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AIP: Seizures > Focal seizures > Flashcards

Focal seizures Flashcards

1
Q

What are the 3 broad types of focal seizures?

A
  1. Motor
  2. Sensory
  3. High cortical function
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2
Q

What do focal motor seizures involve?

A
  • rhythmic twitching or jerking of one part of the body opposite to the epileptic focus, such as fingers, toes or face
    • may spread to rest of the body part - Jacksonian
  • could also involve sustained tonic or dystonic movement of one limb and head with eyes turning
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3
Q

What do focal sensory seizures involve?

A

tingling or numbness affecting one part of the body

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4
Q

What are 6 possible components of focal seizures affecting high cortical function?

A
  1. Dysphasic symptoms
  2. Disturbance of memory in a form of flashbacks, deja vu, dreamy states, fear, anger, irritability
  3. Illusions of size, shape, weight, distance or sound
  4. Visual symptoms
  5. Auditory symptoms
  6. Olfactory symptoms
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5
Q

What may be a potential relationship between a focal aware seizure and a focal seizure with impaired awareness?

A

can start with awareness and then evolve to impaired awareness

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6
Q

What type of seizures may be associated with an aura?

A

focal aware seizures (motor, sensory and high cortical function), often experienced before full blown seizure

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7
Q

What is meant by automatism?

A

coordinated involuntary motor activity that occurs either during or after the seizure. Can be movements with hands, lip smacking, chewing, emotional expression, humming, grunting and whistling

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8
Q

What are 7 examples of automatisms?

A
  1. movements with hands
  2. lip smacking
  3. chewing
  4. emotional expression
  5. humming
  6. grunting
  7. whistling
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9
Q

What are the 4 key types of focal seizures with impaired awareness?

A
  1. Temporal lobe
  2. Frontal lobe
  3. Parietal lobe
  4. Occipital lobe
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10
Q

What is the most common type of focal seizures with impaired awareness and what proportion does this contribute?

A

temporal lobe - 60%

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11
Q

What is the second most common type of focal seizure with impaired awareness?

A

frontal lobe

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12
Q

What is the acronym to remember the 4 key features of temporal lobe seizures?

A

HEAD: hallucinations, epigastric rising/emotional, automatisms, Deja vu/dysphasia post-ictal

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13
Q

What are the 4 key features of temporal lobe seizures?

A
  1. Hallucinations (auditory/gustatory/olfactory)
  2. Epigastric rising sensation + Emotional sensation (anger/terror)
  3. Automatisms - lip smacking/grabbing/pluching
  4. Deja vu/ dysphasia post-ictal
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14
Q

What is meant by deja vu?

A

feature of temporal lobe seizures (focal impaired awareness); feel that what’s happening has happened before

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15
Q

What is jamais vu?

A

feature of temporal lobe seizures (focal impaired awareness); last a few seconds to 2 mins, feeling of unfamiliarity i.e. seeing situation for the first time despite rationally knowing that they have been in the situation before

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16
Q

What are 8 possible features of frontal lobe focal impaired awareness seizures?

A
  1. Deviation of the head and eyes to one side
  2. Head/leg movements
  3. Jerking of the arm
  4. Posturing
  5. Post-ictal weakness
  6. Paralysis of the arm – post-ictal, can continue for a day or two (Todd’s paralysis) - rare
  7. Jacksonian march
  8. Complex or bizarre automatisms
17
Q

What is Todd’s paresis?

A

post-ictal phenomenon that can follow frontal lobe seizures (focal impaired awareness); paralysis of the arm which can continue for a day or two

18
Q

What type of seizures does Todd’s paresis typically follow?

A

frontal lobe seizures (focal impaired awareness)

19
Q

What do parietal lobe seizures involve (focal impaired awareness)?

A

paraesthesias, sensory symptoms e.g. tingling and numbness

20
Q

What do occipital lobe seizures involve (focal impaired awareness)?

A

floaters/flashes, visual symptoms such as visual hallucinations with impairment in sensations of colours, shapes and patterns

21
Q

What type of focal seizures do post-ictal symptoms occur with?

A

common following impaired awareness (e.g. confusion after temporal lobe seizures), but do not following focal aware seizures

22
Q

What are the 2 first-line options for treatment of focal seizures?

A
  1. Carbamazepine
  2. Lamotrigine
23
Q

What are 4 key side effects of carbamazepine?

A
  1. SIADH
  2. Drowsiness
  3. Diplopia
  4. Ataxia
24
Q

What are 3 side effects of lamotrigine to be aware of?

A
  1. Rash including Stevens Johnson syndrome
  2. Tremor
  3. Diplopia
25
Q

What does the process of focal aware seizures usually involve?

A

patient is conscious (aware and alert) and will usually know that something is happening and will remember the seizure afterwards

26
Q

How can patients feel emotionally about focal aware seizures?

A

sometimes pt finds hard to put into words - feel strange but unable to describe feeling afterwards. This may be upsetting or frustrating for them

27
Q

Why are focal aware seizures seomtimes referred to as ‘warnings’ or ‘auras’?

A

for some people, it develops into another type of seizure e.g. generalised tonic-clonic

28
Q

What are 4 possible features of focal aware seizures that start in the temporal lobe?

A
  1. Rising feeling in stomach (like when you get on a fairground ride and feel like you leave tummy at top)
  2. Deja vu
  3. Unusual smell or taste
  4. Sudden intense feeling of fear or joy
29
Q

What are 2 things that focal aware seizures starting in the frontal lobe may involve?

A
  1. Feeling like a wave going through the head
  2. Stiffness or twitching in part of the body e.g. arm or hand
30
Q

What are 2 possible features of focal aware seizures that start in the parietal lobe?

A
  1. Feeling of numbness or tingling
  2. Sensation that an arm or leg feels bigger or smaller than it actually is
31
Q

What are 2 possible features of focal aware seizures that start in the occipital lobe?

A
  1. visual disturbances such as coloured or flashing lights
  2. hallucinations
32
Q

What is the typical focal impaired awareness seizure postictal state?

A

confusion following temporal lobe seizure

AIP: Seizures (14 decks)

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