Epilepsy

Question 1

What is epilepsy

Answer 1

Epilepsy is the syndrome of recurrent unprovoked seizures.

The highest incidence of epilepsy is in children and the elderly

Question 2

What are the 4 basic EEG frequencies?

1. Alpha
2. Beta
3. Theta
4. Delta

Answer 2

What are the 4 basic EEG frequencies?

1. Alpha 8-13 Hz
2. Beta: > 13 Hz
3. Theta 4-7Hz
4. Delta: <4 Hz

*alpha waves are normally seen during wake periods

delta are observed during sleep (stabe 3/4- deep sleep)

Question 3

Absence Seizures:

1. Patient presentation
2. clasification (partial or generalized)
3. what does the pre and post ictal phase look like on an EEG?

Answer 3

Absence Seizures:

1. Patient presentation: pt may have a loss of eye contact of loss of facial expression (zoned out). Pt will NOT have a loss of balance or posture.
2. clasification: generalized- the seizure starts in the entire brain all at once
3. what does the pre and post ictal phase look the same on the EEG- normal. There is no postictal phase (grogginess). Pt has normal consciousness. and the only loss of awareness is during the seizure

Question 4

What do we use to treat absence seizures?

Answer 4

Treat absence seizures with

Valproic Acid- blocks Na currents, NMDA receptor excitation (AE hepatotoxicity, pancreatitis, spina bifida in preggers)

ethosuxamide- inhibits T-type channels (AE GI, fatigue, SLE)

lamotrigine- inactivation of Na, inhibition of VGCC (skin shit- steven-johnson syndrome. Can be life threatening skin shit)

Question 5

Tonic- Clonic Seizures

1. presentation
2. clasification:
3. EEG

Answer 5

Tonic- Clonic Seizures

1. presentation: tonic phase: back arched, arms and legs extended. Clonic phase- large, jerky movements that slow down as the seizure comes to an end
2. clasification: generalized
3. EEG: normal preceeding attack. The tonic phase is characterized by a poly spiked EEG that coorelates to the muscle being signalled to keep contracting. The clonic phase is poly spiked with pauses between them- the spikes represent the jerk movements, the post ictal phase is characterized by delta or very slow waves and the patient is confused, groggy, drowsy.

Question 6

How do we treat Tonic-Clonic Seizures?

Answer 6

Drugs for treatment of Tonic-Clonic seizures include

1. Carbamazepine- blocks Na+ channels (BB: blood dyscrasias, increased risk of stevens-johnsons in people with asian ancestry
2. phenytoin: prolongs the inavtive state of the Na+ channel (AE: DANG, hirsutism, osteomalacia)
   
   1. hypotension and cardiac arrhythmias (with rapid infusion)
3. valproic acid: blocks Na channels and NMDA receptor mediated excitation- (AE: N/V, fine tremor, thromobocytopenia)
   
   1. hepatotoxicity, pancreatitis, spina bifida in pregnant women
4. primidone: breaks down into phenobarbital and PEMA- blocks Na+ channel

Question 7

Partial Seizures:

Answer 7

Partial seizures, aka focal seizures only affect one side of the brain and have clinical manifestations that reflect that area of the brain.

They can remain localized or spread to nearby cortical regions. If they spread to the thalamus (which connects to the entire brain) they can spread to involve both hemispheres and are called secondary generalized seizures.

Answer 8

Question 9

Absence Seizures:

1. brain involvement
2. age of patient
3. duration
4. symptoms recalled by pt
5. movements
6. after-effects
7. EEG pattern
8. Underlying cause
9. effective treatment

Answer 9

Absence Seizures:

1. brain involvement: generalized
2. age of patient: childhood + early adulthood
3. duration: <30 sec
4. symptoms recalled by pt: none or missing time
5. movements: no more than flutter of eyelids or brief shiver
6. after-effects: none
7. EEG pattern: 3Hz spike and slow wave discharges
8. Underlying cause: often familial (genetic)
9. effective treatment: balproate, ethosuximide

Question 10

Patient presents with:

1. psychic symptoms, deja vu, automatism:
2. epigastric sensation, dreamy state, hallucination of taste:
3. auditory hallucinations, vertigo, depression,
4. complex visual hallucinations, depression, dreamy state

Answer 10

Patient presents with:

1. psychic symptoms, deja vu, automatism: anterior-temporal
2. epigastric sensation, dreamy state, hallucination of taste: sylvian
3. auditory hallucinations, vertigo, depression: mid-temporal
4. complex visual hallucinations, depression, dreamy state: posterior temporal

these symptoms all occur if the seizure is localized to the temporal lobe… but different parts of the temporal lobe control different things

Question 11

Partial Complex:

1. brain involvement:
2. age of patient:
3. duration:
4. symptoms recalled by pt:
5. movements:
6. after-effects:
7. EEG pattern:
8. Underlying cause:
9. effective treatment:

Answer 11

Partial Complex:

1. brain involvement: focal
2. age of patient: any age
3. duration: 2-3 minutes
4. symptoms recalled by pt: “complex” eg. odors, deja vu, emotions
5. movements: can be complex- chewing, picking, peering (these movements will be the same during each episode in the same patient)
6. after-effects: confusion, tiredness
7. EEG pattern:focal spikes
8. Underlying cause: something wrong with tissue
9. effective treatment: NOT ethosuximide

Question 12

What are the two most common causes of epilepsy?

Answer 12

idiopathic and vascular causes account for about 3/4 of the cases