epilepsy-bloch Flashcards
What is a seizure?
Paroxysmal, excessive and disorderly discharging of neurons
What are the components of a seizure?
aura- earliest portion of seizureictus- actual seizurepost-ictal- immediately after seizure
What is epilepsy?
Epilepsy is defined as a syndrome of recurrent seizures
What is an aura?
the beginning of a seizure…if it starts in the temporal lobe-may smell something bad.
T/F Some epileptic patients don’t have a post-ictal period.
True.
T/F Epilepsy is a benign disease.
False. sudden death can happen w/ epileptic patients.happens during sleep.
T/F Treatment completely cures epilepsy.
False.50% of epileptics continue to experience seizures despite treatment
T/F Following one seizure, you can make a diagnosis of epilepsy.
False. One seizure does not an epileptic make.
Which age groups is epilepsy most common in?
young children & older age group
What are the categories of seizures?
Partial seizuresGeneralized seizures–convulsive–nonconvulsiveStatus EpilepticusNon-epileptic seizures
What are generalized seizures?
starts in both hemispheres at the same timecan be convulsive or non convulsive (just stare)
What are partial seizures?
starts in one hemisphere & then maybe spreads to another…
Do you intubate for non-convulsive status epileptics?
no.
Describe a simple partial seizure.
patient remains conscious. Stays in one area of the cortex.
Describe a complex partial seizure.
usu start in temporal lobe. Impaired consciousness. Will move.
Describe a secondarily generalized seizure.
loss of consciousness. Clonic jerks of muscles. Pt enters deep stupor of 15-30 min.
What happens in myoclonic jerks?
happen w/o loss of consciouness. Tend to be around sleep time.
What happens in atonic seizures?
sudden loss of muscle tone that lasts for a few seconds, occurs in children often.
Can a simple seizure become complex? What else can it become?
simple–Complex is possible.Either can become secondarily generalized.
What are the different types of generalized seizures?
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.
T/F Patients usu oscillate b/w tonic & clonic movements in their seizure.
True. Rarely just clonic or tonic.
What are the epilepsy syndromes of adolescence?
Juvenile absence epilepsy Juvenile myoclonic epilepsy Epilepsy with TC upon awakening Benign partial seizures of adolescence Temporal lobe epilepsy Progressive myoclonic epilepsies Mitochondrial encephalopathies
When does juvenile absence epilepsy begin?
at puberty, 12-14 yo
What is the condition where you drop your cereal bowl?
juvenile myoclonic epilepsy
What is the most common lobe in the brain for epilepsy to begin?
temporal lobe
What are some important causes of localization-related epilepsies?
Vascular causes infectious causes tumor degenerative-MS traumatic congenital-cortical dysplasia
What are some of the specific vascular causes of localization-related epilepsies?
stroke AVM Subarachnoid hemorrhage venous thrombosis-trauma, hypercoagulative women w/ OCP carotid dissection SCA
What are some infectious causes of localization-related epilepsies?
meningitis
encephalitis (tends to go to the temporal lobe–which is pro-epileptic)
abscess
If someone has an aura, which type of seizure did they likely have?
partial seizure, not generalized.
What are some conditions that can be mistaken for seizures?
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
What are the patterns seen in pseudo seizures or non-epileptic seizures?
-sometimes w/ pts with psychiatric disorders–>often clench their eyes shut. Have head side to side…Shouldn’t be given meds.
What is total global amnesia?
occurs maybe once in a person’s lifeoccurs after a stressful eventwill 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.
What are some clues favoring a non-epileptic event or syndrome?
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
What are some of the common causes of provoked seizures?
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
What are some important questions to ask for HPI for a seizure patient?
Careful review of events days before sz
Presence of prodromal syndrome (aura)
Description of sz from witness
Post-ictal observations–time to recovery
What are some important questions to ask for PMH for a seizure patient?
Febrile convulsions as childHistory of head traumaCerebrovascular or cardiovascular disease
Cancer
Substance abuse
Infectious disease
What are some important questions to ask for Family Hx for a seizure patient?
Febrile convulsions
Epilepsy in siblings, parents, or close relatives
History of other neurologic disorders
What are some important questions to ask for Social Hx for a seizure patient?
Travel
Occupation-look at shift changes, can affect sleep & seizures.
What are some important things to look for on PE for a seizure patient?
Injury Pattern (tongue biting, burns, etc)
Cardiovascular system
Skin (neurofibromatosis, etc)
What are some important things to look for on neurological exam of a seizure patient?
Focal post-ictal deficits, such as Todd’s paralysis, thinking clearly.Focal neuro deficits after recoveryNeuropsychologic assessment
Which parts of the tongue will be bitten by a real seizure patient? Pseudoseizure?
Real Seizure: sides of tonguePseudoseizure: tip of tongue
Our COW patient had which kind of seizure? Why?
partial seizure secondarily generalizedb/c she started jerking on right side & then on both sides
Which tests are unnecessary to obtain for our COW patient?
lumbar puncture–no indication of developing infection**we do want an EEG, CT or MRI, labs (may see increased WBCs), toxicology screening
What is mesial temporal sclerosis?
thinner hippocampus b/c of problem in development, may have been damaged from infection too. When this is sclerosed–>tends to want to seize.
What is the surgical option for mesial temporal sclerosis?
if meds don’t workcan remove part of temporal lobe & cure seizures
What are the indications for meds after a single seizure?
Structural lesion identified on imaging studyInfection of CNS or meningesHistory of epilepsy in siblingHistory of childhood febrile seizuresSignificant head traumaTodd’s post-ictal paresisStatus epilepticus at onsetEEG showing unequivocal epileptiform activityAge over 60 years
What is status epilepticus?
a seizure that does not resolve on its own.seizures should stop at 4 minutesif 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.
When do you NOT recommend using meds after a single seizure episode?
Alcohol withdrawaldrug abuseseizure from hypoglycemia or electrolyte imbalanceprovoked by excessive sleep deprivationimmediate post-impact seizure
When can you discontinue anti-eplipetic drugs?
seizure free for 2 years & are b/w ages of 20-50 yono previous unsuccessful attempts at withdrawalnormal EEG & neurological exam
What is the vagus nerve stimulator?
option for intermittent programmed electrical stimulation of L vagus nerve, implanted in chestinhibitory message up to thalamic tracts–decreases seizures. Also somehow helps depression.
What are the side effects of the vagus nerve stimulator?
hoarseness, throat discomfort, dyspnea
What is an indication for epilepsy surgery?
Unacceptable seizure control despite maximum tolerated doses of 2-3 appropriate AEDs
What is a side effect of anti-eplieptic drugs?
decreases Vit D–>can put patient at increased risk for osteoporosis.
