Lecture 7: Epilepsy: Chapter 16 Flashcards by Guinevere Linders

What is epilepsy?

Abnormal/excessive electrical discharges at the brain level (seizures) + behavioral manifestations

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What are 4 varying characteristics in epileptic seizures?

Level of altered consciousness
Making of involuntary movements
Experiencing of perceptual or autonomous changes
Presence of behavioral changes

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What are 2 classification systems of epilepsy?

Seizure classification: based on seizure symptoms
Epilepsy syndrome classification (ILAE): integration of cause, localization, age of onset, prognosis

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What is the difference between partial/focal seizures and generalized seizures in epilepsy?

Partial = focal : developed in part of the brain

Generalized: symmetrical and bilateral onset that affect entire brain

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What are the 3 types of partial or focal seizures?

Simple: don’t disturb consciousness
Complex: affect consciousness
Secondary generalized seizures: start in specific point and then expand throughout the brain

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What is a tonic-clonic seizure? Describe how this seizure happens in 3 steps

Generalized seizure in which there is a complete loss of consciousness for several minutes.

Muscle contractions (tonic)
Bilateral rhythmic jerks (clonic spasms)
End of seizure: patient falls asleep or wakes up confused

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What is status epilepticus?

If one seizure immediately follows another –> requires medical attention

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What is an absence epilepsy and in which age group is this most prevalent?

Super short unawareness

Disturbance of consciousness for about 10 seconds. No motor symptoms, but a patient just stares and is unresponsive. After the seizure the patient usually picks up where they left off, unaware they had a seizure

Occurs most often in children

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What are 3 classes of causes for location related/generalized seizures?

Idiopathic: unknown cause
Cryptogenic: strong suspicion of cause
Symptomatic: cause is known (e.g. frontal lobe epilepsy, tumors)

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What are 2 causes of generalized seizures?

Global cellular abnormality
Congenital/hereditary factors

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What are 6 types of primary generalized seizures?

Absences: short loss of awareness
Myoclonic: brief, subtle jerking movements in few muscles
Tonic: sudden muscle tensions
Clonic: rhythmic jerking motions
Tonic-clonic: stiffening and rhythmic jerks
Atonic: sudden loss of muscle tension

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What are atonic seizures?

Sudden loss of muscle tension

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What are myoclonic seizures?

Brief and subtle jerking movements typically in one or a few muscles

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What are 3 options for localization of an epileptic seizure?

Location related
Generalized
Unknown

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What is the neurochemical explanation of epileptic seizures?

Disruption of normal functioning of ion channels in cell membrane or an imbalance in neurotransmitters

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What are 2 possible ways of treatment of epilepsy medication?

Inhibit excitatory effect
Increase inhibitory effect of GABA and other neurotransmitters

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What is the pre-ictal period and what symptoms do arise?

And what is the post-ictal period and what symptoms do arise?

Pre: The time before the seizure where patients show behavioral changes such as restlessness

Post: Time after the seizure, where patients can be disoriented, restless, aggressive, fatigued or have increased appetite/thirst

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Patients with epilepsy have an increased risk of … (3)

Cognitive impairments
Psychiatric impairments
Social problems

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How do idiopathic epilepsy and symptomatic epilepsy differ in severity of cognitive impairments?

Idiopathic: more cognitive impairments in general

Sympathetic: impairment is related to the location of the seizure

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What is a common consequence of temporal lobe epilepsy? And frontal lobe epilepsy?

Temporal: memory issues

Frontal: executive functions difficulties

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What are 2 common psychological symptoms in patients with epilepsy?

Depression and anxiety

Increased rate of suicide

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How can you explain the increased rate of suicide among epilepsy patients?

Feeling of lack of control associated with unpredictability of the seizures

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When are psychoses common in people with epilepsy?

In the post-ictal period, so after the seizure

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Give 3 examples of psychosocial effects involved with epilepsy

Low self-esteem
Low expectations of achievement
Stigma

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What is the most effective treatment for epilepsy? Also provide a percentage with it. What happens to the people for whom this doesn't work?

Mono/poly therapy drug treatment Effective in 70-75% of the patients The other 25-30% can undergo neurosurgery if they have epileptic seizures in specific locations

What is the effectiveness of neurosurgery for people with epilepsy?

Surgery eliminates seizures for 70% of the individuals and greatly reduces seizure frequency for the rest

What are 2 side effects of anti-epileptic drugs?

1. Cause memory loss 2. Cause mental slowness

What is the difference between monotherapy and polytherapy of drugs?

Mono: only 1 type of epileptic drug Poly: 2 or more types of drugs if monotherapy is unsuccessful

What are refractory epilepsy patients?

Patients that are drug resistant

What is done before neurosurgery for epilepsy?

Neuropsychological assessment (test battery and WADA test)

What is the WADA test? How is it conducted?

Test done before epilepsy neurosurgery, to ascertain the location of language and memory areas in the brain, so they can be protected during surgery Done by deactivating one hemisphere and seeing whether the functions are maintained

What is vagus nerve stimulation (VNS) as a treatment for epilepsy?

