Epilepsy, concussions, and MS Flashcards
Seizures
brief, sudden, excessive discharge of electrical activity in the brain
Provoked seizure
have a direct cause (head injury, non-epileptic infection, drugs)
Epileptic seizure
does not have an immediate cause
Psychogenic Non-epileptic seizures (PNES)
resemble seizures, but without abnormal brain electrical activity; caused by stress
Focal seizure
onset is localized to a specific region of the brain
Simple seizure
does not impair consciousness
Complex seizure
alters consciousness
Generalized tonic clonic “grand mal” seizure
tonic extension of extremities and trunk (20 seconds) clonic synchronous rhythmic muscle movements (45 seconds)
EEG
measures brain electrical activity to identify seizures
- has poor sensitivity for location, but high specificity for seizures when interictal epileptiform activity is present
epilepsy
a disorder characterized by at least 2 unprovoked seizures 24 hours apart.
-can start @young age or in adulthood
-when starting in adulthood, more PNES
Anti-epileptic drugs (AEDS)
effective in 70% of individuals
-side effects may impact cognition and mood
-if 3 fail, likelihood of control is low (called intractable/refractory epilepsy)
Resection surgery for epilepsy
removal source of seizures
-most common surgery for intractable
-PNES would not improve w/surgery
Disconnection surgery for epilepsy
disrupt pathways allowing seizure to spread
Implantation of medical devices for epilepsy
vagal nerve stimulator (VNS) or deep brain stimulation (DBS)
Status epilepticus
condition in which patient undergoes series of seizures without regaining consciousness
-damage caused by excessive glutamate release during seizure
-seizures last more than 5 mins
Traumatic Brain Injury (TBI)
alteration in brain function or other evidence of brain pathology caused by an external force
Closed injury
non-penetrative, outside force impacts head, skull is not broken
open injury
penetrative injury, results when skill is broken or fractured
Primary injury
what we think of as the brain injury or the immediate cause (Fall or car accident)
-diffuse injury
Secondary injury
occurs in the hours/days following the injury as the injury evolves
-intracranial pressure from hemorrhage, iatrogenic effects from treatment
-could be focused or diffuse
Glasgow coma scale
used to rate how traumatic an injury is
-monitors eye opening responses, verbal responses, and motor responses
GCS mild
13-15, less than one day of posttraumatic confusion, loss of con for less than 30 mins
GCS moderate
9-12, 1-7days of posttraumatic confusion, loss of con for 30mins to less than 24 hours
GCS severe
<9, more than 7 days of posttraumatic confusion, loss of con for more than 24 hours
Mild TBI (concussion)
70-90%
-neurons dysfunctional, not destroyed
-full recovery w/in 7-39 days
less than 3% less than a month
moderate/severe injury
destruction and sheering of white matter (diffuse axonal injury)
-most recovery occurs in 1st year, most rapidly in first 3-6 months
-plateau in 2 years
Post concussion syndrome
presence of persistent subjective cognitive/emotional complaints more than 3 months after injury
-commonly occurs with comorbid psych distress
-does not correlate with injury severity variables
-can be ass w/ inadequate pain symptom management
What predicts recovery from a moderate to severe TBI
force of trauma, brain functions affected, areas that aren’t affected, age and time of injury, other bodily injuries
Multiple sclerosis
Progressive autoimmune disorder where immune system attacks oligodendrocytes in CNS
-degradation of myelin that occurs in MS leads to a breakdown in communication between neurons
-can form at any site w/in CNS
-symptoms depend on lesion location
MS epidemology
peak onset b/t 20 and 40
-more common in women
-genetic factors contribute
MS causes
Hypothesis: a viral infection primes a susceptible immune system for an abnormal reaction later in life
-may be a response to a chronic infection
MS symptoms
vision loss, weakness, double vision, vertigo, fatigue, etc.
MS characteristic (course)
defined by experiences of relapses and disease progression
MS relapses
worse periods of neurological symptoms caused by acute inflammatory demyelination
MS disease progression
individuals will experience progressive disability due to chronic demyelination, gliosis, and axonal loss overtime
MS cognitive impairment
40-65%
-related do damaged or destroyed white matter tracks resulting in diffuse white matter changes
-Most often affected (processing speed, attention, learning, memory, exec functioning)
MS psychosocial
unemployment, functional impairment (decreased participation in activities), mental illness
