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Clin Neuro - SCI, PNS, Epilepsy, Neoplasms > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

Epilepsy is

A

Basically the neurons start firing at a significantly greater rate then they are supposed to

A sudden derangement of the nervous system due to a sudden, excessive, disorderly discharge of cerebral neurons

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2
Q

Terminology:

Seizures vs Epilepsy

A 
Seizures = single event
Epilepsy = recurrent seizures
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3
Q

Causes of epilepsy

A

Idiopathic

Secondary – known cause (CVA, MS, infection)

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4
Q

Seizure Manifestations

A

-Loss of Consciousness
-Convulsive movements
(limbs, trunk, face)
-Impaired psychic function
(Sense that they are no
longer part of their own
body, or everything
seems to fade to
background)
-Disturbance of sensation
Numbness (esp. if 1o
sensory cortex),
-Visual hallucinations

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5
Q

Pathogenesis of epilepsy

A

If more excitatory than inhibitory neurotransmitters are released, the neuron will fire

Everyone has a certain about of excitatory and inhibitory NTs in the brain. So if there is an excessive amount of excitatory NTs to inhibitory NT it can potentially lead to a seizure. Medications try to balance these out either by inc. inhibitory or dec. excitatory

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6
Q

What is a convulsive seizure

A

If the disturbance flashes across the whole brain at once, it could produce a convulsive seizure, temporarily disrupting many of the functions of the brain.

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7
Q

What is the Seizure Threshold

A

If you have a low threshold for seizures that means that there is good chance of having a seizure -this means that there is a lot of excitatory activity in brain
A lot of excitatory activity in the brain is caused from either having a lot of excitatory NT or very little inhibitory NTs

The relative proportions of each determine whether a person has a low threshold for seizures (because of the higher excitatory balance) or a high threshold (because of greater inhibition).

A low seizure threshold ↑ the risk of epilepsy

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8
Q

What factors determine the character of the seizure, impact on person and social consequences involved

A

1) The location of that event
2) The extent of its reach within the tissue of the brain
3) The duration of the event (how long it lasts)

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9
Q

4 Types of Seizures

A

a) Generalized seizures
-Bilateral & symmetrical
w/o
focal onset
-May be idiopathic
b) Focal (Partial) seizures
-Never idiopathic
c) Status epilepticus
d) Non-epileptic seizures

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10
Q

Types of Generalized Seizures (4)

A

Grand Mal Seizures (Tonic-Clonic Seizures-tone to clonic)

Petit Mal Seizures (Absence Seizures)

Myoclonic Seizures

Atonic Seizures

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11
Q

Generalized Tonic-Clonic (grand mal) Duration

A

1 to 2 min

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12
Q

Generalized Tonic-Clonic (grand mal) Seizure Sx

A 
A cry
Fall
Tonicity (rigidity)
Clonicity (jerking)
May have cyanosis
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13
Q

Generalized Tonic-Clonic (grand mal) Postictal Sx

A

Amnesia for seizure events
Confusion
Deep sleep

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14
Q

Absence (petit mal) Duration

A

2 to 15 sec

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15
Q

Absence (petit mal) Seizure Sx

A

Stare
Eyes fluttering
Automatisms if prolonged

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16
Q

Absence (petit mal) Postictal Sx

A

Amnesia for seizure events
No confusion
Promptly resumes activity

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17
Q

What is the most common & best known type of generalized seizure

A

Grand-mal seizures (Tonic-Clonic)

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18
Q

Prodrome means

A

Occurs several hours before the event

Apathy, depression, euphoria, myoclonic jerks

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19
Q

An aura is

A

An ‘aura’ is the term that some people use to describe the warning they feel before they have a tonic clonic seizure.

occurs a few seconds before LOC
Turning of head, palpitations, unnatural sensations (i.e. butterflies in stomach)

(it is a warning sign before a tonic clonic seizure)

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20
Q

Grand mal seizure tonic phase, how long does it last and what happens to the person

A

Seizure – sudden LOC and fall

Tonic Phase (lots of tone) – 10-20 seconds:
Legs extend, arms in “hands up” position
Jaw snaps shut (tongue gets bitten), emits loud cry
Breathing ceases causing cyanosis
Bladder empties
Pupil fixed and dilated
Babinski signs

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21
Q

Grand mal seizure, clonic phase, how long does it last and what happens to the person

A

Clonic Phase (30-60 seconds)-body starts to relax from fully tonic contraction

Generalized coarse tremor (repetitive relaxation of tonic contraction)
Facial grimacing & frothing of the mouth
Continues to be apneic
Often salivates

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22
Q

Grand mal seizure, post-clonic phase, how long does it last and what happens to the person

A

Post-clonic phase – pt lies limp in a deep sleep (body relaxes and slowly returns to normal)

Pupillary reactivity returns
Breathing normalizes
After 5 min, awakens but appears drowsy/confused
May fall asleep for several hours more afterwards

23
Q

3 phases of a grand mal seizure

A

Tonic phase
Clonic phase
Post Clonic phase

24
Q

Petit Mal Seizures are

A

Lapses of awareness, sometimes w/ staring, that begin & end abruptly, lasting only 2-15 sec
There is no warning & no after-effect
More common in children than in adults
Usually begins age 4-12
Always idiopathic
Little, if any, motor activity – may see rhythmic movements of facial muscles (i.e. lipsmacking)
Can be induced by hyperventilation

25
Q

Why do petit mal seizures happen and are there warning signs

A

no warning and no after affect - What we normally see is blank stares ore absents in awareness

