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NEURO CLERKSHIP > Epilepsy and EEG > Flashcards

Epilepsy and EEG Flashcards

1
Q

Criteria for epilepsy

A
  1. Two unprovoked seizures > 24hrs apart
  2. 1 unprovoked seizure with the probability of further seizures
  3. Two seizures in a setting of reflex epilepsy
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2
Q

Which cells are involved in the origin of seizure activity

A

Pyramidal Cells

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3
Q

Definition of seizure

A

Paroxysmal transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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4
Q

What is the definition of epilepsy?

A

A disorder of the brain where there is a predisposition to generate epileptic seizures leading to neurobiological, cognitive and psychological/social consequences of the disorder

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5
Q

What is a generalized seizure?

A

A seizure originating within and rapidly involving bilaterally distributed networks (cortical/subcortical) that can be asymmetrical

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6
Q

What is a focal seizure?

A

Originating from a discrete location within one hemisphere; may spread to contralateral hemisphere

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7
Q

Best test for evaluating and diagnosing epilepsy

A

EEG

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8
Q

Benefits of EEG

A
  1. Distinguish generalized and focal epilepsy
  2. Distinguish epilepsy and non-epileptiform events
  3. Can r/o subclinical seizures causing AMS in ill patients
  4. Diagnosing hypoxic/anoxic brain injuries, herpes encephalitis
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9
Q

Minimum criterion for a useful EEG

A

45mins and asleep

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10
Q

Factors which increase the yield of the EEG

A
  1. Within 24-48hrs of seizure
  2. Done w/ sleep deprivation
  3. Recorded sleep state
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11
Q

When to consider Tx after a single seizure

A

If epileptiform activity is seen on the EEG

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12
Q

What are landmarks used to place the EEG leads?

A
  1. Nasion
  2. Inion (occipital protuberance)
  3. Zygoma
  4. Tragus
  5. Preauricular Point
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13
Q

What are the types of EEG waves and their respective frequencies?

A

Alpha 8-13Hz
Beta 13-30Hz
Theta 4-8Hz
Delta 1-4Hz

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14
Q

What is the T6 Spike?

A

An intra-ictal event which shows up as a sharp peak between episodes

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15
Q

What is a focal seizure without loss of consciousness?

A

Simple Partial

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16
Q

What is a focal seizure with a loss of consciousness/dyscognitive?

A

Complex Partial

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17
Q

What is a focal seizure that evolves to result in bilateral convulsions?

A

Partial Seizure with secondary generalization

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18
Q

What term denotes a focal seizure?

A

Partial

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19
Q

Which term denotes no loss of consciousness?

A

Simple

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20
Q

Which term denotes loss of consciousness?

A

Complex

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21
Q

What are different types of generalized-onset seizures?

A
  1. Absence
  2. Myoclonic
  3. Tonic-Clonic
  4. Atonic
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22
Q

What is the typical EEG finding of an Absence Seizure?

A

3Hz Spike and Wave

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23
Q

What are the possible etiologies of epilepsy?

A
  1. Genetic
  2. Structural/Metabolic
  3. Idiopathic
  4. Immune Mediated Inflammatory Process
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24
Q

What are some examples of genetic causes of epilepsy?

A

Channelopathies (Dravet Syndrome, AD Nocturnal Frontal Lobe Epilepsy)

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25
Q

What are some structural causes of epilepsy?

A
  1. CVA
  2. Tumor
  3. Trauma
  4. AV Malformation
  5. Infection/Abscess
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26
Q

What are some metabolic causes of epilepsy?

A
  1. Hypernatremia

2. DKA

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27
Q

What is a possible cause of seizures in the neonate?

A

Benign Familial Neonatal Epilepsy

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28
Q

What are possible causes of epilepsy in infancy?

A
  1. West Syndrome

2. Dravet Syndrome

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29
Q

What are possible causes of epilepsy in children > 1?

A
  1. Benign Epilepsy with Centrotemporal Spikes

2. Childhood Absence Epilepsy

30
Q

What is the Triad for Infantile Spasm?

A
  1. Hipsarrythmia
  2. Spasms
  3. Psychomotor
31
Q

What is the treatment for Infantile Spasm?

A
  1. ACTH
  2. Pyridoxine
  3. Ketogenic Diet
  4. Vigabatrin
  5. DPK
  6. Zonisamide
  7. TPX
32
Q

What are the possible etiologies of Infantile Spasm?

A
  1. Malformations
  2. Tuberous Sclerosis
  3. Down Syndrome
  4. Phenylkentonuria
  5. HIE
  6. Genetic Mutations (forehead protein G1 14q12 duplications)
33
Q

What is the EEG appearance of hipsarrythmia of Infantile Spasm?

A

Disorganized Background

34
Q

What are the common seizure disorders of Adolescence to Adult?

A
  1. Juvenile Myoclonic Epilepsy

2. Juvenile Absence Epilepsy

35
Q

Which syndrome may present as excessive clumsiness in the morning due to myoclonic jerks?

