Epilepsy & Seizure Disorders

Question 1

What is the definition of a seizure?

Answer 1

Abnormal electrical activity in the brain caused by the hyperexcitability of neurons, especially in cortical area

Question 2

What is the definition of epilepsy?

Answer 2

2 or more unprovoked seizures (recurrent)

Question 3

At what time point in a seizure does an “aura” occur?

Answer 3

the actual start of a seizure & may be though of as a ‘warning’

Question 4

What is an “ictal”?

Answer 4

the period during a sudden attack, sucha s seizure or stroke

Question 5

What does “refractory” mean with reference to seizures?

Answer 5

treatment fails to achieve seizure freedom for 12 months or more

Question 6

What is the term for a prolonged seizure or a series of repeated seizures?

Answer 6

status epilepticus

Question 7

How long does a seizure have to go to be considered status epilepticus?

Is this serious?

Answer 7

5 minutes

medical emergency

Question 8

What are the 3 major etiologies of seizures?

Answer 8

• genetic
• cryptogenic
• structural/metabolic

Question 9

What are the genetic etiologies of seizures?

Answer 9

• mutations of ion channels (NMDA, Ca²⁺, Cl^-)
• mutations of transmitter receptors
• chromosomal abnormalities

Question 10

What are the 3 general seizure classifications?

Answer 10

Focal onset

Generalized onset

Unkown onset

Question 11

What are the subclssifications of Focal Onset Seizure?

Answer 11

• Aware / Impaired awareness
• Motor onset / Non-motor onset

Question 12

Focal onset seizures may progress to what type of seizure?

Answer 12

bilateral tonic-clonic

Question 13

What the subclassifications of Generalized onset seizures?

Answer 13

• motor
  
  • tonic clonic
  • other motor
• Non-motor
  
  • (absence seizures)

Question 14

What are the subclassifications of unkonwn onset seizures?

Answer 14

• motor
  
  • tonic clonic
  • other motor
• Non-motor
• unclassified

Question 15

What type of seizure often begins with a blank dazed stare?

Answer 15

focal with impaired awareness

Question 16

When should a patient be worked up for a febile seizure with an MRI & an EEG?

Answer 16

Todds paralysis or anything that might suggest prolonged seizure or focal nature

Question 17

How many unprovoked seizures can a person have before they should be on seizure medication?

Answer 17

1 unprovoked

Question 18

How many provoked seizures can a person have before they should be on seizure medication?

Answer 18

provoide seizures do not warrant seizure medication

Question 19

What are the steps in evaluating a patient with a seizure disorder?

Answer 19

• History
• EEG
• Neuroimaging
• Lab studies
  
  • prolactin
  • CSF

Question 20

What hormone is often elevated in indicituals who recently had a convulsive episode?

Answer 20

prolactin

Question 21

What questions should you ask a patient when working up a seizure?

Answer 21

• What were they doing before it started?
• How long did it last?
• What did it look like?
• Awareness during episode?
• Incontinence?
• Recovery?
• What do you remember about the episode?

Question 22

If a patient is experiencing a generalzed seizure where the whole brain is involved, what

Answer 22

generalized - whole brain is involved

Question 23

What is the direction that results in a “positive” in an EEG & a “negative”?

Answer 23

positivity - downward deflection

negativity - upward deflection

Question 24

Odd numbered electrodes in an EEG correleate to what side?

Even numbered?

Answer 24

odd - left

even - right

Question 25

What are you looking for when evaluating an EEG?

Answer 25

* state of patient * background activity * asymmetry * focality (slowing / irritability) * events * seizures? * evolution of the pattern (frequency, rhythmicity, topogrophy)

Question 26

What abnormality is shown in the provided EEG? Do we treat them with seizure medication?

Answer 26

PLED downward & upward deflection localized to T5 no- we do not treat with medication (but can see electrical strom potential)

Question 27

What abnormality is shown in the provided EEG?

Answer 27

Triphasics

Question 28

What is the of recurrance for a first time unprovoked seizure?

Answer 28

30%

Question 29

Why might you start someone on a seizure medication after their first unprovoked seizure?

Answer 29

abnormality on EEG or MRI

Question 30

What is the of recurrance after a second unprovoked seizure?

Answer 30

75%

Question 31

What is the of recurrance after a third unprovoked seizure?

Answer 31

90%

Question 32

Describe the characteristics of a temporal lobe epilepsy

Answer 32

* aura * psychic, gastric rising, olfactory hallucination * LOC / loss of awareness * oral/manual automatisms * contralateral limb dystonic posturing w/ ipsilateralhand automatism * ictal spitting or nose wiping * 60-90s

Question 33

What is the most common etiology of temporal lobe epilepsy?

Answer 33

mesial temporal sclerosis

Question 34

What is the EEG pattern of a temporal lobe epilepsy?

Answer 34

5-7 Hz

Question 35

Which patients with temporal lobe epilepsy are ideal surgical candidates?

Answer 35

non-dominant temporal lobe

Question 36

What condition is shown in the provided image?

Answer 36

mesial temporal sclerosis hippocampal atrophy

Question 37

Describe the characteristics of a frontal lobe epilepsy dorsolateral vs. frontopolar

Answer 37

* nocturnal; hypermotor activity * dorsolateral * primary motor cortex * focal clonic or spread to other areas * head turning / eye deviation contralateral to seizure focus * supplementary motor cortex: fencing (contralateral arm extension) * frontopolar/orbitofrontal * staring, unresponsiveness * speech & motor arrest w/ late motor elements * automatisms, complex prodimal motor activity

Question 38

What are the main causes of frontal lobe epilepsy?

Answer 38

* cortical malformations \> tumors \> encephalomalacia

Question 39

In a focal seizure, there is conjugate gaze deviation in what directon? stroke?

Answer 39

toward the abnormal limbs stroke - AWAY from abnormal limbs

Question 40

What is a febrile seizure?

Answer 40

* occurring in child after 1 month of age associated with febrile illness * not caused by CNS infection * no prior neonatal seizure or unprovoked seizure * usually occurrign when patient is rapidly cooled * have to exlude toxometabolic abnormalities

Question 41

Does younger age at onset or duration of first event increase risk of recurrance for a febrile seizure?

Answer 41

younger age - YES duration - NO

Question 42

What are the risk factors for epilepsy in febrile seizure that warrant complete seizure workup?

Answer 42

* developmental delay * abnormal neurological examination * lateralizign feature and prolonged * first degree relative with epilepsy