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Block 5; Week 6 > Epilepsy-Bloch > Flashcards

Epilepsy-Bloch Flashcards

1
Q

What is a seizure?

A

Paroxysmal, excessive and disorderly discharging of neurons

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2
Q

What are the components of a seizure?

A

aura- earliest portion of seizure
ictus- actual seizure
post-ictal- immediately after seizure

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3
Q

What is epilepsy?

A

Epilepsy is defined as a syndrome of recurrent seizures

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4
Q

What is an aura?

A

the beginning of a seizure…if it starts in the temporal lobe-may smell something bad.

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5
Q

T/F Some epileptic patients don’t have a post-ictal period.

A

True.

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6
Q

T/F Epilepsy is a benign disease.

A

False.
sudden death can happen w/ epileptic patients.
happens during sleep.

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7
Q

T/F Treatment completely cures epilepsy.

A

False.

50% of epileptics continue to experience seizures despite treatment

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8
Q

T/F Following one seizure, you can make a diagnosis of epilepsy.

A

False. One seizure does not an epileptic make.

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9
Q

Which age groups is epilepsy most common in?

A

young children & older age group

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10
Q

What are the categories of seizures?

A 
Partial seizures
Generalized seizures
--convulsive
--nonconvulsive
Status Epilepticus
Non-epileptic seizures
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11
Q

What are generalized seizures?

A

starts in both hemispheres at the same time

can be convulsive or non convulsive (just stare)

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12
Q

What are partial seizures?

A

starts in one hemisphere & then maybe spreads to another…

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13
Q

Do you intubate for non-convulsive status epileptics?

A

no.

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14
Q

Describe a simple partial seizure.

A

patient remains conscious. Stays in one area of the cortex.

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15
Q

Describe a complex partial seizure.

A

usu start in temporal lobe. Impaired consciousness. Will move.

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16
Q

Describe a secondarily generalized seizure.

A

loss of consciousness. Clonic jerks of muscles. Pt enters deep stupor of 15-30 min.

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17
Q

What happens in myoclonic jerks?

A

happen w/o loss of consciouness. Tend to be around sleep time.

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18
Q

What happens in atonic seizures?

A

sudden loss of muscle tone that lasts for a few seconds, occurs in children often.

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19
Q

Can a simple seizure become complex? What else can it become?

A

simple–Complex is possible.

Either can become secondarily generalized.

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20
Q

What are the different types of generalized seizures?

A

Typical absence seizures (petit mal)
atypical absence
Myoclonic-subtle. Happens a lot in children. Drop things.
Clonic—more flexing posture
Tonic—more extending posture
Tonic-clonic (grand mal)
Atonic-pt loses all muscle tone, see with helmets.

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21
Q

T/F Patients usu oscillate b/w tonic & clonic movements in their seizure.

A

True. Rarely just clonic or tonic.

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22
Q

What are the epilepsy syndromes of adolescence?

A 
Juvenile absence epilepsy
Juvenile myoclonic epilepsy
Epilepsy with TC upon awakening
Benign partial seizures of adolescence
Temporal lobe epilepsy
Progressive myoclonic epilepsies
Mitochondrial encephalopathies
23
Q

When does juvenile absence epilepsy begin?

A

at puberty, 12-14 yo

24
Q

What is the condition where you drop your cereal bowl?

A

juvenile myoclonic epilepsy

25
Q

What is the most common lobe in the brain for epilepsy to begin?

A

temporal lobe

26
Q

What are some important causes of localization-related epilepsies?

A 
Vascular causes
infectious causes
tumor
degenerative-MS
traumatic
congenital-cortical dysplasia
27
Q

What are some of the specific vascular causes of localization-related epilepsies?

A 
stroke
AVM
Subarachnoid hemorrhage
venous thrombosis-trauma, hypercoagulative women w/ OCP
carotid dissection
SCA
28
Q

What are some infectious causes of localization-related epilepsies?

A

meningitis
encephalitis (tends to go to the temporal lobe–which is pro-epileptic)
abscess

29
Q

If someone has an aura, which type of seizure did they likely have?

A

partial seizure, not generalized.

30
Q

What are some conditions that can be mistaken for seizures?

A 
Syncope
Non-epileptic seizures
Breath holding spells (children)
Paroxysmal REM sleep behavior-associated with Parkinson's
Panic attack
TIA
Migraine
Vertigo
Total global amnesia (TGA)
Symptomatic hypoglycemia-can cause seizures or just syncope
31
Q

What are the patterns seen in pseudo seizures or non-epileptic seizures?

A

-sometimes w/ pts with psychiatric disorders–>often clench their eyes shut. Have head side to side…Shouldn’t be given meds.

32
Q

What is total global amnesia?

