Intro To Epilsepsy: Module 2 Flashcards
1
Q
What is epilepsy?
A
A central nervous system disorder caused by electrical dysfunction in the brain, leading to seizures.
2
Q
What is the prevalence of epilepsy in the United States?
A
1 in 26 people will be affected, with over 150,000 new cases diagnosed annually.
3
Q
True or False: All seizures are epilepsy.
A
False.
4
Q
What are the two main types of seizures?
A
- Generalized seizures * Partial seizures
5
Q
Who first recognized the connection between head injuries and seizures?
A
Hippocrates.
6
Q
What did John Hughlings Jackson contribute to the understanding of seizures?
A
He distinguished between generalized and partial seizures and recognized that some seizures do not involve loss of consciousness.
7
Q
What is the term for seizures that involve the entire brain and loss of consciousness?
A
Generalized seizures.
8
Q
What is a seizure?
A
A sudden electrical discharge in the brain causing alterations in behavior, sensation, or consciousness.
9
Q
What criteria must be met for a diagnosis of epilepsy?
A
- At least two unprovoked seizures occurring greater than 24 hours apart * One unprovoked seizure with a high probability of further seizures
10
Q
What is the major excitatory neurotransmitter in the brain?
A
Glutamate.
11
Q
What is drug-resistant epilepsy?
A
A form of epilepsy that does not respond to treatment with antiepileptic drugs.
12
Q
What is the impact of epilepsy on individuals and society?
A
It can lead to significant social, psychological, and health consequences.
13
Q
Fill in the blank: Epilepsy is the _____ most common serious neurological condition.
A
[fourth]
14
Q
What are the basic phases in the pathophysiology of a partial seizure?
A
- Aura phase * Ictal phase
15
Q
What are the major inhibitory neurotransmitters in the CNS?
A
- GABA * Glycine
16
Q
True or False: Seizures can only occur in individuals with epilepsy.
A
False.
17
Q
What is the significance of the hippocampus in relation to seizures?
A
It is one of the most seizure-prone areas of the brain.
18
Q
What was the first surgical treatment for epilepsy introduced?
A
In 1886.
19
Q
What is the main effect of seizures on health?
A
Alterations in motor control, sensory perception, behavior, or autonomic function.
20
Q
What is the definition of an epileptic seizure?
A
A transient occurrence of signs and/or symptoms due to abnormal excessive brain activity.
21
Q
What is the historical belief about epilepsy?
A
It was often associated with possession by evil spirits or supernatural powers.
22
Q
What are the consequences of drug-resistant epilepsy?
A
Increased morbidity, reduced quality of life, and higher risk of premature death.
23
Q
What are the two groups of glutamate receptors?
A
- Ionotropic * Metabotropic
24
Q
What is an epileptic seizure?
A
An episode of neurologic dysfunction with abnormal neuronal firing, manifesting as changes in motor control, sensory perception, behavior, or autonomic function.
25
What does epilepsy suggest?
An enduring alteration of brain function that facilitates seizure recurrence.
26
Define epileptogenesis.
The sequence of events that converts a normal neuronal network into a hyperexcitable network.
27
What are the four phases of a seizure?
* Preictal
* Ictal
* Interictal
* Postictal
28
What occurs during the preictal phase?
Marked by malaise or emotional changes, often with an aura lasting a few seconds.
29
What is the ictal phase?
Occurs during seizure activity, causing uncontrolled abnormal electrical discharge in the brain.
30
What happens during the interictal phase?
Patients often suffer from emotional changes including fear, anxiety, and depression.
31
What is Todd's paralysis?
Numbness or weakness of an affected extremity or side of the face occurring postictally.
32
What are focal seizures?
Seizures resulting from abnormal electrical activity beginning in one area of the brain.
33
What distinguishes focal seizures?
The presence or absence of impairment of consciousness.
34
Define simple partial seizure.
A focal seizure without loss of consciousness, may alter emotions or sensory perceptions.
35
What is a complex partial seizure?
A focal seizure involving a change in or impairment of consciousness or awareness.
