Epilepsy I&II

Question 1

Signs/symptoms of epileptic seizures

Answer 1

• symptoms often “positive phenomenon”
• post-seizure symptoms = negative (loss of fxn)
• epilepsy = chronicity/recurrent seizures due to underlying brain abnormality
• types
  
  • partial vs. generalized
  • tonic-clonic
  • myoclonic
  • absence

Question 2

Partial vs. Generalized Seizures

Answer 2

• Partial = begins @ one are of the cortex, may remain localized or spread to varying degrees to include the whole cortex
• Generalized = generalized @ onset; occur b/c cortex as whole is “hyper-irratable”
  
  • often genetic basis
  • includes absence seizures

Question 3

DDx of causes of seizure presentation

Answer 3

• syncope
  
  • circulatory problems
  • hematologic problems
• movement disorders
• stroke/TIA
• miraine
• sleep disorders
• psychogenic/behavioral

Question 4

Partial complex seizures vs. Absence seizures

Answer 4

• both: period of AMS + major motor manifestations
• partial complex seizures
  
  • automatisms (chewing, picking at clothing) are common
  • followed by a post-ictal state
• absence seizures
  
  • automatisms less common, but possible
  • not usually followed by a post-ictal state

Question 5

Primary generalized tonic-clonic seizure vs. secondary generalized tonic-clonic

Answer 5

• tonic-clonic seizure =
  
  • tonic = lose consciousness, contraction of muscles
  • clonic = contraction/relaxation of mucles leads to convulsion
• primary = generalized seizure w/out focal starting point
• secondary = begins as partial seizure and spreads to whole cortex

Question 6

Characteristics of postictal period

Answer 6

• negative symptoms following a seizure
• due to neuronal exhaustion of affected brain areas + inhibitory inputs to this area

Question 7

Epilepsy definition

Answer 7

underlying abnormality of the brain that predisposed person to seizures

Question 8

Criteria used in classification of seizures

Answer 8

• anatomical
  
  • focal
  • generalized
• etiologic
  
  • structural-metabolic
  • genetic predisposition
  • unknown
• benign vs. catastrophic

Question 9

Focal vs. generalized seizures

Answer 9

• Focal
  
  • Characterized according to one or more features:
    
    • Aura
    • Motor
    • Autonomic
    • Awareness/Responsiveness altered (Dyscognitive) or retained
• Generalized
  
  • Absence
  • Myoclonic
  • Tonic clonic
  • Tonic
  • Atonic

Question 10

Benign vs. Catastrophic seizures

Answer 10

• Benign
  
  • Easily treated with medications
  • Normal intelligence
  • Tests are usually normal; remission may occur after teens
• Catastrophic
  
  • Intractable to medications
  • Affects development with intellectual disability and shortened lifespan of child
  • EEG and MRI are abnormal

Question 11

Characteristics of intractable epilepsies

Answer 11

• seizures which do not respond to a trial of at least 3 anticonvulsants and that approximately
• 30% of new onset seizure patients may develop intractable epilepsy

Question 12

Special syndromes that lead to pediatric seizures

Answer 12

• febrile
• neonatal
• LKS

Question 13

Non-medical tx for intractable seizures

Answer 13

• ketogenic diet
• vagal nerve stimulation
• epilepsy surgery

Question 14

General use for epileptic surgery

Answer 14

• Used for partial epilepsies
• Most often temporal lobe in adults and extratemporal or hemispherectomy in children
  
  • Lesionectomy
  • Lobectomy
  • Corticectomy
• Not generally used for generalized seizures unless corpus callostomy

Question 15

Characteristics of febrile seizures

Answer 15

• occurs relatively frequently in children (6 mo. - 5 yrs)
• children w/rectal temp @ 102F or above
• 1/25 children have a febrile seizure; >1/3 of these will have recurrent febrile seizures
  
  • risk factors for recurrent:
    
    • young age (<15 mo.) for first seizure
    • frequent fevers
    • fhx of febrile seizures
• can be seconds to 15 min (>10 min ==> seek urgent care)
• generally have few long-term effects