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PHA 333 > epilepsy 2 > Flashcards

epilepsy 2 Flashcards

1
Q

what are the 6 main types of primary generalised seizures?

A 
Absence seizures (‘petit mal’)
Tonic-clonic seizures (‘grand mal’, convulsions)
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures (‘drop attacks’)
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2
Q

what is an absence seizure?

A

begin & end abruptly –last for ~2-20 seconds
may occur a few times to ~100x daily
sudden blank starring (daydreaming / switched off)
brief impairment of consciousness, awareness &
responsiveness
may be accompanied by physical automatisms –blinking, lip
smacking, fumbling, picking at clothes, twitching of face &
body muscles
no memory / recollection of episode by subject
hyperventilation-induced reproduction
commonly occur in children ~4-14 years

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3
Q

what is a tonic-clonic seizure?

A

most common & typical type of seizure (‘epilepsy’)
usually last for ~30-120 seconds
involve ‘tonic’ & ‘clonic’ phases

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4
Q

what is the tonic phase?

A

generalised muscle contraction stiffening of limbs
loss of consciousness & fall (backwards) to the ground
evoked cry or moan
laboured or shallow breathing cyanosis
tongue, cheek or lip biting bleeding

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5
Q

what is the clonic phase?

A

follows after ‘tonic’ phase
rhythmic contraction & relaxation of muscles jerking of
limbs
occasional bladder or bowel incontinence

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6
Q

what is the post-ictal or recovery phase?

A 
slow return to consciousness
muscle relaxation limpness
grogginess, confusion, somnolence
headache & aching limbs
amnesia of event
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7
Q

what are myoclonic seizures?

A

short-lived –lasts for a few seconds
sudden jerks or twitches –irregular, shock-like jerks
may affect whole body
commonly affect arm(s) and/or leg(s), or head / trunk
consciousness is not impaired (single jerks) or impaired
(cluster of jerks clonic-tonic-clonic seizures)
usually occurs in the morning –shortly after waking

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8
Q

what are tonic seizures?

A

generalised tightening of muscles stiffening of body

commonly occur during sleep & short-lived (~20 seconds)

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9
Q

what are atonic seizures?

A

sudden loss of part or all muscle tone limpness
sudden head drop, slump or total collapse
forward fall risk of serious head injury
short-lived
very rapid recovery –no post-ictal confusion

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10
Q

what are the three main types of partial or focal seizures?

A

Simple partial or focal seizures
consciousness is preserved during seizure
subject is alert, can respond to questions/commands &
can remember what occurred during seizure

Complex partial or focal seizures
consciousness is altered or lost
ability to pay attention or respond to questions or
commands is impaired or lost; amnesia of seizure event

Secondarily generalised seizures
partial seizures that spread to become tonic-clonic

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11
Q

what are simple partial seizures?

A

involve only a small part of one side of the brain
subject is fully conscious & aware of surroundings
but have no control over seizure

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12
Q

what do symptoms of a simple partial seizure depend on?

A

symptoms depend on part of brain affected
motor –stiffening, twitching, jerking, etc
sensory –light flashes, hallucinations & illusions, etc
autonomic –sweating, altered HR/BR, gastric discomfort
psychic –fear, anxiety, déjà vu, jamais vu, autoscopy

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13
Q

what is complex partial seizures?

A

nvolve a greater part of one cerebral hemisphere
impaired consciousness & awareness
may occur as
simple partial seizure (Aura) followed by impaired
consciousness
impaired consciousness at seizure onset
most commonly involve one or both temporal lobes
typical duration –few seconds to ~3 minutes

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14
Q

what does a complex partial seizure clinical manifestation depend on?

A

depend on site of origin &
degree of spread:
mainly automatic movements (automatisms)
lip-smacking, chewing, swallowing, etc
fumbling, picking, fiddling, shuffling cards, etc
grunts, repeating a phrase, screaming, running,
disrobing, pelvic thrusting, etc

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15
Q

how long does it take to recover from a complex partial seizure?

A

Variable duration of recovery –minutes to hours

post-ictal confusion & fatigue

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16
Q

what is a secondarily generalised seizure?

A

begin focally (as partial seizures) & spread to
become generalised tonic-clonic
may be preceded by an aura
variable symmetry, intensity & duration of tonic
(stiffening) and clonic (jerking) phases
typical duration ~1-3 minutes
postictal confusion & somnolence, with or without
contralateral Todd’s paralysis

17
Q

what is the basic classification of seizure types?

