Lecture 45: Epilepsy Flashcards
Seizure
Uncontrolled release of electrical activity
Epilepsy
Seizure disorder: two or more unprovoked seizures
How often does a seizure have a found cause?
25%
Kindling
Epilepsy isn’t good for you, the more you have the more you get
Main categories of epilepsy (2)
Primary Generalized; Focal/Partial
Most generalized epilepsy has what cause?
Genetic
Types of generalized epilepsy (6)
Absence, myoclonic, primary generalized tonic-clonic, tonic, clonic, atonic
Focal epilepsy in two categories. Also categorized by…
Simple and complex; brain region (i.e. temporal)
Reflex epilepsy
Triggered by stimuli (i.e. photosensitive by particular Hz)
Epilepsy differential (7)
Syncope, cardiac arrhythmias, migraine, hypoglycemia, narcolepsy, panic attacks, psychogenic non-epileptic seizures
What do you look for when testing epilepsy?
Lesion!
Epileptic regions
Hippocampus, enterorhinal cortex and amygdala (medial temporal lobe)
Why do you record EEG near the ear?
Amplifies EEG
Delta
Theta
4-8Hz
Alpha
8-13Hz: awake, alert but relaxed, eye closed
Beta
> 13Hz: awake/alert in anterior head regions, large numbers associated w/ benzo use
Epilepsy auras differ from migraine in that they…Can include (4)
Are part of (don’t precede) seizure; sudden intense fear, deja/jamais vu, olfactory/gustatory hallucinations, visual/motor
Frontal lobe seizures are common/rare. Only seizure that can be…Symptoms?
Fairly rare; bilateral w/out LOC; vocalizations, shaking, head turn
Generalized tonic-clonic seizure: aura, length, consciousness, post-ictal state
Must be generalized from onset, no aura (no focal areas involved), LOC, 2-3 minutes, amnesia/confused after
Tonic
Freeze
Clonic
Moving
Absence seizures. Another name?
Sudden behavioral arrest, staring/unresponsive, sudden return to normal w/out pre-event amnesia but doesn’t recognize seizure; also called petit-mal seizures
Absence/petit mal common trigger…describe. Common wave pattern?
Triggered by hyperventialation, regular generalized, 3/second spike and slow wave
Absence seizures are common in?
Children
Myoclonic seizure. Common trigger? Always epilepsy?
Brief, quick movements in body; light/startle; no
Todd’s post-ictal paralysis
Post-seizure paralysis due to seizure in motor region of the brain
What is the most common abnormality underlying temporal lobe epilepsy?
Medial temporal sclerosis
Describe temporal seizure symptoms
Epigastric rising feeling, intense fear, deja vu, olfactory hallucinations, automatisms (lip smacking)
Frontal lobe seizures are common/rare. Only seizure that can be…Symptoms?
Fairly rare; bilateral w/out LOC; vocalizations, shaking, head turn
Occipital lobe seizures are common/rare. Symptoms
Rare; poorly formed colored lights across visual field
Juvenile myoclonic epilepsy; associated with? Prognosis?
Myoclonus early in day; positive family history; benign but may last for life
Benign epilepsy with centrotemporal spikes (Rolandic seizure) symptoms. Prognosis?
Parethesiae involving mouth –> unilateral clonic activity of face; often occurs shortly after falling asleep; benign, resolve by adolescence
Infantile spasms (West syndrome) age of onset, symptoms, prognosis. Treatment?
3-12 months of age; jerk followed by stiffening; NOT benign, associated w/ retardation; give high doses ACTH
Lennox-Gaustat Syndrome triad. Prognosis?
Mental retardation, slow spike and wave, multiple seizure types; difficult to treat
Atonic seizures are dangerous because?
Sudden loss of tone can lead to falling –> injury
Febrile seizures definition and prognosis
Occurs w/ high fever in young child, less than 15 min; generally benign and don’t require treatment
Seizures are the _______ most common presentation of brain tumor
Second
Drug treatment response rate and rules
70%; first try monotherapy: “start slow, increase slowly”
How long seizure-free when medication will be often be stopped?
Three years
Surgical treatment is primarily for…
Focal seizures
Status Epilepticus definition
Condition w/ seizures lasting for more than 30 minutes or multiple seizures lasting 30 minutes w/out recovery
Why is Status Eplipeticus serious
Death in 5-10% due to circulatory collapse
Psychogenic Non-Epileptic seizures are associated with (3). What do they look like?
True seizure disorder, sexual abuse, bereavement; non-stereotyped thrusting, eyes closed, face not involved, feels normal afterward
