Epilepsy Flashcards
Tonic?
1st phase
muscles contract and subject falls to ground
can grunt or cry from respiratory muscles contraction
incontinence
can get cyanosed from lack of o2
clonic
usually second phase
rhythmic contractions
What can epilepsy be categorised by
- content of attack
- presumed aetiology
- EEG
- presumed site of origin in brain
What is a myoclonic seizure?
hypnic jerk
what is an atonic seizure
loss of tone cross the cortex… perseon has no tone
what causes deja vu
mesial temporal lobe - recognition phenomena
What is a partial seizure
`when a person does not lose consciousnes. There is no disruption to the RAS
e.g. focal seizure in the frontal lobes will not cause LOC
- simple partial seizures
- complex partial seizures
simple or complex partial seizures evolving into secondary generalised seizures.
What are some times of generalised seizures?
- absense seizures (petit mal)
- myoclonic seizures
- clonic seizures
- tonic seizures
- atonic seizures
- tonic-clonic seizures
What are some location-related epilepsies
focal
- idiopathic with an age-related onset
- symptomatic - e.g. temporal lobe or frontal lobe epilepsies
- cryptogenic - no etiology
What are some generalised epilepsies
- idiopathic
- symptomatic - early myoclonic encepalopathy, speicifc syndromes which have epilepsy as a predominant feature
- cryptogenic - rare with a resumed but undefined etiology.
What are generalised seizures also known as?
petit mal
What are generalised seizures?
- LOC
- petit mal
- simple absence type or complex absence type.
What are simple absence seizures?
without waring, the patient loses contact with environment for 4-5 seconds.
appears dazed and LOC
may occur 5-10 times a day but can go as high as 100s.
what are complex absence seizures??
duration is longer than simple absence
LOC
may include compelx movements i.e. lip smacking.. due to being low on the motor strip.
What are tonic-clonic seizures?
grand mal
- subcortical in origin
- display an abrupt loss of consciousness
- no aura
- all body parts symmetrically involved
- patient is disoriented after confusion
What is an akinetic seizure
these affect the mechanisms which govern posture producing profound muscle relaxation - drop attacks
What are generalised myoclonic jerks?
sudden shock-like movements of a fraction of a second mainly affecting the neck arms and shoulders.
What is the course of progression for partial seizures?
- begin focally often with an aura
- sometimes leads to generalised
- simple partial - no LOC
- complex partial - often shows LOC
- curios - triggered by an enviornmental event like a light flicker.
- gelastic epilepsy (laughing)
Which type of seizures usually have aura?
partial
less common with generalised
Some causes of epilepsy?
unknown etiology
- birth injury or congenital malformation
- CVA
- post infection
- post trauma
- tumour
- degernative disorders
- drugs and toxins
- metabolic causes
What is seen in the brain of epilepsy
- increased gliosis - effectively cells are dead and there is proliferation for glia…
loss of grey matter
mesiotemporal sclerosis
What is a limitation of EEG
it’s on the surface and we’re trying to measure deep structions
What are the modes of treatment for epilepsy?
- anti-epileptic drugs - 25-30% unresponsive
- epilepsy surgery - need to have focal epileptogenic zone that is not in functional area
- electrical stimulation (vagus nerve stimulator)
- seizure prediction
What drug is best for generalised tonic clonic seizures?
Phytoin or carbamazepine (benzo)
carbamazepine is favoured due to higher dosability.
What drug is best for petit mal seizures?
valproate (epilim)
What are some new AEDs?
gabapentin topamax keppra vigabantrin lamotrigin
Psychogenic non-epileptic seizures?
aka pseudoseizures
usually longer in duration,
starts and stops, arrhythmic, non-physiologic evolution
not stereotyped
can appear like a real seizure
patient is awake on EEG.. normal EEG rhythms.
Physical treatments for epilepsy?
- anterior temporal lobectomy, and anterior callosal section.
