Lecture 5

Question 1

Define epilepsy.

Answer 1

Diseases of the brain characterized by an enduring predisposition to generate epileptic seizures are collectively called epilepsy.

Question 2

What can you expect to see in a patient who has epileptic seizures?

Answer 2

brief episode of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. The outward effect can vary from uncontrolled jerking movement (tonic-clonic) to as subtle as a momentary loss of awareness (absence seizure).

Question 3

Describe the differences between tonic and clonic.

Answer 3

Tonic –> patient will quickly lose consciousness and the skeletal muscles will suddenly tense, causing extremities to be pulled toward the body or rigidly pushed away from it. Usually the shortest part of the seizure.

Clonic –> patient’s muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the limbs to violent shaking or vibrating of the stiffened extremities. Don’t get an air into their lungs à blue lips.

Question 4

What are non-epileptic seizures?

Answer 4

Paroxysmal events that mimic epileptic seizures but do not involve abnormal, rhythmic discharges of cortical neurons; caused by either psychological or physiological conditions.

Question 5

What are the differences between focal and generalised seizures?

Answer 5

Focal seizures –> with or without loss of awareness, secondary generalised tonic clonic (if move to forebrain). Only affect one part of the brain (focal) rather than the whole brain (one hemisphere).

Generalized seizures –> affects both sides of hermispheres. Absence (typical/atypical), myoclonic (brief shock like jerks of muscle or group of muscles), clonic, tonic, tonic clonic, atonic

Question 6

Why are EEG’s poor for diganosing epilepsy?

Answer 6

They would be normal in about 50% of epilepsy patients. If you caught a patient on a good day would indicate no epilepsy.

Question 7

Name the 3 main causes of epilepsy.

Answer 7

1. Genetic or developmental
2. Acquired cases (infection, tumour, stroke, autoimmune)
3. Idiopathic/cryptogenic

Question 8

If an adult presents with epilepsy for the first time what is it imperative that you look for?

Answer 8

Brain tumour. 5% of adult patients who present with their first seizure have a brain tumour.

Question 9

What can you use to treat epilepsy?

Answer 9

Antiepileptic drugs focussuing on reducing excitatory synapse activity and increasing inhibitory synapse activity. With focal epilepsy you could have the affected area of the brain removed.

Question 10

Give another example for why a patient may present with symptoms similar to epilepsy (cardiovascular).

Answer 10

Long QT syndrome –> if the patient has recurrent episodes of blackouts then you should perform an ECG to identify whether they have ECG.

Question 11

Describe Lambert Eaton syndrome.

Answer 11

Autoimmune disorder characterised by muscle weakness of the limbs. Autoimmune disease against presynaptic voltage gated calcium channels in the NMJ, around 60% of individuals with LES have an underlying malignancy. In contrast to myasthenia gravis, this weakness affects the legs more than the arms.

Question 12

What are the 5 characteristics of hyperkinesia?

Answer 12

1. Tremor
2. Dystonia
3. Chorea
4. Myoclonus
5. Tic