36
What are the symptoms of generalized tonic-clonic seizures?
* Abrupt loss of consciousness
* Tonic contraction of muscles
* Clonic rhythmic movements
* Possible loss of bladder control
37
What occurs during atonic seizures?
Sudden loss of muscle tone, causing head or limb drop, or drop attacks.
38
What characterizes absence seizures?
Brief loss of consciousness with staring spells and no postictal confusion.
39
What are myoclonic seizures?
Sporadic jerking movements, typically brief and irregular.
40
What is the typical duration of absence seizures?
Only a few seconds.
41
Fill in the blank: Epileptogenesis leads to the occurrence of _______.
spontaneous seizures.
42
True or False: All patients experience every phase of a seizure.
False.
43
What is the common origin of partial seizures?
The limbic cortex, which controls emotions and memories.
44
What are some symptoms of focal seizures without loss of consciousness?
* Involuntary jerking
* Sensory symptoms like tingling
* Changes in perception
45
What are some symptoms of focal seizures with loss of consciousness?
* Staring into space
* Repetitive movements like lip smacking or chewing
46
What are the symptoms of tonic seizures?
Stiffening of the muscles, often affecting the back, arms, and legs.
47
What characterizes generalized seizures?
Involvement of all areas of the brain.
48
What is a common symptom of seizures originating in the frontal lobe?
Adversive seizures, where eyes or head turn to one side.
49
What may occur after a generalized tonic-clonic seizure?
Muscle soreness, headache, and fatigue.
50
What are absence seizures characterized by?
Brief episodes of staring, with no postictal confusion or sleepiness
## Footnote
These seizures may occur in clusters and interrupt activities and conversations.
51
How many seizures do most children with absence seizures experience per day?
10-20 seizures per day, with some experiencing upwards of 50 per day
52
What do myoclonic seizures typically appear as?
Sudden brief, irregular, shock-like jerks or twitches of the head, trunk, or limbs
53
What characterizes clonic seizures?
Repeated or rhythmic jerking muscle movements, usually affecting the neck, face, and arms
54
List factors that may trigger or exacerbate seizures.
* Sleep deprivation
* Fluctuation in medication levels
* Pro-convulsive drugs
* Barbiturate withdrawal
* Benzodiazepine withdrawal
* Diet
* Infection
* Alcohol withdrawal
* Dehydration
* Stress
* Flashing lights
* Hyperventilation
* Head trauma
* Intense exercise
* Change in weather
55
What percentage of epilepsy cases have no identifiable cause?
Approximately 50%
56
Identify some genetic influences linked to epilepsy.
Some types of epilepsy are linked to specific genes, with estimates suggesting up to 500 genes could be tied to the condition
57
What are some brain conditions that may cause epilepsy?
* Tumors
* Strokes
58
What infectious diseases can lead to epilepsy?
* Meningitis
* AIDS
* Viral encephalitis
59
What prenatal injuries can result in epilepsy?
* Infection in the mother
* Poor nutrition
* Oxygen deficiencies
60
What are common age-related risk factors for epilepsy?
Onset is most common during early childhood and after age 60, but it can occur at any age
61
True or False: Seizures in childhood due to high fevers typically develop into epilepsy.
False
62
What are the main classifications of epilepsy disorders?
* Symptomatic: known etiology, usually a structural abnormality
* Idiopathic: presumed genetic etiology without structural lesion or other neurological symptoms
* Cryptogenic: presumed symptomatic with unidentified underlying abnormality
63
What defines an epilepsy syndrome?
A complex of signs and symptoms that define a unique epilepsy condition
64
List the four main categories of epilepsy classification.
* Localization-related (focal, local, or partial)
* Generalized epilepsies
* Syndromes undetermined whether focal or generalized
* Special syndromes
65
What is the prevalence of epilepsy in the United States?
2.2 million people
66
How many new cases of epilepsy are diagnosed annually in the United States?
150,000 new cases
67
What percentage of people with epilepsy live with uncontrolled seizures?
