Epilepsy

Question 1

Define primary generalized seizure.

Answer 1

A primary generalized seizure is a seizure that involves the entire brain at the same time.
- Consciousness is necessarily lost.

Question 2

What is a complex partial seizure?

Answer 2

A complex partial seizure is a seizure of focal onset that involves areas that impair consciousness.
- The patient often appears dazed or confused and remembers only a part of the seizure (if at all).

Question 3

What is a myoclonic seizure?

Answer 3

Myoclonic seizure is a brief generalized seizure that may be so brief as to produce a motor jerk (myoclonus) but no actual loss of consciousness

Question 4

Define petit mal (absence) seizure.

Answer 4

Petit mal seizure is a brief generalized seizure that interrupts consciousness but which does not result in motor symptoms (some eyelid fluttering).
- It may happen hundreds of times a day.

Question 5

What is a simple partial seizure (focal seizure)?

Answer 5

Simple partial seizure is a seizure from portions of the cerebral cortex having very specific functions (i.e., motor, sensory, visual, olfactory, auditory)

Question 6

What is meant by secondary generalization?

Answer 6

Secondary generalization is the spread of a focal seizure to involve the entire brain.
- The secondary generalization usually results in a tonic-clonic seizure.

Question 7

Define status epilepticus.

Answer 7

Status epilepticus is a medical emergency that consists of continuous or recurrent seizures over at least 30 minutes without waking up in between.

Question 8

What is the postitcal period?

Answer 8

The postictal period is a period of cortical depression following a seizure.

Question 9

What is the interictal period?

Answer 9

Interictal refers to the period between seizures.

Question 10

What is Todd’s Paralysis?

Answer 10

Todd’s paralysis is a period of focal weakness after a seizure due to a prolonged postictal period in a region of cerebral cortex.
- This may give clues to the side and location of a seizure focus.

Question 11

Define hippocampal sclerosis and describe when it usually occurs.

Answer 11

Hippocampal sclerosis is scarring of the hippocampus.

• Common cause of temporal lobe epilepsy and occurs early in life.
• It is often associated with prolonged febrile convulsions in early childhood.

Question 12

What are potential causes of primary generalized seizures?

Answer 12

They may be genetic and are commonly provoked by severe metabolic upset

• Electrolyte disturbance
• Organ failure
• Hypoglycemia
• Hypoxia
• Sedative/alcohol withdrawal

Question 13

Does epilepsy last a lifetime?

Answer 13

Some of the primary epilepsies presenting in childhood may be outgrown.

Question 14

What is the usual description of a generalized seizure?

Answer 14

• Tonic-clonic seizures with tonic extension (usually)
  
  • Followed by clonus (alternating jerks of synchronous activity of flexors and extensors and grunting respirations).
• There is usually autonomic upset
  
  • Large pupils, hyperthermia, tachycardia, salivation, often emptying of bladder.
• It is terminated by inhibitory transmitters that result in postictal period of dense stupor or coma.

Question 15

What are common auras of complex partial seizures arising in the temporal lobes?

Answer 15

Fear and a rising abdominal sensation is a common temporal lobe aura.
- A (usually) bad smell may be perceived, as well.

Question 16

What are common causes of status epilepticus?

Answer 16

• Status epilepticus is often due to sedative withdrawal or discontinuation of anticonvulsants by patients with known epilepsy.
• It may also result from severe metabolic upset.

Question 17

Why is status epilepticus an emergency?

Answer 17

Status epilepticus may result in respiratory failure, lactic acidosis, aspiration, erratic changes in blood pressure, hyperthermia and death.

Question 18

What can be done in order to evaluate epilepsy?

Answer 18

• The EEG may be helpful but is often normal in the interictal period.
• An MRI scan is particularly good at demonstrating abnormal seizure foci
  
  • ie hippocampal sclerosis, small tumors, developmental abnormalities, arteriovenous malformations

Question 19

What are “non-epileptic” seizures?

Answer 19

A significant number of patients diagnosed with epilepsy do not have epileptic seizures

• Many of these are psychiatric in nature
• Can also be hysterical, conversion reactions or voluntary.

Question 20

What are the available therapies for epilepsy?

Answer 20

Anticonvulsants are the mainstay of therapy for epilepsy.

• Good control in 80% and excellent control in 50%.
• Surgery may help when focus is identified.
  
  • Callosotomy may cut down on generalization in hard to control cases.