A

Juvenile Myoclonic Epilepsy

36
Q

What are structural syndromes causing epilepsy?

A
  1. Mesial Temporal Lobe Epilepsy w/ Hippocampal Sclerosis
  2. Gelastic Seizures w/ Hypothalamic Hamartoma
  3. Neurocutaneuous Syndromes (Sturge Weber, TS)
  4. Cortical Malformation
37
Q

What is the purpose of +/- contrast MRIs in the evaluation of epilepsy?

A

To r/o heterotopia or mesial temporal sclerosis

38
Q

What is the special consideration in doing an MRI of a child under age 2 for epilepsy?

A

Repeat MRI after a year incase cortical lesions did not show up

39
Q

What imaging studies can be used in patients with Epilepsy?

A
  1. MRI
  2. SPECT
  3. PET
  4. MEG
40
Q

What is the chance of having a second seizure within 5 years of an unprovoked seizure?

41
Q

What is the Goal of Therapy for Epilepsy>

A
  1. Complete Seizure Control
  2. No adverse events
  3. Best quality of life
42
Q

What is Treatment-Resistant?

A

Failure of adequate trial of two well tolerated, appropriately chosen medications to achieve seizure freedom

43
Q

Which anti-epileptics induce CYP enzymes?

A
  1. Phenobarbital
  2. Phenytoin
  3. Carbamazepine
  4. Oxcarbamazepine
  5. Valproate
  6. Ethosuximide
44
Q

What are common side effects of all anti-epileptics?

A
  1. Drowsiness
  2. Dizziness
  3. Fatigue
  4. Teratogenicity
45
Q

What are the broad spectrum AEDs?

A
  1. Valproate
  2. Lamotrigine
  3. Levetiracetam
  4. Topiramate
  5. Phenobarbital
46
Q

What is meant by “broad spectrum” AED?

A

Effective against focal and generalized seizures

47
Q

How can Valproate (Depakote) be administered?

48
Q

What are the side effects of Valproate (Depakote)?

A
  1. Teratogenicity

2. Weight Gain

49
Q

Which AED is good for pregnancy?

A

Lamotrigine (Lamictal)

50
Q

Which AED causes rash/SJS?

A

Lamotrigine (Lamictal)

51
Q

How can Levetiracetam (Keppra) be administered?

52
Q

What is the benefit of Levetiracetam (Keppra)?

A

Few side effects/drug interactions

53
Q

What is a side effect of Levetiracetam (Keppra)?

A

Irritable mood

54
Q

How can Topiramate (Topamax) be administered?

55
Q

Which AED works well for migraine prophylaxis?

A

Topiramate (Topamax)

56
Q

What are the side effects of Topiramate (Topamax)?

A
  1. Weight Loss
  2. Impaired fluency/Cognition/naming objects
  3. Renal Stones
  4. Numbness and tingling
57
Q

How can Phenobarbital be administered?

58
Q

What is the main side effect to watch out for with Phenobarbital?

A

Respiratory Depression

59
Q

Which AED may be abused?

A

Phenobarbital

60
Q

What are non-pharmacologic treatments for seizures?

A
  1. Vagal Nerve Stimulation
  2. Epilepsy Surgery
  3. Ketogenic Diet
  4. Psych Tx
61
Q

What is meant by Catamenial Epilepsy?

A

The increase in seizure frequency some women experience during certain times of their menstrual cycle

62
Q

What is the effect of estrogen on seizures?

A

It lowers seizure threshold

63
Q

Epilepsy in women is associated with

A
  1. Infertility
  2. Decreased libido
  3. Increased Polycystic Ovarian Syndrome
64
Q

What is the effect of AEDs on bone health?

A
  1. Increased fractures

2. Decreased bone mineral density

65
Q

How are AEDs teratogenic?

A

They cause NTDs (even exposure 28 days prior to conception can cause NTDs)

66
Q

Which nutritional supplement may be beneficial to mitigate the teratogenic effects of AEDs?

A

Folic Acid

67
Q

Which AED has the highest risk of major congenital defects?

68
Q

Why should changing AEDs during pregnancy be avoided?

A

Because the risk of a seizure puts the fetus at risk of hypoxic injury and the mother could be injured

69
Q

What is status epilepticus?

A

At least 5 mins of octal activity OR 2+ seizures between which there is incomplete recovery of consciousness

70
Q

What is the risk of status epilepticus?

A

The prolonged convulsive state can lead to cardiorespiratory collapse, multi organ failure or neonatal injury

71
Q

What is the treatment order for Status Epilepticus?

A
  1. Benzodiazepines
  2. IV Fosphenytoin
    • can use Valproate/Levetiracetam/lacosamide
  3. Intubate w/ IV Midazolam or Thiopental
72
Q

What is the criteria for being free of epilepsy

A

10yrs seizure free w/o medication

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