About 1 out of 3 people
68
What are some specific syndromes of idiopathic focal epilepsies?
* Benign infantile seizures
* Benign childhood epilepsy with centrotemporal spikes
* Early-onset benign childhood occipital epilepsy
* Late-onset childhood occipital epilepsy
69
What are the complications associated with epilepsy?
* Falls
* Trauma
* Fractures
70
What percentage of epilepsy patients achieve seizure control with antiepileptic drug therapy?
About 64%
71
What psychiatric problems are epilepsy patients at risk for?
* Depression
* Anxiety
* Psychosis
72
What is the impact of epilepsy on a patient's quality of life?
Diminished quality of life due to uncertainty associated with severity, manifestations, and progression of epilepsy
## Footnote
Patients with epilepsy are at risk for psychiatric problems such as depression and anxiety.
73
What psychiatric problems are commonly associated with epilepsy?
Depression, anxiety, and psychosis
## Footnote
Depression is more prevalent in epilepsy patients compared to the general population.
74
What is one major social consequence of epilepsy?
Loss of driving privileges
## Footnote
Laws vary by state regarding driving after a seizure-free interval.
75
What is the estimated annual economic burden of epilepsy in the United States?
$9.6 billion to $12.5 billion
## Footnote
This does not account for indirect costs from loss in quality of life and productivity.
76
What contributes significantly to the direct health costs of epilepsy?
More severe forms of epilepsy and unresponsiveness to treatments
## Footnote
Indirect costs constitute the majority of the cost burden.
77
What does epidemiologic research on epilepsy aim to identify?
Risk factors, burden, comorbidities, and outcomes for prevention efforts
## Footnote
Epilepsy is one of the most common brain disorders.
78
What are some known causes of epilepsy?
Neurocysticercosis, brain infections, traumatic brain injury, and stroke
## Footnote
Most cases of epilepsy result from unknown causes.
79
List some comorbidities associated with epilepsy.
* Heart disease
* Autism spectrum disorders
* Alzheimer’s disease
* Depression
* Anxiety
* Learning and memory problems
## Footnote
People with epilepsy are at higher risk for injuries and suicide.
80
What is status epilepticus?
A life-threatening condition with continuous seizure activity lasting more than five minutes
## Footnote
Requires hospitalization, often in intensive care units.
81
What is Sudden Unexpected Death in Epilepsy (SUDEP)?
The sudden, unexpected death of someone with epilepsy who was otherwise healthy
## Footnote
SUDEP is the most common cause of epilepsy-related deaths.
82
How many years of life are lost for people with epilepsy from a known cause?
10 years
## Footnote
2 years are lost for those with epilepsy from an unknown cause.
83
What are common causes of death in individuals with epilepsy?
* CNS malignancy
* Cardiovascular disease
* Cerebrovascular diseases
* External causes (accidents, injury, drowning)
## Footnote
Drowning is 15- to 19-times more common in those with epilepsy.
84
What is the greatest risk factor for SUDEP?
Having uncontrolled seizures, especially convulsive and nocturnal seizures
## Footnote
80% of SUDEP cases occurred in the presence of seizures.
85
What is drug-resistant epilepsy (DRE)?
Failure to respond to medication in more than 30% of diagnosed epilepsy cases
## Footnote
DRE increases the risk for structural brain damage and comorbidities.
86
Define drug-resistant epilepsy according to ILAE.
The failure of two appropriately chosen and tolerated AEDs to control seizures
## Footnote
AEDs can be monotherapies or in combination.
87
What are the classifications of seizures?
* Focal seizures (simple partial, complex partial)
* Generalized seizures (absence, tonic, atonic, clonic, myoclonic, tonic-clonic)
## Footnote
Not all seizures are classified as epilepsy.
88
What is the definition of a seizure?
Abnormal, excessive, hypersynchronized discharge of a collection of neurons in the CNS
## Footnote
Seizures can arise from excitability in the cerebral cortex.
89
What percentage of patients with drug-resistant epilepsy show limited success with AEDs?
