Epilepsy

Question 0

What is the definition of epilepsy?

Answer 0

• CHRONIC neurological disorder affecting the brain
• symptoms are RECURRENT seizures
• idiopathic
• must have 2 or more seizures of unknown etiology to be diagnosed with epilepsy

Question 1

What is the definition of a seizure?

Answer 1

• temporary neurological reaction to sudden excessive electrical excitation of cortical neurons
• ## loss of awareness/consciousness, movement or sensation disturbances, changed mood or mental function

Question 2

How can epilepsy be diagnosed?

Answer 2

• Brain imaging (EEG, CT, MRI, PET)
• Blood tests (secondary causes)
• Lumbar puncture (seizures could be caused by infection/bleeding of the brain)

Question 3

What does an electroencephalography (EEG) tell you?

Answer 3

• non-invasive electrical record of the brain’s surface
• locates area of irregularly firing cortical neurons
• determines severity and type of seizure disorder (doesn’t actually diagnose epilepsy)

Question 4

What does a CT scan tell you?

Answer 4

• looks for large abnormalities
• tumors/bleeds
• these could be causing the seizures

Question 5

What does a MRI tell you?

Answer 5

• takes small picture slices of the brain
• next step after CT scan
• looks for tiny abnormalities in the brain
• small tumors, small bleeds, small clots

Question 6

What is the purpose of a PET scan?

Answer 6

• it is a “behavioural” scan
• shows brain activity during specific actions
• if other parts of the brain “light up” during easy activities, there is something wrong

Question 7

What is the effect of GABA?

Answer 7

• It opens up channels and allows more Cl- ions to flow into the cell
• This makes APs less likely to happen

Question 8

Describe the initiation of a seizure

Answer 8

• bursts of APs from cortical neurons
• synchronization of these neurons (AP chain)
• prolonged depol –> repetitive AP
• hyper-excitability due to imbalance of neuronal membrane

Question 9

What are the 2 excitatory transmitters utilized for seizure medications?
What do they do?

Answer 9

• aspartate attaches to AMPA receptor–> Na+ influx
• glutamate attaches to NMDA receptor –> Ca2+ influx
• influx of Ca2+ and Na+ causes an AP

Question 10

Describe the ion situation in the imbalanced neuron

Answer 10

Na+ = excessive influx
Ca2+ = excessive influx
Cl- = insufficient influx 
K+ = insufficient efflux

Question 11

Describe the propagation of seizure

Answer 11

• enough excitability to recruit surrounding cortical neurons
• lose surrounding inhibition
• spread of seizure to areas via cortical connections

Question 12

Describe the termination of seizures

Answer 12

• ends after few seconds or mins
• spontaneous
• unknown mechanism

Question 13

What happens if a seizure doesn’t terminate?

Answer 13

• it is known as status epilepticus
• brain cells begin to die
• fatal
• can be convulsive or non-convulsive

Question 14

What are the 2 types of seizures?

What are their definitions?

Answer 14

Partial - originates in localized area of the brain

Generalized - occurs in both hemispheres of the brain

Question 15

What are the different types of partial seizures?

Answer 15

• simple
• complex
• secondary generalized

Question 16

What are the different types of generalized seizures?

Answer 16

• absence
• atonic
• myoclonic
• tonic-clonic

Question 17

Describe a simple partial seizure

Answer 17

before: aura = physiological warning (scents, anxiety, deja vu)

during: symptoms depending on brain area 
Motor - twitching, stiffening
Sensory - tingling
Autonomic - abdominal discomfort
Psychic - hallucinations, fear, sad
person remains conscious/aware

After: memory intact, can recall what happened

Question 18

Describe a complex partial seizure

Answer 18

Before: aura

During:

• impaired consciousness
• automatisms (mumbling, wandering, picking at clothes)
• may progress into generalized seizure

After:

• cannot recall event
• confusion and fatigue following

Question 19

Describe absence generalized seizures

Answer 19

Before: no aura

During:

• brief lapse of consciousness, blank stare, unaware, then continue with activity
• begins and ends suddenly
• may occur many times during the day

After:

• continue with activity
• prompt recovery

Question 20

Describe atonic generalized seizures

Answer 20

Before: no warning

During:

• abruptly lose muscle tone
• brief loss of consciousness
• collapse and fall

After:

• recover after a few seconds
• regain consciousness

Question 21

Describe myoclonic generalized seizures

Answer 21

Before: no warning

During:

• muscle jerks/spasms
• may have 1 seizure or many in a row
• conscious throughout

After: memory intact

Question 22

Describe clonic-tonic generalized seizures

Answer 22

Before: no warning

During:

• epileptic cry, loss of consciousness, collapse
• body stiffens (tonic)
• body jerks (clonic)
• convulsive
• change in breathing, bites tongue, incontinence

After:

• no recollection
• confused, tired, fatigued

Question 23

What are the triggers of secondary seizures?

Answer 23

• head trauma
• head injury
• stress
• lack of sleep
• drug use
• alcohol withdrawal
• poor nutrition
• infection or disease

Question 24

How does alcohol affect epilepsy patients?

Answer 24

• lowers the seizure threshold
• chronic consumers experience seizures during withdrawal
• patients should not drink as they can react negatively with AEDs (less effective, side effects, risk of seizures)

Question 25

What is a febrile seizure?

Answer 25

• convulsions due to fever
• common in kids, usually harmless
• most last a few minutes
• not considered epilepsy (because it’s cause by fever)

Question 26

What are the treatment goals for epilepsy?

Answer 26

• decreases the frequency and severity of seizures
• AEDs
• non-pharm treatment (surgery, vagal nerve stim, ketogentic diet)

Question 27

What are some common side effects of AEDs?

Answer 27

• drowsiness
• nausea
• irritability
• skin rash
• lack of coordination

Question 28

What are the 2 main types of surgery?

Answer 28

1. Resection surgery
   - removal of area of brain involved with seizure activity
2. Dissection surgery
   - interrupt nerve pathways that allow seizures to spread
   - useful when you can’t remove that part of the brain

Question 29

What are the first aid measure for complex partial seizures?
Atonic?
Clonic-tonic?

Answer 29

Complex partial

• guide person away from danger
• do not restrain

Atonic
- call 911 if there are injuries from fall

Clonic-tonic

• protect head from injury
• turn person on side to clear airway
• do not restrain
• do not put anything in mouth
• cover in case of incontinence
• if they are constantly seizing, time how long the seizures last so you can tell the paramedics