence to early adulthood
33
PNES occurs more frequently in females than males. True or false
True
34
Which clinical signs support a diagnosis of PNES (rather than epilepsy syndrome)
Long duration Fluctuating course Asynchronous movements Pelvic thrusting Side to side head or body movements Ictal crying Memory recall Inconsistent response to anti seizure medication
35
Which clinical signs support a diagnosis of epilepsy syndrome (rather than PNES)
Sleep EEG Postictal confusion Stertorous breathing (low pitched ‘snoring’ sounds from partial blockage of upper airways)
36
What are the most common oro-alimentary automatisms?
- lip-smacking - chewing - swallowing
37
What are some common gestural automatisms?
- repetitively picking at clothing - repetitive adjusting clothing - handling objects
38
What are some common vocal automatisms?
- Perseverative utterances - humming - singing - laughing
39
What is another name for perseverative utterances?
Epileptic pallilalia
40
Gelastic seizures
Laughing
41
Ambulatory automatisms
Wandering
42
Cursive seizures
Walking in circles
43
What are the types of automatisms (4)
Vocal Ambulatory Oro-alimentary Gestural
44
What is seen on EEG during a complex partial seizure?
Unilateral or bilateral epileptiform discharges most commonly in the temporal or frontotemporal regions
45
Secondary generalisations occur in which percentage of patients with partial seizures?
60%
46
What is the defining characteristic of generalised seizures?
No detectable focal onset
47
What are the differential diagnoses for epilepsy syndrome?
Panic attack Syncope Common faint PNES
48
Which classes of antidepressants are indicted in epilepsy?
SSRIs SNRIs TCA
49
SSRI
Selective serotonin reuptake inhibitor
50
SNRI
Selective norepinephrine reuptake inhibitor
51
TCA
Tricyclic antidepressant
52
Which SSRIs are indicated in epilepsy?
- fluoxetine - sertraline - paroxetine - citalopram
53
Which SNRI is indicated in epilepsy?
Duloxetine
54
Which TCAs are indicated in epilepsy?
- Amitryptilline - Imipramine
55
What are the clinical features of medial temporal lobe epilepsy (mTLE)
- aura - motionless stare - speech automatisms - ipsilateral automatisms - contralateral dystonic posture - head version before bilateral tonic-clonic seizure - postictal coughing - ipsilteral postictal nose wiping - interictal … - ictal
56
Postictal coughing is a clinical feature of epilepsy from which region
Right medial temporal lobe epilepsy
57
What are the clinical features and EEG pattern seen in lateral temporal lobe epilepsy?
*clinical features* - aura - motionless stare - contralateral jerking movements (clonic) - imaging is either normal or lateral temporal lesions are seen *EEG* - interictal spikes over the mid temporal region - ictal EEG slower than mTLE and over a wider field
58
Clinical features and characteristics of occipital lobe epilepsy
Localised or spread Etc (slides)
59
Describe the features of visual features of OLE
Multicoloured, rounded patterns which appear and disappear rapidly. They are associated with other seizure symptoms/ signs. *or* Predominantly black snd white linear zigzag patterns which appear and disappear slowly. Associated with photophobia or phonophobia
60
Name reflex epilepsy syndromes
Photosensitivity Reading
61
What proportion of people with epilepsy have a lifetime history of psychiatric disorders?
**1 in 3** people with epilepsy have a lifetime history of psychiatric disorders
62
What is the increased risk of developing a psychiatric disorder in epilepsy?
People with epilepsy have a **2 to 5 times** increased risk of developing a psychiatric disorder
63
What is the prevalence of different psychiatric disorders in people with epilepsy?
Mood disorders 11-62% Depression 20-55% Personality disorders 5-33% Psychiatric disorders 30-35% Psychosis 7-10%
64
What is the lifetime prevalence of psychiatric disorders in people with epilepsy?
35.5%
65
What is the increased risk of anxiety and depression after epilepsy onset in patients compared to controls?
**2-3 times higher** compared to the general population

Neuropsychiatric disorders (30 decks)

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