Stimulator is connected to the vagus nerve through an electrode in the neck. It results in desynchronisation, which decreases seizures (seizures happen with abnormal synchronisation and that doesn't happen now :))

What is deep brain stimulation (DBS) as a treatment for epilepsy?

An electrode is added to the thalamus to stimulate intermittently and therefore it prevents or can interrupt epileptic discharges

When can epileptic drugs doses be reduced? How do you reduce that intake?

When there is a 2-5 year seizure free period Reduce drugs slowly, since a rapid reduction may cause recurrence of seizures

What is the effect of a ketogenic diet and what is it?

Diet that is high in fat and low in protein. It can decrease frequency of epileptic seizures for some individuals

What are the 3 defining symptoms to get the diagnosis of epilepsy?

1. 2 or more unprovoked seizures in an interval >24 hours 2. 1 seizure with 60% chance of experiencing more seizures in 10 years time 3. Diagnosis of epilepsy syndrome

What is the prevalence of epilepsy?

5-9 people in 1000

What age categories most often experience epilepsy and why?

<10 years and >65 years Because of developing brain and degenerating brain. These processes increase risk it goes wrong

What percentage of epilepsy patients live in non-western countries? Why?

80% --> some diseases are more common in other countries because of the climate, less treatment and less access to medical care

What percentage of people experience a seizure?

10%

What percentage of people with epilepsy gets a seizure before 18 years of age?

50%

What are the 3 steps in the epilepsy syndrome classification (ILAE)?

1. Seizure type (focal, generalized, unknown) 2. Epilepsy type (focal, generalized, combi, unknown) 3. Epilepsy syndromes

What are the 3 steps in classifying the seizure type in the ILAE? What characteristics fit with focal seizures and which with generalized ones?

1 Look for awareness 2 Motor behavior 3 Progress/development Focal: aware, motor onset/non-motor onset, progress to bilateral tonic/clonic Generalized: unaware, motor tonic clonic other

What are clonic seizures?

Stiffening and relaxing of muscles alternating repeatedly --> rhythmic jerks

How does establishing the epilepsy syndrome work in the ILAE classification?

Information that is needed for seizure type, age of onset, disease time/coarse, EEG/MRI profile, co-occurring problems

What is photosensitive epilepsy?

When lights or images can trigger epileptic seizures A range of frequencies is a risk for people

What can trigger epilepsy?

Flashing lights, lack of sleep, drugs, alcohol

What can be a cause of juvenile myoclonic epilepsy?

Lack of sleep

People with epilepsy have an increased risk of cognitive impairments and psychiatric and psychosocial problems. Which 3 factors are they related to? Give examples of each

1. Stable clinical factors (age of onset) 2. Dynamic clinical factors (duration of seizures) 3. Treatment factors (type of medication, surgery)

What is typically the age of onset for juvenile myoclonic epilepsy (JME)? What does this type of epilepsy entail?

Adolescence Generalized tonic-clonic seizures and myoclonic spasms (in specific limbs) often shortly after waking up

What is the prevalence of frontal lobe epilepsy (FLE) in patients with partial seizures?

20%

What is the prevalence of temporal lobe epilepsy in chronic symptomatic epilepsies? What is the main cause of this?

70% Main cause is hippocampal sclerosis or atrophy (50%)

What type of impairment is associated with temporal lobe epilepsy (TLE)? How does it differ with the different ages of onset?

Loss of memory Early onset: less material specific loss of memory Late onset: more material specific memory loss

What is specific for temporal lobe epilepsy in the left hemisphere?

Verbal memory loss

What are the impairments following frontal lobe epilepsy?

Heterogenous somewhere in the spectrum of executive skills

What are the 3 different cognitive phenotypes in temporal lobe epilepsy (TLE)? What are important factors determining which level a person is in?

1. Minimal cognitive disorders 2. Specific memory loss 3. Generalized cognitive disorders and severe memory loss Cortical thickness and volumes

What are main cognitive impairments commonly linked to? (5)

1. Early age of onset 2. Extended duration of seizures 3. Presence tonic-clonic seizures 4. Long-term treatment with drugs 5. Experiencing one or more epileptic states

How do anti-epileptic drugs work? Name 3 ways

1. Decrease excitation of cell membrane 2. Increase postsynaptic inhibition 3. Change synchronization of neural network

What can the changing of synchronization of neural networks have as a consequence/risk?

More neuropsychological side effects (mental slowness, memory loss, word-finding problems)

What percentage of epilepsy patients suffer from psychiatric disorders (anxiety/depression)?

40-60% --> Incidence of psychiatric disorders is significantly higher in patients with epilepsy compared with general population

What type of epilepsy fits with personality changes?

Partial epilepsy (TLE and FLE) and generalized epilepsy

What are inter-ictal psychoses? How are they compared to post ictal psychoses?

Inter: during the epileptic seizure --> less common, but more severe and longer duration than post-ictal Post ictal: 25% of cases

What are socially/culturally the most stigmatizing seizures? And the least?

Most: tonic-clonic Least: simple partial seizures