Epilepsy: Continuum (Dx of Epilepsy)

Question 1

Epilepsy definitions

Answer 1

2 + unprovoked seizures at least 24 hours apart or onse seizure accompanied by >60% risk of recurrence

Question 2

Two types of seizure classifications

Answer 2

Focal or generalized

Question 3

3 general Types of Focal seizure

Answer 3

Focal with impaired awareness
Focal without impaired awareness
Focal with rapid generalization

Question 4

5 areas of focal seizures

Answer 4

Frontal
Mesial Temporal
Posterolateral neocortical Temporal
Parietal
Occipital

Question 5

5 Neurologic Ddx for seizure

Answer 5

Psychogenic
TIA/Stroke
Migraine
Movement disorder
Sleep disorder

Question 6

3 Cardiac Ddx

Answer 6

syncope, vasovagal, hypotension

Question 7

Syncope: 3 crucial characteristics

Answer 7

presyncope:lightheaded/dizzy

Falls/eye closure/variable movements, 1-5 minutes in duration

Question 8

Duration of a spike discharge

Answer 8

20-70 ms

Question 9

Duration of a sharp

Answer 9

70-200 ms

Question 10

Diagnostic yield after 1 and 3 single EEGs

Answer 10

50 and 90%

Question 11

5 drugs that lower seizure threshold/ can give epileptic discharges in EEG

Answer 11

bupropion, cefepime,clozapine, lithium, tramadol

Question 12

What 4 areas can an EEG NOT detect very well

Answer 12

basal regions, sulci, medial temporal lobe, interhemispheric regions

Question 13

How many cm squared need to discharge in order to be detected on EEG

Answer 13

6

Question 14

What is the most epileptogenic area ?

Answer 14

medial temporal lobe (amygdala and hippocampus)

Question 15

What is the second most epileptogenic area

Answer 15

Frontal lobe

Question 16

What % of patients admitted to EMU have PNES ?

Answer 16

25%

Question 17

What % of patients with PNES have coexistent seizures ?

Answer 17

9-15%

Question 18

What % of people in an EMU with epilepsy will have an interictal discharge

Answer 18

80%

Question 19

CJD EEG findings

Answer 19

periodic sharp wives at 1hz

Question 20

Bancaud’s Phenomenon

Answer 20

Unilateral failure of the PDR to attenuate with eyes opening. Early sign of stroke.

Question 21

Triphasic wave definition

Answer 21

Seen in Metabolic Encephalophty. A-P delay. Negative-positive-negative deflections.

Question 22

Define reactivity

Answer 22

with stimulation there is a change of amplitude or frequency

Question 23

Four types of coma

Answer 23

Beta, Alpha, theta/delta, spindle

Question 24

Define alpha coma

Answer 24

diffuse rhythmic alpha coma that is more prominent in the frontal derivations.

Question 25

EEG in a locked in state

Answer 25

alpha coma that attenuates with stimulation

Question 26

Spindle Coma definition

Answer 26

prominent spindles (stage 2 sleep) from high mesencephalic lesion. Outcome better than alpha.

Question 27

Beta Coma definition

Answer 27

high amplitude beta activity seen with barbituatues,BZD and has a good outcome.

Question 28

ACNS definition of Burst Suppression

Answer 28

> 50% of the record is suppressed with alternating .5-30 second bursts.

Question 29

Sequential EEG changes in general anesthesia

Answer 29

normal sleep, diffuse delta, burst suppression, isopotentiality

Question 30

Function of inducing burst suppression

Answer 30

decreasing metabolic demand

Question 31

% of patients in ICU who develop of NCSE

Answer 31

75%

Question 32

Define electrographic seizures

Answer 32

generalized or focal spike-wave discharges at 3 Hz or faster and clearly evolving discharges that reach >4Hz.

Question 33

Definition of EEG evolution

Answer 33

2 or more sequential changes in frequency, location, or morphology

Question 34

What to do when you are unsure if cEEG looks like seizure

Answer 34

Give fast acting AED to see if it improves.