Epilepsy Part 1 Flashcards
Clinical definition of Epilepsy
Clinical definition:
- At least two unprovoked seizures occurring >24 hr apart
- One unprovoked or reflex seizure and a probability of further seizures similar to general recurrence risk after two unprovoked seizures, occurring over the next 10 years
- Diagnosis of epilepsy syndrome.
Epilepsy: 40/100,000 persons per year.
- Chance of having at least 1 seizure of any cause during a person’s lifetime is 10%.
- 1% of population has active epilepsy, affecting 300-350k canadians.\
- About 2-3% of the populations will have active epilepsy at sometime in their life.
Generalized epilepsy of presumed ___ origin
Focal lesional epilepsy secondary to __ __/more of a structural issue.
Generalized epilepsy of presumed genetic origin
Focal lesional epilepsy secondary to hippocampal sclerosis/more of a structural issue.
Bilateral Tonic Clonic: begins suddenly without warning, or may be preceded by an aura if focal seizure with secondary generlization
Patient often cries out (tonic contraction of trunk muscles causes forced expiration)–> tonic phase → generalized stiffening → clonic phase → end of seizure +/- incontinence and or tongue biting
Usually associated with increase in HR and BP, lasts 1-2 minutes
Confusion and fatigue always occur immediately after the seizure lasting generally 5-10 minutes, but can be longer (days)
is this a generalized or focal seizure?
Generalized Seizure; these types of seizures Originates at some point within and rapidly engages bilateral distributed networks. Can include cortical and subcortical structures, but necessarily the entire cortex.
Child comes in with complete loss of consciosness and abrupt onset and offset. This happens multiple times a day. Has eyelid fluttering and EEG shows a 3Hz spike and wave discharges. What kind of seizure is this and what is it’s generalized classification?
generalized absence (petit-Mal seizure)
• Childhood absence epilepsy usually remits in adolescence and typically responds well to treatment (best response with valproic acid)
Sudden, brief, shock-like contractions
May be subtle or make the patient fall. Patient may often drop things.
May be mistaken for tics. Most commonly seen in adult patients with juvenile myoclonic epilepsy
generalized myoclonic seizures
a kid comes in with myoclonic jerks +/- tonic clonic seizures and rarely absence seizures.
EEG shows 4-6 Hz spike and polyspike waves
His mom also has seizures like this
Juvenile Myoclonic Epilepsy (JME)
Focal Aware seizures are a focal type of seizure that often affects the ___ lobe. What 3 features may or may not be added to this?
Key finding:
FAS affects the parietal lobe
AUTOMATISMS can occur
Motor: lip smacking, picking, fumbling
Dystonia: dystonia of a limb is contralateral to epileptic focus in the brain
non-motor: rising epigastric sensation, nausea, fear, smell (brutn toast, Dejavu
KEY: THE PATIENT KNOWS THEY ARE HAVING A SPELL
Key difference between focal aware seizures and focal impaired awareness seizures
in focal impaired awareness seizures, paitent does not know the seizure is happening.
Prominent motor manifestations: complex motor actions bizarre bimanual/bipedal activity, contralatearl head or eye deviation may occur→ eyes look away from the seizure, may have Todd’s paralysis if originating from motor cortex (contralateral weakness post seizure)
Minimal or no postictal confusion
Usually happens at night and tend to cluster
what kind of seizure is this?
frontal lobe seizures
-eyes look AWAY from a seizure and towards a stroke
__ __ is the most common cause of new onset epilepsy in adulthood.
Hippocampal sclerosis is the most common cause of new onset epilepsy in adulthood.
Frontal lobe seizures can include __ seizures and __ seizures
cognitive seizures:
include: imparied language, other cognitive domains, positive features like deja vu (mesial temporal lobe), hallucinations, perceptual distortions.
Other common temporal lobe auras include olfactory and gustatory hallucinations, jamais vu, and sudden intense panic. Hippocampal sclerosis is the most common cause of new onset epilepsy in adulthood.
Mesial temporal lobe/medial temporal lobe houses the uncus, hippocampus, amygdala
Superior temporal lobe/gyrus houses the auditory cortex
and emotional seizures: anxiety, fear, joy
Catamenial Epilepsy: epilepsy that is influenced by ___ __.
estrogen= __convulsant
progesterone= ___convulsant
Some women have increased seizures during phases of the menstrual cycle when the estrogen: progesterone ratio is ___ (ex/ ovulation causes rise in seizure likelyhood since there is a rise in estrogen)
Catamenial Epilepsy: epilepsy that is influenced by female hormones.
estrogen= PROconvulsant
progesterone= ANTIconvulsant
Some women have increased seizures during phases of the menstrual cycle when the estrogen: progesterone ratio is higher (ex/ ovulation causes rise in seizure likelyhood since there is a rise in estrogen)
Why do ASMs compromise birth control efficacy
Many Anti-epileptics affect liver metabolism via P450. P450 gets upregulated and the liver can eliminate birth control faster and increase the risk of birth control failure.
Valproic acid has a lot of drug drug interactions that can compromise birth control efficacy
When women are on AEDs, their birth control dose should be increased by >35 mg (ideally 50) and recommend using additional contraceptive method
How can you tell the difference between psychogenic epilepsy and neurological epilepsy
epileptic seizures tend to be stereotypes; they are quite hllmark and can be characterized.
Psychogenic nonepileptic seizures have a worse prognosis;
- Longer duration of symptoms
- Older age of onset
- No formal treatment
- Continued stressors
- Rejection of diagnosis by patient
- Severe psychiatric comorbidities
T/D Sudden unexpected death in epilepsy can be caused by status epilepticus
false. this is an unexpected death of a person with epilepsy, excluding a documented status epilepticus, drowning or trau,a.
- post mortem DOES NOT REVEAL CAUSE OF DEATH
