Epilepsy

Question 1

Seizure definition

Answer 1

abnormally excessive or synchronous neuronal activity in the brain
*on the EEG: will look normal unless having an active seizure

Question 2

Epilepsy definition

Answer 2

recurrent, unprovoked seizures (>/= 2)

Question 3

2 Seizure classifications, further classifications

Answer 3

1. Primary generalized (all parts of cortex simultaneously)
2. Partial-onset (starts in one region, w/wo spread)

• further classified as insidious or symptomatic

Question 4

Types and description of primary generalized seizures

Answer 4

1. Generalized tonic-clonic (GTC)
2. Absence seizures (staring spells- peds)
3. Myoclonic seizures (shaking)
4. Tonic Seizures (rigid)

Question 5

Types of Partial Onset seizures

Answer 5

1. Simple partial seizures (SPS) - doesn’t spread

2. Complex partial seizures (CPS)- spreads

Question 6

Location related seizure: Temporal Lobe

• time frame
• what it starts with
• what happens when it’s over

Answer 6

• lasts 1-3mins
• Starts with oral movements (chewing, lip smacking)
• lethargy afterwards

Question 7

Location related seizure: Frontal Lobe

• time frame
• when does it occur
• afterwards

Answer 7

• lasts 10-15s
• usually when a person is waking up
• may have vocalizations, no auras
• no lethargy phase afterwards

Question 8

Location related seizure: Occipital Lobe

- what is associated with these

Answer 8

aura

Question 9

Location related seizure: Parietal Lobe

• where it originates
• what is associated with it

Answer 9

• originates in hippocampus

- associated with sensory aura

Question 10

Medical Treatment

Answer 10

Antiepileptic drugs - will cycle through drugs until they can prevent a seizure

Question 11

Why do you want to prevent a seizure

Answer 11

disturbance to the brain and some damage!

in GTCs increase in CPK after seizure

Question 12

Surgery: Temporal lobe

Answer 12

easiest, accessible,

Question 13

Surgery: Vascular malformations, low grade tumors

Answer 13

easy enough, can go in and deal with it (not as easier as temporal lobe surgery)

Question 14

Surgery: Corpus Callostomy

Answer 14

if seizures are so bad they will consider doing this

Question 15

Surgery: Hemisppherectomy

Answer 15

If seizures are so bad they will consider this (gets performed more often in children

Question 16

Surgery: Gamma knife radiosurgery

Answer 16

clinical trials

Question 17

Surgery: Brain stimulation

Answer 17

clinical trials
only works if pt has partial onset (specific location)
when they sense it is starting, the simulation is applied to shift electrical activity in the brain

Question 18

What is the least harmful procedure for pregnancy when you have seizures

Answer 18

• get seizures under control with 1 medication; control should be at its best (seizure during pregnancy is very harmful)
• do not change medication after conception

Question 19

What to do if pt has a seizure in clinic

Answer 19

1. put pt into supine (nothing in the mouth, no turning head)
2. Time the seizure
3. make astute observations (what were they doing when it started, what happened when it started, what happened during it, how did it end)
4. Call RR team or 911
5. Postictal time (time of unconsciousness afterwards)