Neurology 4.10 Flashcards
epilepsy
predisposition to recurrent seizures
seizure
synchronized, high-frequency neuronal firing
seizure or epilepsy: symptomatic or provoked
seizure
seizure or epilepsy: unprovoked and isolated
may be epilepsy; too early to tell
seizure or epilepsy: recurrent and unprovoked
epilepsy
What are seizure mimic conditions?
- syncope (sudden loss of consciousness) or cardiac arrest due to hypoxemia +/- hypotension
- acute drug toxicity
- migraine
- metabolic/endocrine [encephalopathy]
What is the most common serious neurologic disorder?
epilepsy
What is the bimodal curve of epilepsy?
highest incidence in pediatrics and geriatrics
Which percentage of cases of epilepsy are idiopathic?
50-60%
What is the main consequence of epilepsy to society?
cost [diagnosis and initial treatment particularly high]
What is the most important thing to consider when diagnosing epilepsy?
- history and observation
testing: EEG, MRI, blood work, lumbar puncture
What is the important genetic component of epilepsy?
primary generalized epilepsy: Juvenile Myoclonic Epilepsy
What are risk factors for recurrence of an initial seizure?
- first seizure before 16 y/o
- seizure during sleep/early morning
- mental retardation
- neurologic deficit
- sibling with epilepsy
Why might simple partial or complex seizures be read as normal on an EEG?
lesion is deep within the brain
What is a localization related seizure?
partial/focal seizure (60% of all)
How do prodrome and aura differ?
prodrome:
-forewarning hours before seizure
aura:
- actual manifestation of partial seizure
- aids in localization
What is Mesial Sclerosis?
- complex partial seizure
- commonly bilateral in temporal lobes; early adulthood onset/occurance
What is the duration of a complex partial seizure?
1-3 minutes
w/ secondary generalization 2-4 minutes
What is the main manifestation of complex partial seizures?
automatisms
- picking at clothes
- smacking lips
- wandering
- repeating words
What is Todd’s postictal hemi-paralysis suggestive of?
origin location; complex partial seizure with secondary generalization
Why are absence seizures typically not noticed?
- quick
- no warning/aura
- consciousness lost briefly but immediately regained
What is the recurrence rate of febrile seizures?
high
What is the best timing of performing an EEG?
best within 24 hours of seizure and sleep-deprived
What are the recurrence rates after an initial seizure in children and adults?
children: 29% [25-33% relapse after medication stopped]
adults: 33% [50% relapse after medication stopped]
Are anti-epileptic drugs neuroprotective?
no; discontinue after 2-5 years (usually)
Why is the relapse rate lower in children than in adults?
absence seizure more typical in children
How is therapy in epilepsy initiated?
monotherapy is preferable; only sufficient in 50% of patients
[2= +13%, 3= +4%]