We don’t know why it happens, but it usually happens when we are younger
no motor activity when it happens

26
Q

Myoclonic seizures are

A

Rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body

contraction of the muscles - tonic seizures

27
Q

Atonic seizures are

A 
Abrupt loss of muscle tone 
Aka drop attacks
Causes head drops, loss of posture, or sudden collapse ➡ head injuries
Protective headgear is sometimes used 
Tend to be resistant to drug therapy
28
Q

Which seizure is known for drop attacks

A

Atonic seizures- all the muscles stop working/loss of muscle tone, lead to “drop attacks” just fall to the ground (this is very dangerous, injuries to neck and face common)

29
Q

What are partial seizures and what is the part of the brain it often affects

A

Most commonly seen in temporal lobe
Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized.
Virtually any movement, sensory, or emotional symptoms can occur as part of a partial seizure, including complex visual or auditory hallucinations.

30
Q

2 common subdivisions of partial seizures

A

Simple partial seizures – (-) LOC

Complex partial seizures – (+) LOC

31
Q

Simple partial duration

A

90 sec

32
Q

Simple partial Seizure Sx

A

No LOC
Sudden jerking
Sensory phenomena

33
Q

Simple partial Postictal Sx

A

Possible transient weakness or loss of sensation

34
Q

Complex partial Duration

A

1 to 2 min

35
Q

Complex partial Seizure Sx

A

May have aura
Automatisms
Unaware of environment
May wander

36
Q

Complex partial Postictal Sx

A

Amnesia for seizure events
Mild to moderate confusion
Sleepy

37
Q

Complex partial seizure auras

A

Complex hallucinations of all senses
Perceptual illusions
Dyscognitive state: ↑ reality or familiarity (deja vu); unfamiliarity (jamais vu), depersonalization (i.e. undressing in public)
Affective experiences: fear, anxiety, rage

38
Q

Automatism ex, and happens with

A

Automatism example: hand tapping that keeps going, lip smacking

Happens with complex partial seizures

39
Q

Complex partial seizures and simple partial seizures

A

They do have LOC and can keep doing complex activities

When you have a complex partial seizure they are a bit more involved. You start getting more hallucinations and decreased period of responsiveness and after the complex some sort of altered behavior

40
Q

Status Epilepticus is

A

Literally a “continuous state of seizure”

Seizures are prolonged, or occur in a series, lasting > 30 minutes

41
Q

What is one of the first things you should do if a person is having a seizure

A

Make sure person is safe and check the time

42
Q

When should you call the hospital for a seizure

A

if it lasts more than 5 mins and the person is pregnant

43
Q

Status Epilepticus likely causes

A

Do not know what causes it but some likely causes

Brain tumors or infections
Craniocerebral trauma 
Cerebrovascular disease
Ingestion of cocaine or other illegal drugs
Toxic or metabolic disorders
44
Q

Status epilepticus and history of seizures

A

Most people that this happens to have no history of seizures

and do not have a h/o epilipsy

45
Q

Nonepileptic Seizures aka and what is this

A

Pseudoseizures
They have very similar symptoms as a seizure but they do not have the excessive electrical activity in the cortex of the brain.

46
Q

Nonepileptic Seizures vs epileptic seizures

A

Episodes that briefly change a person’s behavior & often look like epileptic seizures.
Epileptic seizures are caused by abnormal electrical changes in the cortex, whereas nonepileptic seizures are not caused by electrical disruptions in the brain.

47
Q

Seizure triggers are and can include

A

Typically unpredictable, triggers can include:
Missed medication
Sleep/wake cycle fluctuations
Hormonal fluctuations
Pregnancy & menstrual cycles
Excessive use and/or withdrawal from alcohol or drugs
Fever; physical stress
Mental/emotional stress (worry, anxiety, anger)
Hyperventilation

48
Q

What is “reflex epilepsy” and name some triggers

A

When cause by one specific stimulus

A condition in which seizures can be provoked by an external stimulus (flashing lights) or, occasionally, by an internal mental process (mathematical calculation).

Fairly predictable in response to specific stimuli, and may coexist with spontaneously occurring seizures

Triggers: flashing lights, high contrast color/shape/stripe patterns, complex mental processes (calculations)

49
Q

Diagnosis of epilepsy

A

-Patient history
-Neurological exam
-Supporting blood work - to rule out
-Electroencephalograph (EEG)
(Records signals produced by electrical discharge of neurons)
-MRI/CT of the brain - to rule out
-PET scans if available
-Must r/o other causes: TIA, hypoglycemia, fainting

50
Q

Management of Epilepsy and can it be cured

A

There is no cure for epilepsy currently:

  • Medications
  • Surgery
  • Vagus Nerve Stimulation
  • Ketogenic Diet
51
Q

When is surgery and option for epilepsy

A

For intractable surgery not responding to meds

52
Q

What type of surgery is done for epilepsy

A

-Surgical removal of seizure-producing areas

-Partial/complete lobectomy or cortical resection
(Anterior temporal lobectomy most common)

  • Hemispherectomy
  • Corpus Callosotomy (so it doesn’t travel to the other side of the hemisphere)
  • Multiple Sub-pial Transection (cutting the connections so seizure can not travel
53
Q

Who would benefit from vagus nerve stimulation

A

For people who know their trigger, if they stimulate the vagus nerve they can limit the oncoming of the seizure

Clin Neuro - SCI, PNS, Epilepsy, Neoplasms (17 decks)

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