More than 30%
## Footnote
This includes any single AED or combination of AEDs.
90
What is the categorization of seizure outcomes?
* Seizure free
* Treatment failure
* Undetermined
## Footnote
Seizure free means no seizures for an adequate period.
91
What does SUDEP stand for?
Sudden Unexpected Death in Epilepsy
92
What are the major consequences of epilepsy?
* Psychological
* Educational
* Social
* Hospitalizations
* Health-related events
* Mortality
93
What is the primary method used by physicians to diagnose epilepsy?
Diagnosis is based on several factors including patient history, clinical evaluation, and diagnostic tests.
94
What types of tests are included in developmental, neurological, and behavioral assessments for epilepsy?
* Motor abilities
* Behavior
* Intellectual ability
95
What information is essential in a patient's history for diagnosing epilepsy?
* Medical history
* Characteristics of seizures
* Onset and duration
* Family history
96
What is the gold standard for epilepsy diagnosis?
Electroencephalogram (EEG)
97
What does an EEG measure?
Changes in electric potentials in areas of the brain
98
True or False: A normal EEG rules out epilepsy.
False
99
What is the purpose of an Epilepsy Monitoring Unit (EMU)?
To capture seizure activity and observe EEG patterns alongside patient behaviors.
100
What imaging technique uses powerful magnets and radio waves to view the brain?
Magnetic Resonance Imaging (MRI)
101
What is the function of SPECT in epilepsy diagnosis?
To create a 3-D map of blood flow activity in the brain during seizures.
102
What does PET stand for in the context of epilepsy diagnostics?
Positron Emission Tomography
103
Fill in the blank: _______ is a functional imaging technique used to measure brain functioning by detecting glucose metabolism.
PET or SPECT
104
What are some imitators of epilepsy?
* Syncope
* Hypoglycemia
* Migraine headaches
* Sleep disorders
* Movement disorders
* Transient ischemic attacks (TIAs)
* Cardiac arrhythmias
* Vertigo
* Non-epileptic seizures (PNES)
105
What are non-epileptic seizures (PNES)?
Episodes resembling seizures but are psychologically induced and not caused by abnormal electrical discharges.
106
What is essential for accurate epilepsy diagnosis and classification?
Good patient history and a witness’s account.
107
List the types of diagnostic tests used in evaluating epilepsy
* EEG
* Continuous video-EEG monitoring
* MRI
* CT
* MEG
* PET
* SPECT
* Genetic or metabolic testing
108
What is the indication for using MRI in epilepsy diagnosis?
To detect structural abnormalities in the brain.
109
What does a detailed patient description of seizure events help with?
It assists the clinician in assuring a correct diagnosis.
110
What is the role of genetic or metabolic testing in epilepsy?
To determine if there is a genetic cause of the epilepsy.
111
Fill in the blank: The EEG recording is typically around _______ minutes.
20
112
What percentage of people may have epileptiform activity on EEG between seizures?
Approximately 50%
113
What are the key features that suggest a common underlying mechanism in epilepsy syndrome?
* Seizure type(s)
* Age of onset
* Natural history/Prognosis
* EEG patterns
* Genetics
* Response to treatment
114
Why is it important to differentiate between epileptic and non-epileptic seizures?
Misdiagnosis can lead to incorrect and possibly harmful treatments.
115
What does continuous video-EEG monitoring combine?
Long-term EEG recording with video recording of behavior.
116
What is the purpose of functional neuroimaging like PET and SPECT?
To assess glucose metabolism or blood flow in the brain.
117
What is functional neuroimaging used for in relation to epilepsy?
Supplementary investigations when considering epilepsy surgery
118
What does an abnormal EEG show in the context of epilepsy?
Generalized fast spike and wave discharges
119
What is the duration of an absence seizure?
10 to 30 seconds
120
True or False: An absence seizure is also called a petit mal seizure.
True
121
What is an atonic seizure?
Loss of normal muscle tone or tension in certain muscles
122
What are symptoms that precede some partial seizures called?
