Epilepsy Flashcards
Seizure
occasional, sudden, excessive and rapid discharge of gray matter –> positive sx
Post-seizure –> negative sx (post-ictal period)
Posictal period mechanisms
neuronal exhaustion, inhibitory inputs to seizure area
Signs of epileptic seizures
paroxysmal change in behavior or movement, or altered consciousness
Partial seizure
begins in one area of cortex
remains localized or spreads (may spread to whole cortex –> grand mal seizure)
Generalized epilepsy
due to whole cortex hyper-irritability (genetic). Overreaction to deep gray matter inputs –> seizure
Difference between partial complex seizures and absence seizures
partial complex seizures –> postictal state
no postictal state in absence seizures
DDx of episodic epilepsy sx
Syncope/near syncope (circulatory, altered blood state like hypoxia), movement disorders (myoclonus, paroxysmal dyskinesia), fasciculation, stroke/TIA, Migraine, sleep disorder, psychogenic/behavioral
Focal seizures, consciousness preserved
motor signs (Jacksonian, aversive), somatosensory sx, autonomic s/sx, psychic sx
Focal seizures, loss/impaired conciousness
Partial onset –> impaired consciousness; OR impairment of consciousness on onset
Can evolve into convulsive seizure
Generalized seizures
tonic-clonic, tonic, atonic, myclonic, absence
Epilepsy
chronic disease of recurrent, unprovoked sizures. 2+ unprovoked seizures, more than 24h apart OR 1 seizure with studies suggesting further risk for seizures
Drug resistant epilepsy
36% of cases
symptomatic seizures
30% with structural abnormality (tumor, arteriovenous malformation). Half remit
Idiopathic seizures
genetic. Usually children
Benign epilepsy
easily treated, normal intelligence, normal tests.
Genetic, remission by teen years
Catastrophic epilepsy
Med resistant. Affects development –> mental retardation, shortened lifespan of child
Abnormal EEG, MRI. Symptomatic seizures
Febrile seizures
age 6mo-3y. seizure c fever without evidence of intracranial infection or defined cause
Simple seizure
generalized, less than 10-15min, do not recur in less than 24h
Complex seizure
focal, > 10-15 min, recur in less than 24h. 30% of febrile seizures
Timing of febrile seizures
within first 24h of illness
Risk factors for recurrence of febrile seizure
less than 1 yo, family hx, low grade fever, brief fever
Seizure’s effect on cognition
nearly all children have normal cognition. prolonged or complex seizures –> increased risk of cognitive problems (most do well)
Tendency for sleep problems
Risk factors for developing epilepsy
Complex febrile seizure, neurologically abnormal prior to seizure, family hx of afebrile seizures
Treatment of seizure now
DOES NOT prevent later epilepsy
