Epilepsy

Question 1

What is a seizure?

Answer 1

Temporary neurological reaction to sudden excessive electrical excitation of cortical neurons

Question 2

What is epilepsy?

Answer 2

chronic neurological disorder affecting the brain with unknown cause, resulting in recurrent seizures

Question 3

What are the diagnostic requirements for epilepsy?

Answer 3

2 or more seizures of unknown cause

Question 4

What are 3 diagnostic tests used to diagnose epilepsy?

Answer 4

Brain imaging
blood tests
lumbar puncture

Question 5

What are 4 brain imaging diagnostics used to diagnose epilepsy?

Answer 5

electroencephalogram (EEG)
computerized tomography scanning (CT Scan)
Magnetic resonance imaging (MRI)
Positron emission tomography (PET Scan)

Question 6

What is EEG? What is its use in diagnosing epilepsy?

Answer 6

records electrical activity on brain surface and locates areas of irregularly firing cortical neurons
determines severity/type of seizure disorder

Question 7

What is a CT scan used for?

Answer 7

Detects blood clots or tumours present in the brain (if any)

Question 8

What is an MRI? What is its use in diagnosing epilepsy?

Answer 8

Takes micron slices of images of brain to detect smaller abnormalities not caught in CT scans
Determine severity/area of blood clot in brain

Question 9

What is a PET scan used for?

Answer 9

functional and behavioural scan to see if abnormal areas light up when asked to do something

Question 10

Why is a blood test important in diagnosing epilepsy?

Answer 10

determines any secondary causes (infections, anemia, minerals, poisions) that may have caused a seizure to rule out epilepsy

Question 11

Why is a lumbar puncture important in diagnosing epilepsy?

Answer 11

check to see if seizure was caused by infection or bleeding in the brain

Question 12

What are the two main kinds of seizures?

Answer 12

partial seizure

generalized seizure

Question 13

what is a partial seizure?

Answer 13

originates in a localized part of the brain in one hemisphere or specific lobe

Question 14

what are 3 subclasses of partial seizures?

Answer 14

simple partial
complex partial
secondary generalized

Question 15

what happens before a simple partial seizure?

Answer 15

physiological warning sign (deja vu, anxiousness)

Question 16

what are some symptoms of a simple partial seizure? what do these symptoms depend on?

Answer 16

depend on lobe effected
motor - jerking movements, stiffening
sensory - tingling, numbness
autonomic - abdominal discomfort
psychic - hallucinations, fear, sadness

Question 17

what is characteristic of a simple partial seizure?

Answer 17

very benign

person is conscious and remembers what happened

Question 18

what is a complex partial seizure?

Answer 18

progression of a simple partial seizure

Question 19

what happens during a complex partial seizure?

Answer 19

impaired consciousness, unaware of environment

automatisms (mumblings, picking at clothing, random walking)

Question 20

what happens after a complex partial seizure?

Answer 20

the person does not remember what happened

usually feel very tired or confused

Question 21

what is a secondary generalized seizure?

Answer 21

progression from simple partial to complex partial to secondary generalized
seizure spread to whole head

Question 22

What is a generalized seizure?

Answer 22

seizure that occurs in both hemispheres of the brain

Question 23

what are the 4 subclasses of generalized seizure?

Answer 23

absence
atonic
myoclonic
tonic-clonic

Question 24

what is an absence seizure?

Answer 24

seizure that affects CHILDREN (2yr-18yr)

black out for 30-40min

Question 25

what happens during an absence seizure?

Answer 25

brief lapse of consciousness (blank stare, unaware) then continue on with activity usually begins and ends very suddenly may involve automatisms and could occur several times during the day

Question 26

What is an atonic seizure?

Answer 26

seizure where you lose all muscle tone

Question 27

what happens during an atonic seizure?

Answer 27

abrupt loss of muscle tone brief loss of consciousness collapse and fall (Drop attack)

Question 28

what happens after an atonic seizure?

Answer 28

recover and regain consciousness after a few seconds

Question 29

what is a myoclonic seizure?

Answer 29

suddenly freeze up and can't move

Question 30

what happens during a myoclonic seizure?

Answer 30

muscle jerks could be several in a row or just one still conscious throughout seizure

Question 31

what is a tonic-clonic seizure?

Answer 31

freeze then relax (muscles contract then lose all tone)

Question 32

what happens during a tonic-clonic seizure?

Answer 32

epileptic cry, lose consciousness and collapse tonic phase - body stiffens clonic phase - body jerks (contract then relax) convulsive change in breathing bite tongue incontinence

Question 33

what happens after a tonic-clonic seizure?

Answer 33

no recollection fatigue confusion tiredness

Question 34

what is status epilepticus?

Answer 34

seizure that lasts a long time and may repeat without recovery?

Question 35

what could happen if status epilepticus is left untreated?