Aura
123
What is automatism in the context of seizures?
Involuntary stereotypical movement, such as chewing or lip smacking
124
Define clonic movement.
Repetitive jerking movements involving flexion and extension
125
What characterizes a complex partial seizure?
Impaired consciousness and relatively complex symptomology
126
What is a convulsion?
Involuntary contraction of the voluntary muscles
127
What does EEG stand for?
Electroencephalography
128
What is epilepsy?
Group of conditions involving recurrent unprovoked seizures
129
What defines an epilepsy syndrome?
Pattern of features suggesting a common underlying mechanism
130
What does the term 'epileptiform' refer to?
Pertaining to epilepsy or resembling epilepsy
131
What is the alternative term for a focal seizure?
Partial seizure
132
What is a focal symptom?
Localized symptom caused by a seizure from a specific area of the brain
133
What is functional imaging?
Method of detecting or measuring changes in metabolism and blood flow
134
What does GABA stand for?
Gamma-aminobutyric acid
135
What is a generalized seizure?
Seizure arising from diffuse areas of both cerebral hemispheres
136
What does the term 'hypersynchronized' mean?
Abnormal simultaneous discharge of a large number of neurons
137
What is the definition of incidence in a medical context?
Number of new cases occurring in a population during a measured time
138
What is a myoclonic seizure?
Form of generalized seizure involving brief muscle contraction
139
What does neurocysticercosis refer to?
Infection of the central nervous system with cysticerci of the pork tapeworm
140
What does the term 'paroxysmal' indicate?
Pertaining to a sudden attack or increase of disease symptoms
141
What is a partial seizure?
Seizure arising from a discrete lesion on the cerebral cortex
142
What occurs during Todd's paralysis?
Slight paralysis in the affected area after partial motor seizures
143
What characterizes a tonic-clonic seizure?
Initial tonic contraction followed by a clonic phase
144
What is a tonic seizure?
Generalized seizure involving muscle stiffening
145
What is the definition of drug-resistant epilepsy according to the consensus proposal by the ILAE?
Drug-resistant epilepsy is defined as epilepsy that does not respond to adequate trials of two tolerated and appropriately chosen antiepileptic drug schedules.
## Footnote
This definition is established by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies.
146
Who authored the 'Handbook of Epilepsy Treatment'?
S. Shorvon.
## Footnote
The handbook was published by Blackwell Science in Oxford, UK, in 2000.
147
What is the focus of Table 1 in the module?
Table 1 focuses on Psychic Auras.
## Footnote
This table was modified from the work of Rudzinski and Shih on the classification of seizures and epilepsy syndromes.
148
What was the purpose of the study by Hauser WA et al. regarding epilepsy?
To assess the prevalence of epilepsy in Rochester, Minnesota, from 1940 to 1980.
## Footnote
The study was published in Epilepsia in 1991.
149
What are the definitions proposed by the ILAE regarding epileptic seizures and epilepsy?
The definitions include criteria for classifying epileptic seizures and epilepsy syndromes.
## Footnote
These were published in Epilepsia in 2005.
150
What is the significance of the study on sudden unexpected death in epilepsy (SUDEP) by Thurman DJ et al.?
The study assesses the public health burden of SUDEP.
## Footnote
It was published in Epilepsia in 2014.
151
Who edited the report 'Epilepsy Across the Spectrum: Promoting Health and Understanding'?
England MJ, Liverman CT, Schultz AM, et al.
## Footnote
This report was published by The National Academies Press in Washington, DC, in 2012.
152
Fill in the blank: The classification of seizures and epilepsy syndromes is modified from the work of _______.
Rudzinski LA, Shih JJ.
153
True or False: The prevalence of epilepsy in Rochester, Minnesota, was studied only for the year 1980.
False.
## Footnote
The study covered the years 1940 to 1980.
154
What is the primary objective of the ILAE Commission on Therapeutic Strategies?
To define and improve the treatment strategies for epilepsy.
## Footnote
The commission focuses on addressing drug-resistant epilepsy among other issues.
