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Applied Pathophysiology > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is a seizure?

A

Temporary neurological reaction to sudden excessive electrical excitation of cortical neurons

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2
Q

What is epilepsy?

A

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

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3
Q

What are the diagnostic requirements for epilepsy?

A

2 or more seizures of unknown cause

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4
Q

What are 3 diagnostic tests used to diagnose epilepsy?

A

Brain imaging
blood tests
lumbar puncture

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5
Q

What are 4 brain imaging diagnostics used to diagnose epilepsy?

A

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

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6
Q

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

A

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

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7
Q

What is a CT scan used for?

A

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

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8
Q

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

A

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

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9
Q

What is a PET scan used for?

A

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

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10
Q

Why is a blood test important in diagnosing epilepsy?

A

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

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11
Q

Why is a lumbar puncture important in diagnosing epilepsy?

A

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

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12
Q

What are the two main kinds of seizures?

A

partial seizure

generalized seizure

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13
Q

what is a partial seizure?

A

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

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14
Q

what are 3 subclasses of partial seizures?

A

simple partial
complex partial
secondary generalized

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15
Q

what happens before a simple partial seizure?

A

physiological warning sign (deja vu, anxiousness)

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16
Q

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

A 
depend on lobe effected
motor - jerking movements, stiffening
sensory - tingling, numbness
autonomic - abdominal discomfort
psychic - hallucinations, fear, sadness
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17
Q

what is characteristic of a simple partial seizure?

A

very benign

person is conscious and remembers what happened

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18
Q

what is a complex partial seizure?

A

progression of a simple partial seizure

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19
Q

what happens during a complex partial seizure?

A

impaired consciousness, unaware of environment

automatisms (mumblings, picking at clothing, random walking)

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20
Q

what happens after a complex partial seizure?

A

the person does not remember what happened

usually feel very tired or confused

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21
Q

what is a secondary generalized seizure?

A

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

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22
Q

What is a generalized seizure?

A

seizure that occurs in both hemispheres of the brain

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23
Q

what are the 4 subclasses of generalized seizure?

A

absence
atonic
myoclonic
tonic-clonic

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24
Q

what is an absence seizure?

A

seizure that affects CHILDREN (2yr-18yr)

black out for 30-40min

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25
Q

what happens during an absence seizure?

A

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

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26
Q

What is an atonic seizure?

A

seizure where you lose all muscle tone

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27
Q

what happens during an atonic seizure?

A

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

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28
Q

what happens after an atonic seizure?

A

recover and regain consciousness after a few seconds

29
Q

what is a myoclonic seizure?

A

suddenly freeze up and can’t move

30
Q

what happens during a myoclonic seizure?

A

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

31
Q

what is a tonic-clonic seizure?

A

freeze then relax (muscles contract then lose all tone)

32
Q

what happens during a tonic-clonic seizure?

A

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

33
Q

what happens after a tonic-clonic seizure?

A

no recollection
fatigue
confusion
tiredness

34
Q

what is status epilepticus?

A

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

35
Q

what could happen if status epilepticus is left untreated?

A

can lead to neurological disability or death if not treated

36
Q

what is a febrile seizure?

A

a tonic-clonic seizure due to fever

37
Q

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

A

infants/children

usually harmless, just try to slowly cool down child

38
Q

what is the main pathologic cause of a seizure?

A

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

39
Q

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

A

Bursts of APs from a cluster of cortical neurons synchronize

40
Q

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

A

prolonged neuronal depolarization leads to repetitives APs

41
Q

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

A

hyperexcitability due to imbalance of neuronal membrane

42
Q

what causes the imbalance of neuronal membrane?

A

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)

43
Q

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

A 
Na - excessive influx
Ca - excessive influx
K - insufficient efflux
Cl - insufficient influx
Asp/Glu - excess
GABA - insufficient
44
Q

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

A

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

45
Q

how long does a seizure typically last?

A

a few seconds or minutes

46
Q

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

A

absence
atonic
myoclonic
tonic-clonic

47
Q

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

A

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

48
Q

what ion does GABA deal with?

A

Cl-

49
Q

what is the receptor for Asp? Glu?

A

Asp - AMPA

Glu - NMDA

50
Q

What are 2 common types of AEDs?

A

Na channel blockers

Ca channel blockers

51
Q

how do Na+ channel blockers help with epilepsy?

A

prevent Na influx and decrease frequency of recurrent APs

52
Q

how do Ca 2+ channel blockers help with epilepsy?

A

limit depolarization of cortical neuron by restricting Ca entrance

53
Q

What are the two mechanisms that enhance GABA activity?

A

activation of GABA-A receptors

decrease GABA turnover by blocking its reuptake and decrease its metabolism

54
Q

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

A

increases and prolong the response to GABA (inhibitory)

55
Q

what are common side effects for AEDs?

A 
drowsiness
irritability
skin rash
lack of coordination
nausea
56
Q

what can trigger secondary seizures? (7pts)

A 
head trauma
lack of sleep
poor nutrition
drug use
disease/infection
stress
alcohol withdrawal
57
Q

how can alcohol cause a seizure?

A

lowers seizure threshold

58
Q

is there a cure for epilepsy?

A

nope

can only decrease frequency/severity of seizures

59
Q

what are some other methods of epilepsy treatment?

A

vagal nerve stimulation
ketogenic diet
surgery

60
Q

what is vagal nerve stimulation? what is its function?

A

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

61
Q

what is the ketogenic diet?

A

high fat low carb diet (trick brain to think it’s starving)

for kids, not healthy

62
Q

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

A

guide person away from danger and do not restrain them

63
Q

what do you do if someone has an atonic seizure?

A

call 911 if any injuries from fall

64
Q

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

A

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

65
Q

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

A

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

66
Q

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

A

maximize seizure control

minimize disruption of normal brain function

67
Q

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

A

Resection/resective surgery

disconnection surgery

68
Q

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

A

removal of the area in brain involved with seizure activity

goal: cure seizure disorder

69
Q

what is a disconnection surgery? what is the goal?

A

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

Applied Pathophysiology (11 decks)

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