Epilepsy-Bloch

Question 1

What is a seizure?

Answer 1

Paroxysmal, excessive and disorderly discharging of neurons

Question 2

What are the components of a seizure?

Answer 2

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

Question 3

What is epilepsy?

Answer 3

Epilepsy is defined as a syndrome of recurrent seizures

Question 4

What is an aura?

Answer 4

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

Question 5

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

Answer 5

True.

Question 6

T/F Epilepsy is a benign disease.

Answer 6

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

Question 7

T/F Treatment completely cures epilepsy.

Answer 7

False.

50% of epileptics continue to experience seizures despite treatment

Question 8

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

Answer 8

False. One seizure does not an epileptic make.

Question 9

Which age groups is epilepsy most common in?

Answer 9

young children & older age group

Question 10

What are the categories of seizures?

Answer 10

Partial seizures
Generalized seizures
--convulsive
--nonconvulsive
Status Epilepticus
Non-epileptic seizures

Question 11

What are generalized seizures?

Answer 11

starts in both hemispheres at the same time

can be convulsive or non convulsive (just stare)

Question 12

What are partial seizures?

Answer 12

starts in one hemisphere & then maybe spreads to another…

Question 13

Do you intubate for non-convulsive status epileptics?

Answer 13

no.

Question 14

Describe a simple partial seizure.

Answer 14

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

Question 15

Describe a complex partial seizure.

Answer 15

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

Question 16

Describe a secondarily generalized seizure.

Answer 16

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

Question 17

What happens in myoclonic jerks?

Answer 17

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

Question 18

What happens in atonic seizures?

Answer 18

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

Question 19

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

Answer 19

simple–Complex is possible.

Either can become secondarily generalized.

Question 20

What are the different types of generalized seizures?

Answer 20

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.

Question 21

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

Answer 21

True. Rarely just clonic or tonic.

Question 22

What are the epilepsy syndromes of adolescence?

Answer 22

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

Question 23

When does juvenile absence epilepsy begin?

Answer 23

at puberty, 12-14 yo

Question 24

What is the condition where you drop your cereal bowl?

Answer 24

juvenile myoclonic epilepsy

Question 25

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

Answer 25

temporal lobe

Question 26

What are some important causes of localization-related epilepsies?

Answer 26

``` Vascular causes infectious causes tumor degenerative-MS traumatic congenital-cortical dysplasia ```

Question 27

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

Answer 27

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

Question 28

What are some infectious causes of localization-related epilepsies?

Answer 28

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

Question 29

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

Answer 29

partial seizure, not generalized.

Question 30

What are some conditions that can be mistaken for seizures?

Answer 30

``` 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 ```

Question 31

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

Answer 31

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

Question 32

What is total global amnesia?

Answer 32

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.

Question 33

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

Answer 33

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

Question 34

What are some of the common causes of provoked seizures?

Answer 34

``` 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 ```

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

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

Answer 37

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

Question 38

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

Answer 38

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

Question 39

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

Answer 39

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

Question 40

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

Answer 40

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

Question 41

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

Answer 41

Real Seizure: sides of tongue | Pseudoseizure: tip of tongue

Question 42

Our COW patient had which kind of seizure? Why?

Answer 42

partial seizure secondarily generalized | b/c she started jerking on right side & then on both sides

Question 43

Which tests are unnecessary to obtain for our COW patient?

Answer 43

lumbar puncture--no indication of developing infection | **we do want an EEG, CT or MRI, labs (may see increased WBCs), toxicology screening

Question 44

What is mesial temporal sclerosis?

Answer 44

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

Question 45

What is the surgical option for mesial temporal sclerosis?

Answer 45

if meds don't work | can remove part of temporal lobe & cure seizures

Question 46

What are the indications for meds after a single seizure?

Answer 46

``` 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 ```

Question 47

What is status epilepticus?

Answer 47

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.

Question 48

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

Answer 48

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

Question 49

When can you discontinue anti-eplipetic drugs?

Answer 49

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

Question 50

What is the vagus nerve stimulator?

Answer 50

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.

Question 51

What are the side effects of the vagus nerve stimulator?

Answer 51

hoarseness, throat discomfort, dyspnea

Question 52

What is an indication for epilepsy surgery?

Answer 52

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

Question 53

What is a side effect of anti-eplieptic drugs?

Answer 53

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