Epilepsy and Seizures Flashcards
what are the characteristics of benign childhood epilepsy? (3)
- occurs in 3-13 year olds
- accounts for ~1/4 of childhood epilepsy
- seizures occur during sleep or shortly after awakening
what are the characteristics of childhood absence epilepsy? (6)
- accounts for 10-15% of childhood epilepsies
- blank stare during seizure
- longer seizures can have automatisms (blinking or mouth movements)
- can have dozens of seizures per day
- no post-ictal changed
- certain anti-epileptic drugs can make it worse (hard to tell apart from complex partial seizures)
what is the progression of childhood absence seizures? (3)
- majority remit in later adolescents or adulthood
- if they also have generalized tonic-clonic seizures it is more likely to persist
- prognosis is good, with some data suggesting lower vocational attainment, poor social adjustment, or increased psychiatric diagnoses as adults
what are the characteristics of juvenile myoclonic epilepsy? (3)
- onset in adolescents (~14 years)
- inherited (dominant but not perfect penetrance)
- accounts for 3-12% of epilepsies
what are the 3 types of seizures that are usually seen in juvenile myoclonic epilepsy?
- myoclonic
- generalized tonic clonic
- absence
what is the prognosis of juvenile myoclonic epilepsy?
good, but it is a lifelong condition
how is juvenile myoclonic epilepsy treated?
AEDs
what are the neuropsychological deficits that occur in juvenile myoclonic epilepsy? (5)
- processing speed
- working memory
- fluency
- naming
- executive functioning
what are the characteristics of West’s Syndrome? (4)
- onset at 6-18 months
- high mortality rate
- infantile spasms, developmental arrest, and chaotic EEG patterns
- poor prognosis, intellectual delay, develop a second type of seizure syndrome
what are the characteristics of Lennox-Gastaut Syndrome? (4)
- onset 27 months to 6 years
- rare; pathological genesis for many (meningitis, trauma, etc)
- severe and difficult to control
- intellectual delay; autistic features; behavioural problems
what are the characteristics of Landau-Kleffner Syndrome? (5)
- acquired epileptic aphasia
- rare
- present after normal development
- behaviours on the autism spectrum
- variable prognosis (depends on age of onset)
what are the characteristics of focal (partial) epilepsies? (2)
- focal onset
- present with simple partial seizures (may or may not have motor symptoms)
what are the characteristics of temporal lobe epilepsy (TLE)? (4)
- most common type of epilepsy
- mesial temporal sclerosis
- many have a history of febrile seizures
- most have hippocampal sclerosis (stiffening of tissue)
what do temporal lobe seizures usually involve?
- non-motor simple partial (auras) but with oral related automatisms or upper extremities; then lose consciousness
- can have the usual sensations: rising gastric, auditory hallucinations, deja-vu, post-ictal paraphasias
what are the neuropsychological deficits associated with temporal lobe epilepsy? (5)
- intellectual delay
- language
- memory
- attention/executive function
- visuospatial impairments
what are the characteristics of frontal lobe epilepsy (FLE)? (4)
- short clusters of seizures with no clear loss of consciousness, but more motor activity
- jacksonian march (if in primary motor cortex)
- hypermotor behaviour
- variable neuropsychological deficits
what are the characteristics of parietal lobe epilepsy? (3)
- rare
- vertigo is common
- neuropsychological deficits in language and/or apraxia
what are the characteristics of occipital lobe epilepsy? (3)
- very rare
- visual auras, flashing colours, and blindness can occur
- visuospatial deficits
what are the characteristics of refractory epilepsy? (5)
- most commonly partial complex seizures (medial temporal sclerosis is very common)
- at risk for sudden unexplained death in epilepsy (SUDEP)
- progressive neuropsychological deficits
- psychiatric dysfunction
- lower quality of life; poorer educational and vocational attainment
what are the types of neurosurgery? (5)
- anterior temporal lobectomy
- hemispherectomy (for patients with hemiparesis)
- corpus callosotomy (for patients with drop attacks)
- multiple supial transection (for patients with motor, sensor, or language involvement)
- implants
what is a non-drug/non-surgical intervention for epilepsy?
initiating ketosis
what percentage of patients experience declines after neurosurgery?
18-50%
what is a double loser?
someone who is not seizure free and has new onset memory/language impairments after neurosurgery
what makes a patient more likely to avoid being a double loser? (5)
- lesion likely causing seizures close to the seizure focus
- unilateral EEG abnormalities
- memory is laterally impaired for the hemisphere where the lesion/seizure focus is (ipsilateral)
- higher general cognitive ability
- Wada’s test on contralat says memory and language is good
ictal
physiological state - such as during a seizure
refractory
not modified by any known treatment
what is a seizure?
hyper-synchronous discharge of neurons with behavioural change
what are the characteristics of seizures? (3)
- can be provoked or unprovoked
- anyone can have a provoked seizure (TBI, hypoglycaemia)
- more than one unprovoked seizure is considered epilepsy
what are the different classifications of seizures? (3)
- focal (focal read of brain) associated with abnormality
- epileptogenic focus (part of the brain that is damaged)
- generalized (both hemispheres involved)
what are the aspects of seizure classification? (2)
we have to think:
- is the onset focal or generalized?
- do you lose consciousness or not?
partial vs complex seizures
partial: do not lose consciousness (only part of brain)
complex: lose consciousness (multiple parts of brain)
what are the characteristics of simple partial seizures? (5)
- one focal area
- does not impair consciousness
- sensory, motor, autonomic, or psychic (deja-vu, jamais-vu)
- lasts from a few seconds to minutes
- sometimes non-motor simple partial seizures are referred to as auras
what are the characteristics of complex partial seizures? (6)
- one focal area
- impairs consciousness
- typically starts as simple partial and moves to complex partial
- no response to environment
- lasts a few seconds to a few minutes
- blank stare with repeated motor movements
what are the characteristics of absence seizures? (4)
- onset involves both hemispheres (generalized)
- impairs consciousness
- brief (less than 20 seconds)
- blank stare
what are the characteristics of atonic seizures? (3)
- onset involves both hemispheres (generalized)
- sudden loss of muscle tone
- falling seizures
what are the characteristics of clonic seizures? (3)
- onset involves both hemispheres (generalized)
- impairs consciousness
- jerking movements
what are the characteristics of tonic seizures? (4)
- onset involves both hemispheres (generalized)
- bilateral tonic extension of arm or flexion of the head and neck
- impairs consciousness
- lasts several seconds
what are the characteristics of myoclonic seizures? (4)
- onset involves both hemispheres (generalized)
- impairs consciousness
- fast jerks of the head, limbs, etc
- might evolve to generalized tonic-clonic seizures
what are the characteristics of tonic-clonic seizures? (5)
- onset involves both hemispheres (generalized)
- impairs consciousness
- tonic extension of extremities for about 20 seconds
- clonic synchronous muscle movements lasting about 45 seconds
- patient tends to be confused and exhausted after the seizure has ended
what is status epilepticus?
- a seizure lasting more than 5 minutes
- the longer the seizure the less likely it will stop on its own
- dangerous and can increase chances of death
what are the common post-ictal behaviours? (3)
- after a complex partial or generalized tonic-clonic seizure the person is confused
- mood disorders
- psychosis