A

occurs maybe once in a person’s life
occurs after a stressful event
will be in the middle of their day & will be totally confused about where they are even tho they know who they are…
forget for 2-4 hrs & then it comes back.
probably caused by decreased neuronal activity in the hippocampus.
unknown if it is seizure related.

33
Q

What are some clues favoring a non-epileptic event or syndrome?

A

Never witnessed
Provoked by emotional stress
Variable presentation from one event to the next
Screaming or vocalizing through the whole event-only normal for beginning if hits the frontal lobe
Prolonged event (greater than a few minutes)
Sudden termination of event
No post-ictal confusion
Induced by suggestions
Responsive during event

34
Q

What are some of the common causes of provoked seizures?

A 
Massive sleep deprivation
Excessive use of stimulants
Withdrawal from sedatives or alcohol, esp benzodiazepines
Substance abuse
High Fever
Hypoglycemia
Electrolyte imbalance
Hypoxia
Hormonal variations
Concussion or head trauma, even relatively minor
Stress
35
Q

What are some important questions to ask for HPI for a seizure patient?

A

Careful review of events days before sz
Presence of prodromal syndrome (aura)
Description of sz from witness
Post-ictal observations–time to recovery

36
Q

What are some important questions to ask for PMH for a seizure patient?

A 
Febrile convulsions as child
History of head trauma
Cerebrovascular or cardiovascular disease
Cancer
Substance abuse
Infectious disease
37
Q

What are some important questions to ask for Family Hx for a seizure patient?

A

Febrile convulsions
Epilepsy in siblings, parents, or close relatives
History of other neurologic disorders

38
Q

What are some important questions to ask for Social Hx for a seizure patient?

A

Travel

Occupation-look at shift changes, can affect sleep & seizures.

39
Q

What are some important things to look for on PE for a seizure patient?

A

Injury Pattern (tongue biting, burns, etc)
Cardiovascular system
Skin (neurofibromatosis, etc)

40
Q

What are some important things to look for on neurological exam of a seizure patient?

A

Focal post-ictal deficits, such as Todd’s paralysis, thinking clearly.
Focal neuro deficits after recovery
Neuropsychologic assessment

41
Q

Which parts of the tongue will be bitten by a real seizure patient? Pseudoseizure?

A

Real Seizure: sides of tongue

Pseudoseizure: tip of tongue

42
Q

Our COW patient had which kind of seizure? Why?

A

partial seizure secondarily generalized

b/c she started jerking on right side & then on both sides

43
Q

Which tests are unnecessary to obtain for our COW patient?

A

lumbar puncture–no indication of developing infection

**we do want an EEG, CT or MRI, labs (may see increased WBCs), toxicology screening

44
Q

What is mesial temporal sclerosis?

A

thinner hippocampus b/c of problem in development, may have been damaged from infection too. When this is sclerosed–>tends to want to seize.

45
Q

What is the surgical option for mesial temporal sclerosis?

A

if meds don’t work

can remove part of temporal lobe & cure seizures

46
Q

What are the indications for meds after a single seizure?

A 
Structural lesion identified on imaging study
Infection of CNS or meninges
History of epilepsy in sibling
History of childhood febrile seizures
Significant head trauma
Todd’s post-ictal paresis
Status epilepticus at onset
EEG showing unequivocal epileptiform activity
Age over 60 years
47
Q

What is status epilepticus?

A

a seizure that does not resolve on its own.
seizures should stop at 4 minutes
if it is longer (5 min or more)–it could cause permanent brain damage.
or long period of intermittent seizures (10 min)
**diazepam is given to relieve.

48
Q

When do you NOT recommend using meds after a single seizure episode?

A 
Alcohol withdrawal
drug abuse
seizure from hypoglycemia or electrolyte imbalance
provoked by excessive sleep deprivation
immediate post-impact seizure
49
Q

When can you discontinue anti-eplipetic drugs?

A

seizure free for 2 years & are b/w ages of 20-50 yo
no previous unsuccessful attempts at withdrawal
normal EEG & neurological exam

50
Q

What is the vagus nerve stimulator?

A

option for intermittent programmed electrical stimulation of L vagus nerve, implanted in chest
inhibitory message up to thalamic tracts–decreases seizures. Also somehow helps depression.

51
Q

What are the side effects of the vagus nerve stimulator?

A

hoarseness, throat discomfort, dyspnea

52
Q

What is an indication for epilepsy surgery?

A

Unacceptable seizure control despite maximum tolerated doses of 2-3 appropriate AEDs

53
Q

What is a side effect of anti-eplieptic drugs?

A

decreases Vit D–>can put patient at increased risk for osteoporosis.

Block 5; Week 6 (6 decks)

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