Answer 35

can lead to neurological disability or death if not treated

Question 36

what is a febrile seizure?

Answer 36

a tonic-clonic seizure due to fever

Question 37

who usually experiences a febrile seizure? what do you do to treat it?

Answer 37

infants/children | usually harmless, just try to slowly cool down child

Question 38

what is the main pathologic cause of a seizure?

Answer 38

cluster or cortical neurons in a localized area simultaneously fire abnormally and this may spread to other regions of the brain

Question 39

What is the first step of the pathology of a seizure?

Answer 39

Bursts of APs from a cluster of cortical neurons synchronize

Question 40

what is the second step of the pathology of a seizure?

Answer 40

prolonged neuronal depolarization leads to repetitives APs

Question 41

what is the third step of the pathology of a seizure?

Answer 41

hyperexcitability due to imbalance of neuronal membrane

Question 42

what causes the imbalance of neuronal membrane?

Answer 42

Asp and Glu excite Na+ and Ca2+ entry, but GABA (inhibitory NT) is inhibited, meaning Cl- cant go in and K+ can't go out (+ive charge can't leave)

Question 43

what is the result for each ion/NT when the neuronal membrane is imbalanced?

Answer 43

``` Na - excessive influx Ca - excessive influx K - insufficient efflux Cl - insufficient influx Asp/Glu - excess GABA - insufficient ```

Question 44

what is the 4th step of the pathology of a seizure?

Answer 44

propagation - enough excitability to recruit surrounding cortical neurons and lose surrounding inhibition

Question 45

how long does a seizure typically last?

Answer 45

a few seconds or minutes

Question 46

which types of seizures have no warning signs before the seizure occurs?

Answer 46

absence atonic myoclonic tonic-clonic

Question 47

what are the 3 main mechanisms of anti-epileptic drugs (AED)?

Answer 47

1) modification of Vgated ion channel activity 2) increase GABA mediated inhibitory neurotransmission 3) derease glu mediated excitatory neurotransmission

Question 48

what ion does GABA deal with?

Answer 48

Cl-

Question 49

what is the receptor for Asp? Glu?

Answer 49

Asp - AMPA | Glu - NMDA

Question 50

What are 2 common types of AEDs?

Answer 50

Na channel blockers | Ca channel blockers

Question 51

how do Na+ channel blockers help with epilepsy?

Answer 51

prevent Na influx and decrease frequency of recurrent APs

Question 52

how do Ca 2+ channel blockers help with epilepsy?

Answer 52

limit depolarization of cortical neuron by restricting Ca entrance

Question 53

What are the two mechanisms that enhance GABA activity?

Answer 53

activation of GABA-A receptors | decrease GABA turnover by blocking its reuptake and decrease its metabolism

Question 54

how does activation of GABA-A receptors help with epilepsy?

Answer 54

increases and prolong the response to GABA (inhibitory)

Question 55

what are common side effects for AEDs?

Answer 55

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

Question 56

what can trigger secondary seizures? (7pts)

Answer 56

``` head trauma lack of sleep poor nutrition drug use disease/infection stress alcohol withdrawal ```

Question 57

how can alcohol cause a seizure?

Answer 57

lowers seizure threshold

Question 58

is there a cure for epilepsy?

Answer 58

nope | can only decrease frequency/severity of seizures

Question 59

what are some other methods of epilepsy treatment?

Answer 59

vagal nerve stimulation ketogenic diet surgery

Question 60

what is vagal nerve stimulation? what is its function?

Answer 60

jolts of electrical energy sent to brain to interrupt/prevent electrical disturbances in brain decrease frequency and severity of seizures

Question 61

what is the ketogenic diet?

Answer 61

high fat low carb diet (trick brain to think it's starving) | for kids, not healthy

Question 62

what do you do if someone has a complex partial seizure?

Answer 62

guide person away from danger and do not restrain them

Question 63

what do you do if someone has an atonic seizure?

Answer 63

call 911 if any injuries from fall

Question 64

what do you do if someone has a tonic-clonic seizure?

Answer 64

protect from head injurt turn person on side to clear airway do not restrain or put anything in their mouth cover midsection in case of incontinence

Question 65

what is the important question to ask when someone has a seizure?

Answer 65

how long has the seizure last? (more than 5 min, need medical attention)

Question 66

What are the two goals of having surgery to treat epilepsy?

Answer 66

maximize seizure control | minimize disruption of normal brain function

Question 67

what are the two main types of surgery to treat epilepsy?

Answer 67

Resection/resective surgery | disconnection surgery

Question 68

what is a resection/resective surgery? what is the goal?

Answer 68

removal of the area in brain involved with seizure activity | goal: cure seizure disorder

Question 69

what is a disconnection surgery? what is the goal?

Answer 69

interrupts nerve pathways that allow seizures to spread (best for critical areas of brain) goal: provide relief