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Epilepsy Board Study > General Epilepsy > Flashcards

General Epilepsy Flashcards

1
Q

Incidence

A

3.1% of population (9 million people) suffer from epilepsy

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2
Q

Risk of epilepsy

A

5% of US population (15 million) will have a seizure at sometime in their lives
~1/2 of those will progress into epilepsy

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3
Q

Incidence rate of epilepsy

A

44/100,000 people in US
-61 for first time unprovoked seizures
39 for acute symptomatic seizures
100 for all seizures

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4
Q

Age with highest risk of epilepsy

A

> 75yo

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5
Q

Common etiology for epilepsy

A
  • Stroke ~11%

- CP ~8%

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6
Q

First lifetime unprovoked seizure work up

A

Class B evidence:
EEG
MRI (pref 3 Tesla)

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7
Q

Types of abnormalities found on MRI after first unprovoked seizure

A

Tumors > developmental anomalies > hippocampal patholies > vascular malformations

Seen in ~14-23%

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8
Q

Recurrence rate for seizures

A

After 1st unprovoked sz: 40% within the first 2 years
After 2nd: 73%
After 3rdL 76%
After treated first unprovoked 15%

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9
Q

Seizure Recurrence after first unprovoked seizure according to Etiology and EEG findings

A

Etiology:
Idiopathic 32%
Symptomatic 57%

EEG
normal 27%
Epileptiform 58%

Etiology + EEG
Idiopathic +Normal 24%
Symptomatic + abnormal EEG 65%

Berg + Shinnar et all

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10
Q

Factors for seizure reucrrence

A 
Focal >generalized
Nocturnal seizures > daytime seizure
Status epilepticus 
Abnormal interictal neuro exam
Abnormal brain imaging
Multiple or clustered seizures 
Strong family history of seizures
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11
Q

Percentage of seizure freedom

A

70% of epilepsy patients will eventually achieve seizure freedom
~11-41% will relapse after AED
-Less in children 20%
-Higher in adults 40%

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12
Q

Risk of relapse of epilepsy

A

Most within 1st year or AED withdrawal

More at risk if:
Severe and long lasting epilepsy before remission
JME 85%
Structural lesion

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13
Q

Risk from Epilepsy vs Surgery

A
  1. Injury
  2. SUDEP
  3. Quality of Life
  4. Side effects of medications
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14
Q

Temporal Lobe Epilepsy

A

Aura: epigastric, olfactory, gustatory sensation, emotional changes, sense of familiarity or strangeness, hallucinations, staring, automatisms

Abdominal aura 52% sensitivity and 90% specificitivity

Basal temporal lobe epilepsy presents with behavioral arrest or motor changes

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15
Q

Frontal lobe seizure semiology

Superior or Interhemispheric onset

A

Superior or Interhemispheric -> contralateral eye, head or body turning with tonic/dystonic posturing

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16
Q

Orbital frontal seizure semiology

A

unusual behaviors, hypermotor activity, rapid leg kicking/bicycling, autonomic findings, behavioral arrest, automatisms.
-Frequently in sleep, and are brief

17
Q

Inferior frontal lobe seizures semiology

A

Referrable to face or to speech

18
Q

Dorsolateral or dorsomedial frontal seizures

A

Contralateral motor findings

19
Q

Premotor seizures semiology

A

Tonic version

20
Q

Supplementary motor areas

A

Speech arrest
Fencer posturing
Bilateral hand motor findings
Head version

21
Q

Insular seizure semiology

A

Visceral, gustatory, somatosensory symptoms (laryngeal constriction or paresthesias)

22
Q

Parietal lobe seizure semiology

A

Somatosensory phenomena (pain/dysethesias)
Can be silent until propagated
-Can look like superior frontal lobe seizures or sensorimotor symptoms

23
Q

Occipital lobe semiology

A

Visual auras and phenomena

Can be silent until propagation

24
Q

Restrictions for Patients with Epilepsy

A

No working at unprotected heights (roofs, ladders)
No working around heavy machinery with moving parts
No construction equipment
No use of manufacturing equipment including fork lifts, heavy presses, conveyor belt systems
Avoid environmental triggers
Shower/bathe
Swim when supervised by someone and capable of helping
No cooking or working around open flames
No driving

25
Q

Driving comercial Truck and Epilepsy

A

If seizure free on and off of meds 10 years can get license
One time event that is thought to be non-epileptic requiring no anti-seizure medication. Needs to be seizure free x 6mo
Single unprovoked seizure with no recurrence - 5 years off of medication
Acute symptomatic seizures with low risk of recurrence
No restriction if no seizures for 2+ years off of AED

Any one that has a procedure that penetrates the dura should not be considered eligible

26
Q

Merchant Mariners and Epilepsy

A

If low risk recurrence and seizure free off of medication for at least 1 year

Seizures with high risk of recurrence - must be seizure free for 8 years on or off meds. If on meds, dose must be stable for 2 years. If off of meds, must be seizure free for 8 years from when stopping meds

27
Q

Aircraft Pilots and Epilepsy

A

Disturbance of conciousness without satifsactory medical explanation - must report

Rolandic seizure - may be eligible if seizure free >4 years with normal EEG

Febrile seizure - without recurrence and off of meds for 3 years

Transient loss of neurologic function - required to report; FAA decision

Unexplained syncope, single siezure - denied

Special considerations: childhood epilepsy, but seizure free for number of years

28
Q

Common seizure triggers

A 
Stress 
Fatigue
Medication compliance
Excessive EtoH use 
Sleep deprivation
29
Q

Accomodations in work setting for epilepsy

A

Minimize excessive stress
Limited work hours to 8-10hr/day
No third or midnight shift
No working at unprotected heights
No working around heaving moving and machinery
Avoided environmental situations that are known triggers
Providing assistive technology

30
Q

Accomodations in school

A

Leniency on attendance
If seizures are active, they may need to rely on others for transportation
Can result in assignments not being completed or late
All night study sessions not possible
Avoidance of multiple exams on same day
Short term memory loss - no pop quizzes
Assitnace with reading, taking notes, or recording lectures.
Single room in college
Dogs/pets, single level home, access for rides, use of wheelchair

31
Q

Disability and Epilepsy

What needs to be documented

A

EEG corroborating nature and frequency of seizures

Seizure semiology - observed by 3rd party or provider
History of treatment, response, recent changes

Compliance
Absorption or metabolism
AED levels - if low then explain,

Epilepsy Board Study (8 decks)

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