Epilepsy med Flashcards
Define epilepsy
Epilepsy defines a group of brain disorders affecting individuals of all age groups, of varying and often of unknown cause, characterised by recurrent unprovoked seizures, or by one unprovoked seizure but with an “enduring predisposition” to further seizures. It may have significant consequences in terms of adverse educational, vocational, and psychosocial functioning, and physical morbidity (and potential mortality), especially in the one third of patients with drug-resistant epilepsy.
Epilepsy can be classified according to the type of seizure, each of which is associated with
different forms of brain pathology;; generalized, focal or provoked epilepsy
Define seizure
aka fits- manifestations of abnormal discharges of neurones in the brain.
A seizure results when a sudden imbalance occurs between the excitatory and inhibitory forces within the network of cortical neurons in favor of a sudden-onset net excitation
Classify epilepsy
General epilepsy- synchronous abnormal neuronal discharges. This usually commences in childhood with no particular cause.
Examples:
-Idiopathic(primary) i.e brain functions normally - juvenile absence AND juvenile myoclonic epilepsy
-symptomatic
-severe childhood epilepsy that is often a/w learning disability
Focal/Partial/Localised-discharges originate from a specific cortical
region, e.g. temporal lobe epilepsy, and can either
remain localised or spread to other regions.
Examples: temporal, frontal,occipital,parietal
lesional or non lesional (MRI negative)
Define juvenile myoclonic epilepsy
cornflake epilepsy- presence of myoclonic jerks that occur on awakening from sleep either in the morning or from a nap. They are typically described as shock-like, irregular and arrhythmic movements of both arms.
Define symptomatic a/ epilepsy
Underlying de novo mutation where mutation in protein affects brain development
Define juvenile absence epilepsy
occurs in childhood and adolescent - involves loss of awareness
Classification of seizures?
Generalized:
- Absence
- Myoclonic
- Tonic/Atonic
- Generalized tonic clonic convulsion
Focal/Partial:
- Simple Partial
- Complex partial
- Secondarily generalized tonic clonic convulsion
Difference between simple or complex partial seizures?
Compare absence vs complex partial seizures
Simple partial - patient is focally aware
Complex partial seizure: pt has impaired awareness - not fully conscious
Absence seizures:
lasts <10 seconds w simple automatisms, and a generalized spike and slow wave forms on EEG, normal imaging. Normal post event
Complex Partial seizures
lasts up to 2-3 mins w complex autonmatisms, and a focal sz onset for EEG, normal/lesion imaging. Fatigue post event
What is another name for tonic clonic convulsions?
Grand mal seizure which has the worst prognosis
Define tonic seizures
Define clonic seizures
Define atonic seizures
Tonic- tense/stiff arms or legs
-sudden-onset tonic extension or flexion of the head, trunk, and/or extremities for several seconds. These seizures typically occur in relation to drowsiness, shortly after patients fall asleep, or just after they awaken. Tonic seizures are often associated with other neurologic abnormalities
Clonic-rhythmic jerking motor movements with or without impairment of consciousness
Atonic- “drop attacks.” These seizures occur in people with clinically significant neurologic abnormalities and consist of brief loss of postural tone, often resulting in falls and injuries (hence, some patients need helmets)
Define myoclonic seizures
- muscle jerk
- brief arrhythmic jerking motor movements that last less than 1 second and often cluster within a few minutes.
List causes of epilepsies
- Unknown
- Genetic – hereditary
- Genetic – de novo mutations
- Acquired
- Cortical dysplasia
- Complicated febrile convulsions
- Meningitis / encephalitis
- Head trauma
- Stroke / vascular anomaly / tumour
List epidemiology of epilepsy
-Epilepsy is one of the commonest
serious neurological conditions, with around 350 000 affected patients in the UK.
-10 per 1,000 population.
Differential diagnoses for epilepsy
Non-epileptic (psychogenic) seizures
- Non-epileptic attack disorder (NEAD)
- Diagnosed by in-patient video EEG monitoring
Convulsive syncope
- About 8% of faints
- Syncope not a “top-order” diagnosis
How is epilepsy diagnosis
Epilepsy is primarily a clinical diagnosis
Importance of eye-witness account
Investigations may help to refine diagnosis, establish aetiology, guide treatment, and predict prognosis
Review / reconsider diagnosis in those with uncontrolled seizures
High diagnostic error rate