A

where the seizure began
the lebel of awarness during focal onset seizure
the nature of the first prominent signs and symptoms

18
Q

where are the different places a seizure could begin in the brain?

A

Focal onset –limited to one hemisphere of the brain
Generalised onset –originates simultaneously in both
hemispheres of the brain (based clinical or EEG findings)
Unknown onset –nature of onset not know with certainty

19
Q

what are the levels of awarness that can occur in a seizure?

A

Focal Aware –retained awareness

Focal Impaired Awareness –impaired awareness

20
Q

what are the different types of first prominent signs and symptoms of a seizure?

A

Motor onset –motor signs/symptoms at the onset

Non-motor onset –non-motor signs/symptoms at onset

21
Q

what is the ILAE classification of eplipsies and epliepsy syndromes?

A

based on whether seizures arise in a circumscribed
part of brain or in the whole brain
based on whether (or not) the disorder is associated
with an identifiable neurological abnormality (or cause)

22
Q

where could a seizure arise in a circumscribed part of the brain/ whole brian?

A

Localisation-related, Partial or Focal Epilepsies
seizures arise in a circumscribed part of brain
Generalised Epilepsies
seizures arise diffusely in entire brain –both cerebral
hemispheres

23
Q

what are the classes of an identifiable neurological abnormality?

A

Idiopathic
no apparent or obvious identifiable cause
presumed genetic basis
Symptomatic
known or obvious identifiable cause
Cryptogenic
no currently known cause, but presumed likely cause

24
Q

what are the two types of partial epilepsy?

A

Idiopathic (with age-related onset)
benign childhood epilepsy (‘Rolandic’ epilepsy)
childhood epilepsy with occipital paroxysms
primary reading epilepsy

Symptomatic or Cryptogenic
chronic epilepsia partialis continua of childhood
(e.g. ‘Rasmussen’s encephalitis’ )
temporal, frontal, occipital & parietal lobe epilepsies, etc

25
Q

what are the two types of generalised eplipsies?

A 
Idiopathic (with age-related onset)
benign neonatal familial convulsions
benign myoclonic epilepsy in childhood, juvenile 
myoclonic epilepsy 
childhood absence epilepsy, juvenile absence epilepsy  
Symptomatic or Cryptogenic
West Syndrome
Lennox-Gastaut Syndrome
26
Q

how do you diagnose epilepsy?

A 
based on probability –after exhaustive patient 
evaluation & assessment
involves combined series of investigations
Patient medical history
Seizure description
Physical examination
Laboratory assessment
EEG (and ECG)
Neuroimaging (CT scan & MRI)
27
Q

what would be involved in a patient history for diagnosing epilepsy?

A

perinatal & developmental history
history of febrile seizures
history of CNS infection, trauma, etc
family history of epilepsy

28
Q

what would be involved in a seizure description and history for a diagnosis?

A

past seizure episodes, duration, patterns, associated
motor, sensory & behavioural features, etc
pre-ictal phenomenon –aura
ictal manifestations
post-ictal state
precipitating or trigger factors
observer or eye witness accounts
real-time eye witness video recordings of episodes

29
Q

what would be involved in a lab assessment for the diagnosis of epilepsy?

A 
to rule out other possible causes of seizure
complete blood count
electrolyte panel & blood glucose
blood urea nitrogen
toxicology screen
30
Q

what would be involved in an EEG for the diagnosis of epilepsy?

A

the most useful diagnostic procedure for epilepsy
involves recording of ictal or inter-ictal spikes, sharp
waves & spike-wave discharges
provides answers to 2 main questions
does the patient have epilepsy?
where is the ectopic focus or epileptogenic zone?
various forms
standard / sleep / ambulatory / video-telemetry

31
Q

what would be involved in neuroimaging for a diagnosis of epilepsy?

A

useful for detection or exclusion of structural or
organic cause of epilepsy
helps detect or define underlying brain lesions or
neurological abnormality
main indications
adult-onset seizures
seizures with focal features & suspected focal source
refractory or worsening seizures

32
Q

overall, what are the 4 main steps of an epilepsy diagnosis?

A

Identify the type of seizure & precipitating factors
consider differential diagnosis for non-epileptic event
Correlate seizure type with EEG, if possible
Determine the aetiology of epilepsy using history &
diagnostic measures
Classify the epilepsy syndrome

PHA 333 (42 decks)

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