Epilepsy Flashcards
What is the a seizure?
What is epilepsy
Seizure - clinical event
Paroxysmal episodes of brain dysfunction manifested by stereotyped alteration in behavior
Not always associated with loss of consciousness
Any part of the brain can seize
–> manifestation of seizure is where the seizure is located
Epilepsy- syndrome that includes recurrent seizures
Implies the risk for recurrent seizures in the absence of an extra-cerebral cause
(recurrent that are not directly provoked by infection, drug/alcohol withdrawl, metabolic changes or fever)
Pathophys behind seizures:
What receptors are important for inhibition ?
What receptors are important for activation?
Excessive or oversynchronized discharges of cortical neurons
Ineffective recrutment of inhibitory neurons together with excessive neuronal excitaiton
GABA R mediated inhibition and responible for normal termination of a seizure
NMDA (glutamate) R activation* required for *propagation of seizure activity
Who is at risk?
Neonates and young children:
(inherited, congenital malformations, prenatal injury)
Increasing age:
(trauma, infection, vascular disease, tumors neurodegenerative disorders)
What are the two general classifications of seizures?
What are key features of types of each?
Partial Seizures:
Key Features: seizure has a focal onset in the brain (identifiable/loc)
Types: simple partial (NO consciousness alteration), complex partial (focal onset with impaired consciousness), partial seizure with secondarily generalized tonic-clonic seizures (focal that evolved to a bilateral convulsive seizure)
Generalized Seizures:
Key Features: the ENTIRE BRAIN seizes at once
Types: absence, mycolonic, atonic, tonic-clonic, tonic and clonic
How is Epilepsy classified?
Localized-related (focal problem in the brain, partial; usually underlying reason is know ie- multiple strokes)
Generalized - whole brain seizure
Idiopathic (genetically determined)
Symptomatic (etiology an known or presumed)
generalized and idipathic are sometimes combined
What is a common area of the brain to have partial seizures?
what common associations come with this type of seizure?
Temporal Lobe Seizures -likely the most common partial seizure
Many times pt get an “epigastric aura” - epigastric rising sensation, fear, deja vu, olfactory and gustatory sensations
May have contralateral limb posturing
How do patients present with partial seizures in the frontal lobe?
What is versive movements?
What is meant by the Jacksonain march?
What is a post-ictal Todd’s paralysis?
- often at night
- can involve complex movements (bicycling, fencer posturing)
- Versive movements (head and eyes turn to the side OPPOSITE the seizure –> look AWAY from the seizure
Jacksonian march –> face seizes –> arm –> moving along the humunculus
Todd’s paralysis = paralysis of up to 24 hours after a jacksonian march w/seizure
Occipital?
Usually with darkness or sparks, flashes of light -almost looks like migraine
RED is the most commonly described color
Absence Seizure:
age presentaiton?
Classification of seizures:
How would the seizure present on an EEG?
RX
Presents ages 4-10 years old - pediatric diagnosis
Seizures are usually brief <10 seconds but frequently ~10x/day, characterized by staring spells
EEG with 3 Hz spike and wave pattern
RX: ethosuximide
Mycolonic seizures…
what age population is it seen in?
what are some triggers/risk factors that predisposes to mycolonic seizures?
RX?
shock-like or lightening like contractions of a group of muslces
Juvenile mycolonic epilepsy
myoclonic jerks that often occur in the morning shortly after waking
Precipitated by: use of alcohol and sleep deprivation
RX: valpronic acid/depicote
Atonic seizures:
sudden loss of TONE
can be focal (head drop) or involved in all muslces
very brief loss of consiousness
(****young kid who suddlenly falls!***)
Generalized Tonic-Clonic
“grand mal”
tonic - contractino producing extension and arching
clonic - alternating contration
sx- loss of bladder control (not everyon loses control)
prolong post-ictal confusion
good questions: bladder control? tongue trauma? ended up in a room and don’t know how you got there? shoulder trauma?
Seizures and epilepsy
Differentials:
What was the last thing you remember? waking up on the floor - probably syncopal..if its the ambulance or ER, seizure
Cardiac: syncope, arrhythmias
Movement disorders: tremor, dystonia, asterixis, myoclonus
Stroke (TIA)
Migraines H/A
Infection w/rigors
Psychiatric disorders - psudoseizures, somatoform, malingering disorders, panic attack/anxiety, breath holding spells
Metabolic issues - hypo/hyper-glycemia
Meds - buproprion
Pseudoseizures-
what to look for:
to and fro- movements/ heading turning side to side
pelvin thrusting
eye closure
increased respiratory rate (similar to after exercising)
absent post-ictal phase
Evaluation of a seizure:
1st seizure unprovoked in adult, in children
Unprovoked first seizure in adults: EEG, brain imaging, labs, LP (not required, considered in pt with concern for infection), Tox screen, elevated serum prolactin should be helpful to help differentiate between seizure adn pseudoseizure – don’t have to treat
First unprovoked seizure in CHILDREN: Rx is not necessarily indicated of the development of epilepsy; Rx with AED may be considered where the beefits of reducing the risk of an 2nd outweigh the side effects
