Epilepsy Intro

Question 1

What is the definition of a seizure? What else is on the differential diagnosis for epilepsy?

Answer 1

seizures: abnormal hypersynchronous discharges of neurons. Epilepsy is a condition with recurrent epileptic/electrical seizures
DDx: non epileptic seizures (psychogenic, migraine w/ neuro symptoms, syncope, parasomnias)

Question 2

4 categories of epilepsies

Answer 2

location related, primary generalized, secondary generalized, other

Question 3

What is West’s syndrome?

Answer 3

a kind of infantile spasm. 3 symptoms:

1. epileptic spasms
2. hypsarrhythmia
3. intellectual disability

Question 4

What should I know about prognosis/symptoms of infantile spasms?

Answer 4

not a good sign: many neuro deficits with stasticity, hemiplegia, atonia, and as many as 95% with intellectual disability. many live in group homes later. Often related to perinatal insult, cerebral malformations, inborn errors of metab, infection
symptoms:
seizures/spasms with flexion (jack-knifing), extension (“cheer-leading”), rhythmic myoclonic jerks, mixed. Often occur in clusters w/ each spasm lasting 1-15 s..

Question 5

What is hypsarrhythmia?

Answer 5

abnormal EEG pattern seen in 2/3 of pts with infantile spasms. characterized by high voltage disorganized slow waves w/ spikes and polyspikes.

Question 6

Prognosis for infantile spasms?

Answer 6

spasms transform by 5 yrs.

many progress to Lennox-Gastaut syndrome

Question 7

To what category of seizures does Lennox-Gastaut syndrome belong?

Answer 7

secondary (cryptogenic/symptomatic) generalized epilepsy due to neuronal dysfunction

Question 8

What are the characteristics of Lennox-Gastaut seizures?

Answer 8

stare, jerk, fall
aka atypical absence, myoclonic, tonic and atonic (drop). tonic-clonic or partial seizures may also occur; status epilepticus in 2/3s. Pts often need to wear helmets. This is a chronic condition.

Question 9

What are the EEG characteristics of Lennox-Gastaut syndrome?

Answer 9

diffuse slow spike wave in waking. bursts of diffuse fast rhythms in sleep.

Question 10

What is the onset of Lennox-Gastaut syndrome? Treatment?

Answer 10

onset: 2-10; peak at 3-5. Usually preceded by infantile spasms or encephalopathy. treat with multiple anti-seizure meds, vagal nerve stim; corpus callosotomy

Question 11

What is Childhood absence epilepsy? (seizure type, seizure characteristics)

Answer 11

primary generalized epilepsy
seizures abrupt onset and offset, no warning. see impaired consciousness with or without other signs. short duration. activated by sleep or hyperventilation. a few have rare generalized tonic clonic seizures
high frequency of seizures: up to hundreds per day

Question 12

onset and prognosis for childhood absence epilepsy

Answer 12

good. onset 3-12 yrs; peak 6-7, but usually resolves in adolescence and most are fully responsive to meds

Question 13

What are the EEG charachteristics of childhood absence epilepsy?

Answer 13

3 HERTZ SPIKE and slow wave during seizure.

Question 14

What is juvenile myoclonic epilepsy? Type and seizure characteristcs

Answer 14

primary generalized epilepsy
myoclonic jerks, esp. in arms, without loss of consiousness
clusters of jerks often after awakening; occasional absence seizures
But, they get generalized tonic-clonic seizures precipitated by sleep deprivation, alcohol, or photic stim.

Question 15

What is the prognosis of juvenile myoclonic epilepsy?

Answer 15

most (90%) fully responsive to anti-seizure meds

but this is a life-long condition

Question 16

What are the EEG characteristics of juvenile myoclonic epilepsy?

Answer 16

3-4 Hz generalized polyspike, spike, and slow wave, often photosensitive

Question 17

What is benign rolandic epilepsy/BECTS? Type, onset, seizure characteristics

Answer 17

BECTS= benign childhood epilepsy with centro-temporal spikes

onset: 3-13; brief simple partial hemifacial motor/sensory seizures. some secondarily generalized seizures during sleep

Question 18

What are the EEG findings of BRE/BECTS?

Answer 18

during sleep, frequent unilateral/shifting bilateral high voltage centro-temportal spikes (pos end of dipole in mid-frontal region)

Question 19

Prognosis of BECTS?

Answer 19

disappears with puberty. BENIGN

Question 20

What are symptomatic localization related epilepsies? What are the most common areas for the foci?

Answer 20

focal or partial epielpsis. temporal is most common, so they get psychomotor
then frontal
less common is parietal or occipital

Question 21

Describe the seizure of a localization related epilepsy.

Answer 21

very varied
simple partial just gives aura
complex partial may have impaired consciousness
and some have secondary generalization with tonic-clonic developments

Question 22

EEG for localization related epliepsy

Answer 22

focal abnormalities/discharges; sometimes also see generalized abnormalities
often the tracing is normal

Question 23

Treatment for localization related epilepsy

Answer 23

most antiseizure meds

resection if not responsive to meds