Epilepsy Intro Flashcards
What is the definition of a seizure? What else is on the differential diagnosis for epilepsy?
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)
4 categories of epilepsies
location related, primary generalized, secondary generalized, other
What is West’s syndrome?
a kind of infantile spasm. 3 symptoms:
- epileptic spasms
- hypsarrhythmia
- intellectual disability
What should I know about prognosis/symptoms of infantile spasms?
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..
What is hypsarrhythmia?
abnormal EEG pattern seen in 2/3 of pts with infantile spasms. characterized by high voltage disorganized slow waves w/ spikes and polyspikes.
Prognosis for infantile spasms?
spasms transform by 5 yrs.
many progress to Lennox-Gastaut syndrome
To what category of seizures does Lennox-Gastaut syndrome belong?
secondary (cryptogenic/symptomatic) generalized epilepsy due to neuronal dysfunction
What are the characteristics of Lennox-Gastaut seizures?
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.
What are the EEG characteristics of Lennox-Gastaut syndrome?
diffuse slow spike wave in waking. bursts of diffuse fast rhythms in sleep.
What is the onset of Lennox-Gastaut syndrome? Treatment?
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
What is Childhood absence epilepsy? (seizure type, seizure characteristics)
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
onset and prognosis for childhood absence epilepsy
good. onset 3-12 yrs; peak 6-7, but usually resolves in adolescence and most are fully responsive to meds
What are the EEG charachteristics of childhood absence epilepsy?
3 HERTZ SPIKE and slow wave during seizure.
What is juvenile myoclonic epilepsy? Type and seizure characteristcs
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.
What is the prognosis of juvenile myoclonic epilepsy?
most (90%) fully responsive to anti-seizure meds
but this is a life-long condition
What are the EEG characteristics of juvenile myoclonic epilepsy?
3-4 Hz generalized polyspike, spike, and slow wave, often photosensitive
What is benign rolandic epilepsy/BECTS? Type, onset, seizure characteristics
BECTS= benign childhood epilepsy with centro-temporal spikes
onset: 3-13; brief simple partial hemifacial motor/sensory seizures. some secondarily generalized seizures during sleep
What are the EEG findings of BRE/BECTS?
during sleep, frequent unilateral/shifting bilateral high voltage centro-temportal spikes (pos end of dipole in mid-frontal region)
Prognosis of BECTS?
disappears with puberty. BENIGN
What are symptomatic localization related epilepsies? What are the most common areas for the foci?
focal or partial epielpsis. temporal is most common, so they get psychomotor
then frontal
less common is parietal or occipital
Describe the seizure of a localization related epilepsy.
very varied
simple partial just gives aura
complex partial may have impaired consciousness
and some have secondary generalization with tonic-clonic developments
EEG for localization related epliepsy
focal abnormalities/discharges; sometimes also see generalized abnormalities
often the tracing is normal
Treatment for localization related epilepsy
most antiseizure meds
resection if not responsive to meds
