Epilepsy: Continuum (Dx of Epilepsy) Flashcards
Epilepsy definitions
2 + unprovoked seizures at least 24 hours apart or onse seizure accompanied by >60% risk of recurrence
Two types of seizure classifications
Focal or generalized
3 general Types of Focal seizure
Focal with impaired awareness
Focal without impaired awareness
Focal with rapid generalization
5 areas of focal seizures
Frontal Mesial Temporal Posterolateral neocortical Temporal Parietal Occipital
5 Neurologic Ddx for seizure
Psychogenic TIA/Stroke Migraine Movement disorder Sleep disorder
3 Cardiac Ddx
syncope, vasovagal, hypotension
Syncope: 3 crucial characteristics
presyncope:lightheaded/dizzy
Falls/eye closure/variable movements, 1-5 minutes in duration
Duration of a spike discharge
20-70 ms
Duration of a sharp
70-200 ms
Diagnostic yield after 1 and 3 single EEGs
50 and 90%
5 drugs that lower seizure threshold/ can give epileptic discharges in EEG
bupropion, cefepime,clozapine, lithium, tramadol
What 4 areas can an EEG NOT detect very well
basal regions, sulci, medial temporal lobe, interhemispheric regions
How many cm squared need to discharge in order to be detected on EEG
6
What is the most epileptogenic area ?
medial temporal lobe (amygdala and hippocampus)
What is the second most epileptogenic area
Frontal lobe
What % of patients admitted to EMU have PNES ?
25%
What % of patients with PNES have coexistent seizures ?
9-15%
What % of people in an EMU with epilepsy will have an interictal discharge
80%
CJD EEG findings
periodic sharp wives at 1hz
Bancaud’s Phenomenon
Unilateral failure of the PDR to attenuate with eyes opening. Early sign of stroke.
Triphasic wave definition
Seen in Metabolic Encephalophty. A-P delay. Negative-positive-negative deflections.
Define reactivity
with stimulation there is a change of amplitude or frequency
Four types of coma
Beta, Alpha, theta/delta, spindle
Define alpha coma
diffuse rhythmic alpha coma that is more prominent in the frontal derivations.
EEG in a locked in state
alpha coma that attenuates with stimulation
Spindle Coma definition
prominent spindles (stage 2 sleep) from high mesencephalic lesion. Outcome better than alpha.
Beta Coma definition
high amplitude beta activity seen with barbituatues,BZD and has a good outcome.
ACNS definition of Burst Suppression
> 50% of the record is suppressed with alternating .5-30 second bursts.
Sequential EEG changes in general anesthesia
normal sleep, diffuse delta, burst suppression, isopotentiality
Function of inducing burst suppression
decreasing metabolic demand
% of patients in ICU who develop of NCSE
75%
Define electrographic seizures
generalized or focal spike-wave discharges at 3 Hz or faster and clearly evolving discharges that reach >4Hz.
Definition of EEG evolution
2 or more sequential changes in frequency, location, or morphology
What to do when you are unsure if cEEG looks like seizure
Give fast acting AED to see if it improves.