Lec 42 Epilepsy Flashcards
What is a seizure?
release of excessive and uncontrolled electrical activity in the brain
What is epilepsy?
seizure disorder –> neurologic condition cahracterized by 2 or more unprovoked seizures
When does epilepsy usually present?
childhood or elderly
What is intractable epilepsy?
epilepsy that is at least partially resistant to drug treatment
found in ~30% of those with epilepsy
What is differential diagnosis for epilepsy [other things that look like epilepsy but aren’t]?
- syncope attack due to loss of cerebral blood flow
- cardiac arrhythmias
- migraines
- hypoglycemia
- narcolepsy
- panic attacks
- pseudoseizures [psychosomatic disorder]
What are the 2 main categories of epileptic siezures?
- partial/focal/localization related
- primary generalized
What are possible causes of primary generalized epilepsy?
- genetic causes, starts in childhood, adolescence
What are possible causes of focal epilepsy?
- trauma, tumor, stroke, encephalitis [infection]
What is onset/symptoms of primary generalized seizures?
- onset in both hemispheres, no aura, lasts 2-3 minutes, see EEG changes in al leads
- symptoms: generalized, post-ictal confusion, incontinence, amnesia
What is the difference simple vs complex seizures?
- both are types of partial seizures
simple = have full consciousness, onset in 1 site or lobe
complex = impaired consciousness, onset in 1 site then spreads, most common site is MTL [medial temporal lobe]
What is secondary generalized tonic-clonic seizure? common causes?
- a partial complex seizure that starts at a focus and then spreads to the rest of brain
- becomes secondarily generalized
- associated with trauma, stroke, drugs, old brain trauma, drug withdrawal
What is absence seizure [petit mal]? characteristic EEG?
- type of generalized seizure
- common in kids
- sudden behavior arrest without falling
- EEG = 3Hz/s spikes
- no post-ictal confusion
What are myoclonic jerks?
type of generalized seizure
- brief, rapid movement
- may or may not lose consciousness, no aura, may precede tonic-clonics
What is juvenile myoclonic epilepsy? etiology?
- myoclonic jerk generalized epilepsy
- need life-long treatment
- due to familial/genetic
- associated with channelopathy
What are tonic-clonic seizures [grand mal]?
- loss of consciousness
- alternating stiffening/jerking
- not preceded by aura
- amnestic for the event
What are atonic seizures?
- drop seizure
- fall to the floor, mistaken for fainting
What is reflexive epilespy?
- epilepsy brought on by particular triggers for seizure to occur
ex. triggered by flashing light or by reading
What is delta wave?
< 4Hz
seen in slow wave stage 3+4 sleep
also seen in encephalopathy, delirium, diffuse lesions
What is theta wave?
4-8 Hx
drowsiness and stage 1+2 sleep
What is alpha wave?
8-13 Hz
when awake, relaxed, eyes closed
what is beta wave?
> 13 Hz
seen in anterior head regions
increasingly common in pts on benzos/barbs
normally sen when pt eyes open, alert, active thinking
What type of EEG waveforms suppressed or promoted by caffeine/stimulants?
- suppress theta and alpha
- promote beta
What are epilepsy auras?
- perceptual disturbance considered a simple seizure but often followed by secondary generalized seizure = considered “warning” sign
manifests as: intense fear, deja vu, olfactory or gustatory hallucinations, rising abdominal sensation, moving sensory symptoms or visual/motor symptoms
What is status epilepticus?
continuous seizure for > 30 min OR recurrent seizures without regaining consciousness between seizures for > 30 min
= medical emergency
