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Neuro Clerkship > Epilepsy & EEG > Flashcards

Epilepsy & EEG Flashcards

1
Q

What are the three definitions of epilepsy?

A
  1. At least two unprovoked seizures more than 24 hrs apart
  2. One unprovoked seizure + probability of another (EEG records and real time brain waves recorded)
  3. At least two seizures in setting of reflex epilepsy
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2
Q

How does epilepsy differ from a seizure?

A

In epilepsy there is an enduring predisposition to generate epileptic seizures–> neurobiological, cognitive, psychological, social consequences

A simple seizure is paroxysmal and transient

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3
Q

Generalized seizures

A

Starts on both sides:

Originates within and rapidly involves bilaterally distributed networks (cortical and subcortical)

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4
Q

Focal seizures:

A

Originated from network restricted to one hemisphere; may be discrete or wider distribution

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5
Q

How are EEGs useful?

A

Distinguish between focal or generalized seizure

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6
Q

What are the uses for continuous video EEG? (2)

A
  • Distinguish between epilepsy and non-epileptiform events

- Rule out subclinical seizure in critically ill patients

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7
Q

How is seizure treatment customized?

A

Based on ONSET not spread

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8
Q

What are the shortcomings of 30 minute outpatient EEG?

A
  • Limited sleep state (jaw muscle artifact)

- Misses some frontal lobe seizures

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9
Q

What is the ideal method to get maximum yield from an EEG?

A
  • Done within 24-48 hrs of seizure

- Sleep deprivation and recorded sleep state

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10
Q

What is the proper method for placing EEG leads?

A

10%-10% of patient’s measurement and placement of leads accordingly; as long as head shape doesn’t change due to trauma or suture bulging, as long as you follow the system the leads will be put in the same place

Scalp location is surrogate for brain location

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11
Q

What are the Hz values for Alpha, beta, delta, and gamma waves

A

8-12 Hz = alpha
13+ Hz = beta
4-6 Hz= Delta
1-4 Hz= gamma

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12
Q

How do eye blinks appear on EEG? What is “Bell’s phenomenon”?

A

Negative vector is up, positive is down

Eye blinks are the cornea with a humongously positively charge touching the frontal region = “Bells phenomenon” causes the downward dip on EEG due to cornea rolling

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13
Q

Which leads change with maturity?

A

Occipital leads– you will see a posterior dominant background

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14
Q

What will you see with hyperventilation on EEG?

A

Diffuse slowing throughout all leads.
Caused by dip in CO2

**Note that if you saw focal slowing, you’d think focal brain lesion

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15
Q

In terms of spike and wave activity, what constitutes a seizure?

A

Lasts longer than ten seconds

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16
Q

What are the three types of focal seizures?

A
  • simple partial (no LOC)
  • complex partial (LOC / awareness)
  • secondary generalization (w bilateral convulsions)
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17
Q

What are the 4 types of generalized seizures?

A
  • Absence
  • Myoclonic
  • Tonic-Clonic
  • Atonic
18
Q

What are the typical EEG findings associated with generalized absence seizures?

What is a primary characteristic of absence epilepsy?

A

3 hz spike and wave discharge, generalized absence seizure

**No postectal confusion

19
Q

What are the 4 classifications for epilepsy etiology?

A
  • Genetic (especially frontal lobe)
  • Structural/ metabolic (DKA, Hypernatremia)
  • Unknown
  • Immune/ Inflammatory mediated
20
Q

Neonatal epilepsy is commonly caused by…

A

Benign familial neonatal epilepsy

21
Q

What are two common causes of infantile seizures?

A

West syndrome

Dravet Syndrome

22
Q

What is Benign Epilepsy with centrotemporal spikes?

At what age does it manifest?
What are the clinical features?

A

“Rolondic epilepsy”

Manifests after 1 yoa with twitching mouth and drooling

23
Q

What are infantile spasms? What is the triad?

A
  • EEG Hipsarrythmia
  • Spasms
  • Arrested psychomotor development
24
Q

6 potential causes of infantile spasms:

A
  • Malformations
  • TS
  • Chromosomal abnormalities
  • Genetic mutations
  • Inborn error of metabolism
  • Hypoxic ischemic encephalopathy
25
Q

What are the EEG features of Juvenile Myoclonic Epilepsy?

How does it present?

A

Not typical 3 Hz and spikes; 4-5 Hz

More clumsy in the morning; you need to ask about this and people may not complain.

26
Q

What type of brain imaging would we order to assess heterotopia or mescal temporal sclerosis?

A

MRI with thin cuts +/- Gad protocol

27
Q

At what age should we repeat MRI to ensure we see cortical lesions?

A

In all kids 2 and under; repeat after 1 year

28
Q

What are the chances of having a second seizure in patients who have a single unprovoked seizure?

A

30-50% in 2-5 years

** ^ likelihood w EEG abnormalities or known etiology (Stroke, anatomical anomalies, etc)

29
Q

Define treatment resistant epilepsy:

A

Failure of two well tolerated, appropriately chosen AEDs, used in appropriate schedule to achieve seizure freedom

30
Q

What are some of the common ADRs associated with AEDs? (3)

A
  • Drowsiness/ fatigue
  • Dizziness
  • Teratogenicity

**More meds = More ADRs

31
Q

What are the meds used to treat focal and generalized seizures? (5)

A
  • Valproate
  • Lamotrigine
  • Levetiracetam
  • Topiramate
  • Phenobarbital
32
Q

Which is the most rash provoking AED?

A

Lamotrigine; can not load the drug–will cause SJS

33
Q

What is the DOC for preggos w seizures?

A

Lamotrigine

34
Q

Which drugs can be given IV and PO? (3)

A
  • Valproate
  • Levetiracetam
  • Phenobarbital
35
Q

What are some of the ADRs for Valproate? (2)

A
  • CYP inhibitor; ^ Warfarin!!!

- Induces HPA axis–> weight gain–> PCOS

36
Q

What is the notible ADR associated with Levetiracetam?

A

irritable mood

37
Q

What are the ADRs associated with topirimate? (4)

A
  • Weight loss
  • Renal stones
  • Poor cognition
  • Teratogenic

***Takes 3 days to load

38
Q

Which drug treats status epilepticus?

Is it an enzyme inducer or inhibitor?

A
  • Phenobarbital (use IV fosphenytoin second line)

- INDUCES CYPS–> Decreases warfarin

39
Q

What is catamenial epilepsy?

A

Seizure frequency increases during certain phases of menstrual cycle

40
Q

What are some clinical pearls related wot women with epilepsy?

  • Menopause?
  • Estrogen?
  • Etc?
A
  • Earlier menopause
  • Estrogen lowers seizure threshold (contraceptives…)
  • ^ Infertility, decreased libido, PCOS
  • Poor bone health (enzyme inducing AEDs)
41
Q

Define status epilepticus:

A
  • 5+ yoa

- 5 minutes of ictal activity w/ 2+ seizures between which there is incomplete recovery of consciousness

42
Q

Non convulsive staus epilepticus: How do we ID this?

When should it be suspected?

A
  • EEG only

- Suspect in patients w unexplained AMS or failure to regain consciousness 30 min after cessation of clinical seizures

Neuro Clerkship (13 decks)

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