Epilepsy**** Flashcards
What happens in the brain leading to seizures?
How do you describe a seizure in one hemi and both hemi’s?
What does post-ictal mean?
Abnormal electrical activity
Focal (aka partial) - underlying structural disease
Generalised
The period immediately after the seizures
Risk factors:
Developmental causes - 2
Traumatic brain injury - how long after the TBI is it thought to be caused by it?
Structural causes? - 3
Infectious causes? - 2 - M, S
Autoimmune causes - just read and lookup
Cerebral palsy
Down’s syndrome
30 days
Space-occupying lesion
Stroke
Hippocampal sclerosis - seen in Alzheimer’s
Meningitis
Syphilis
SLE
PAN
Sarcoidosis
Focal seizures - classification:
What does simple partial/aware mean?
Complex partial:
- other names for it?
- how does it manifest?
- Post-ictal symptom if it is temporal lobe based?
- How fast do they recover if it is frontal lobe based?
What can focal seizures progress to?
When is the only time generalised seizures can have an aura?
No loss of consciousness
Impaired consciousness
Dyscognitive
Blank stare and/or behavioural arrest
Confusion
Bilateral tonic-clonic (aka partial seizure with secondary generalisation)
If they have progressed from a partial!!!!
Focal seizures - classification:
What is an aura?
What lobe does a seizure cause an aura in?
What sort of symptoms do you get with aura? - 4
Symptoms before main seizure - WARNING SIGN
Temporal lobe seizures - most common
Flashing lights
Strange gut feeling
Deja vu
Sensing smells
Focal - Temporal lobe seizures:
Autonomic symptoms - name a few - think back to yr 1
Altered higher functions - name a few?
Motor symptoms:
- what complex movements might they do?
- what automatisms may they do?
Rising sensation or pain in abdomen Vomiting Flush Pallor Altered HR ----------------------- Deja vu or jamais vu Amnesia Altered emotions Delusions Hallucinations (including of smell or taste) Dysphasia (also post-ictal) ------------------------- Singing Driving Undressing
Lip-smacking
Fumbling
Focal - Frontal lobe seizures:
What cortex tends to be affected? What does this mean?
Onset
Recovery
When do they tend to occur?
Motor cortex > Abdominal movements (e.g. eye and head movements, peddling movements) or motor arrest.
Short, quick onset
Rapid recovery
At night and come in clusters.
Focal - Frontal lobe seizures:
What is Jacksonian march?
What speech symptoms may they have? - 3
What else may be changed if you think of the frontal lobe?
Recovery
What is Todd’s palsy?
Tingling spreading from one area to another (e.g. from hand up to face)
Vocalisations
Dysphasia
Speech arrest
Behavioural changes
Rapid
Todd’s paresis (or postictal paresis/paralysis, “after seizure”) is a focal weakness in a part or all of the body after a seizure. This weakness typically affects appendages and is localized to either the left or right side of the body. It usually subsides completely within 48 hours.
Focal - Benign Rolandic epilepsy:
Who is it very common in?
When do the seizure occur?
Symptoms:
- Face
- Eye
- Lips
- Speech
- Mouth
Post-ictal symptoms
Children - commonest epilepsy syndrome in children -
5-10
Facial twitches Eye flickering Lip-smacking Aphasia Salivation
Little weak
Altered sensation
Focal - Parietal lobe seizures :
Where does it tend to occur? - think about anatomy
Main symptoms - thinking about prev q
When will you get motor symptoms?
Somatosensory cortex
Abnormal sensations - tingling or numbness
If it spreads to the pre-central gyrus
Focal - Occipital lobe seizures:
Where does it occur?
What symptoms do you get?
What is the difference between the symptoms in seizures and migraines?
Visual cortex
Visual symptoms - shapes, lines and/or flashes
Shapes more colourful and circular than migraine.
Primary generalised seizures:
Absence seizures (non-motor):
- What happens
- How long does it last?
- At what age does it tend to begin?
Behavioural pause - reflecting altered consciousness without a change in muscle tone
<10 seconds
Childhood
Primary generalised seizures:
Generalised tonic-clonic seizures (GTCS):
- Are you aware?
- What does tonic and clonic mean?
- What sound do they make when it is about to begin?
- What can happen to the tongue?
- How might their colour change?
- Other features
- Post-ictal symptoms - 2
Loss of consciousness
T - limbs stiffen
C - rhythmically jerk
Cry
Biting the side of the tongue
Cyanosed due to chest spasm - so blue!!!
Urine and faecal incontinence
Confusion
Drowsiness
Primary generalised seizures:
Atonic seizures (akinetic):
- What 2 things happen?
- Recovery?
Sudden, brief loss of tone and consciousness
Will fall or regain consciousness and catch themselves
Primary generalised seizures:
Myoclonic seizures:
You get sudden jerks:
- Is it bilateral/unilateral?
- What jerks?
- When might it occur?
Bilateral
Arms (usually
Face
Trunk
On waking up
Primary generalised seizures:
Juvenile myoclonic epilepsy - they occur in the morning:
- What 3 types of seizures can you get?
- What does it tend to lead to?
West’s syndrome:
- What is it?
- Age of onset
- What also tends to co-exist?
GTCS Myoclonic seizures Absence seizures ----- Infantile spasms Limb and trunk myoclonus
<1 yr
Severe developmental delay - 90% die by adulthood
Triggers, especially for generalised seizures:
Lack of sleep Alcohol Fever Flickering light Drug, or drug withdrawal
