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Neuro II > Epilepsy & Seizure Disorders > Flashcards

Epilepsy & Seizure Disorders Flashcards

1
Q

What is the definition of a seizure?

A

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

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2
Q

What is the definition of epilepsy?

A

2 or more unprovoked seizures (recurrent)

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3
Q

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

A

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

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4
Q

What is an “ictal”?

A

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

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5
Q

What does “refractory” mean with reference to seizures?

A

treatment fails to achieve seizure freedom for 12 months or more

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6
Q

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

A

status epilepticus

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7
Q

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

Is this serious?

A

5 minutes

medical emergency

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8
Q

What are the 3 major etiologies of seizures?

A
  • genetic
  • cryptogenic
  • structural/metabolic
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9
Q

What are the genetic etiologies of seizures?

A
  • mutations of ion channels (NMDA, Ca2+, Cl-)
  • mutations of transmitter receptors
  • chromosomal abnormalities
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10
Q

What are the 3 general seizure classifications?

A

Focal onset

Generalized onset

Unkown onset

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11
Q

What are the subclssifications of Focal Onset Seizure?

A
  • Aware / Impaired awareness
  • Motor onset / Non-motor onset
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12
Q

Focal onset seizures may progress to what type of seizure?

A

bilateral tonic-clonic

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13
Q

What the subclassifications of Generalized onset seizures?

A
  • motor
    • tonic clonic
    • other motor
  • Non-motor
    • (absence seizures)
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14
Q

What are the subclassifications of unkonwn onset seizures?

A
  • motor
    • tonic clonic
    • other motor
  • Non-motor
  • unclassified
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15
Q

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

A

focal with impaired awareness

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16
Q

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

A

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

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17
Q

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

A

1 unprovoked

18
Q

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

A

provoide seizures do not warrant seizure medication

19
Q

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

A
  • History
  • EEG
  • Neuroimaging
  • Lab studies
    • prolactin
    • CSF
20
Q

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

A

prolactin

21
Q

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

A
  • 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?
22
Q

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

A

generalized - whole brain is involved

23
Q

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

A

positivity - downward deflection

negativity - upward deflection

24
Q

Odd numbered electrodes in an EEG correleate to what side?

Even numbered?

A

odd - left

even - right

25
Q

What are you looking for when evaluating an EEG?

A
  • state of patient
  • background activity
  • asymmetry
  • focality (slowing / irritability)
  • events
  • seizures?
    • evolution of the pattern (frequency, rhythmicity, topogrophy)
26
Q

What abnormality is shown in the provided EEG?

Do we treat them with seizure medication?

A

PLED

downward & upward deflection localized to T5

no- we do not treat with medication (but can see electrical strom potential)

27
Q

What abnormality is shown in the provided EEG?

A

Triphasics

28
Q

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

A

30%

29
Q

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

A

abnormality on EEG or MRI

30
Q

What is the of recurrance after a second unprovoked seizure?

A

75%

31
Q

What is the of recurrance after a third unprovoked seizure?

A

90%

32
Q

Describe the characteristics of a temporal lobe epilepsy

A
  • 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
33
Q

What is the most common etiology of temporal lobe epilepsy?

A

mesial temporal sclerosis

34
Q

What is the EEG pattern of a temporal lobe epilepsy?

A

5-7 Hz

35
Q

Which patients with temporal lobe epilepsy are ideal surgical candidates?

A

non-dominant temporal lobe

36
Q

What condition is shown in the provided image?

A

mesial temporal sclerosis

hippocampal atrophy

37
Q

Describe the characteristics of a frontal lobe epilepsy

dorsolateral vs. frontopolar

A
  • 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
38
Q

What are the main causes of frontal lobe epilepsy?

A
  • cortical malformations > tumors > encephalomalacia
39
Q

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

stroke?

A

toward the abnormal limbs

stroke - AWAY from abnormal limbs

40
Q

What is a febrile seizure?

A
  • 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
41
Q

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

A

younger age - YES

duration - NO

42
Q

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

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

Neuro II (30 decks)

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