Neurology: Seizures and Epilepsy

Question 0

What is Todd’s Phenomenon?

Answer 0

(AKA: Todd’s Paresis or paralysis)
Focal weakness in a part of the body after a seizure. Most commonly affects appendages but can affect vision and speech.

Question 1

What is a seizure?

Answer 1

Abnormal synchronized discharge of neurons.

Epilepsy is repeated seizures

Question 2

What are major defining features for a Generalized Tonic Clonic Seizure?

Answer 2

• Loss of Consciousness
• “ictal” cry
• stiff and jerky in all four limbs and axial muscles
• tongue biting and urinary incontinence

Question 3

What are the defining characteristics of a Generalized Absence Seizure?

Answer 3

• Sudden behavioral arrest w/ staring
• Automatisms (brief unconscious behaviors: chewing, lip smacking)
• no aura or postictal confusion

Question 4

What does an EEG look like in a patient with a Generalized Absence Seizure?

Answer 4

3Hz spike and wave discharge

exacerbated by hyperventilzation

Question 5

What are the defining characteristics of Generalized Atonic Seizures?

Answer 5

• sudden loss of postural muscle tone
• drop attacks
• minimal impaired consiousness

Question 6

What does the EEG look like in patients having an Atonic Seizure?

Answer 6

Low voltage, fast activity, polyspike and wave

Question 7

What are characteristics of Generalized Myoclonic Seizures?

Answer 7

• sudden brief jerks in arms, legs, or face

- no impaired consciousness or postictal confusion.

Question 8

What is the major difference between a “simple partial” and a “complex partial” seizure?

Answer 8

Simple - no alteration of consciousness

Complex - altered consciousness

Question 9

What is a characteristic feature of Simple Partial Seizures and explain it.

Answer 9

Jacksonian March: abnormal electrical activity in the primary motor cortex that travels down the homunculus influencing the corresponding muscles. May start in the face with a twitching or jerking facial muscles and travel down to the toes.

(this does not have to occur with simple partial seizures, many instances just involve a focal region like taste, smell, or vision)

Question 10

Describe Complex Partial Seizures including the most common location.

Answer 10

Most commonly in the Temporal Lobe

-often have aura
-stop, stare, automatisms (similar to absence sz.)
(absence seizures are more commonly in children whereas Complex partials are more in adults)

Question 11

What are psychogenic non-epileptic attacks (PNEAs)?

Answer 11

Pseudoseizure:
mimics frontal lobe seizures but can be differentiated with EEG scans.
The difference physiologically is that there is no electrical discharges in the brain in PNEA, the cause may be synapse pathology or autoimmune. (the exact mechanism is unknown)

Question 12

Symptomatic seizures occur because of some physiologic pathology in the body that eventually affects the brain. What types of seizures most often present because of these causes?

Answer 12

Generalized Seizures

Question 13

What are characteristics of Primary Generalized Epilepsy?

Answer 13

• genetic cause
• neurologically normal though the EEG shows epileptiform actvity
• controlled easily with anti-epileptic meds

Question 14

Describe Benign Febrile Convulsions.

Answer 14

• occurs in kids (4mo. to 4 yrs.)
• occurs in response to rapid rise in body temp (fever)
• generalized and usually genetic origin

Question 15

What is treatment for Benign Febrile Convulsion?

Answer 15

• Symptomatic

- rectal valium (diastat)

Question 16

Describe Childhood Absence Epilepsy.

Answer 16

• age 4-8years
• brief starring
• provoked by HYPERVENTILATION

Question 17

What does the EEG look like in childhood absence epilepsy?

Answer 17

3Hz spike and wave

just like absence seizure

Question 18

Treatment for Childhood Absence Epilepsy

Answer 18

Ethosuxamide

valproic acid also

Question 19

Describe Juvenile Myoclonic Epilepsy.

Answer 19

• genetic
• myoclonic jerks and absence
• stimulated by alcohol, photic stimulation, sleep deprivation

Question 20

What is the treatment for Juvenile Myoclonic Epilepsy?

Answer 20

Depakote

-prescribed indefinitely

Question 21

Describe 3 characteristics of West Syndrome and the treatment.

Answer 21

1. Infantile Spasms
2. Hypsarrhythmia on EEG
3. Severe Developmental Delay

Treatment: supportive, this is a Secondary Epilepsy Syndrome that does not respond to medication

Question 22

Name 3 characteristics of Lennox-Gastaut Syndrome and the treatment.

Answer 22

1. Multiple Seizure Types
2. EEG has slow spike and wave w/ multifocal spikes
3. Mental Retardation

Treatment: supportive, this is a Secondary Epilepsy Syndrome that does not respond to medication

Question 23

Name 3 characteristics of Mesial Temporal Sclerosis and its treatment.

Answer 23

a Partial Epilepsy Syndrome

1. Complex partial seizures
2. febrile convulsions
3. EEG shows focal temporal slowing or spikes

Treatment: responds well to a temporal lobectomy

Question 24

What is the definition of Status Epilepticus?

Answer 24

Seizure lasting longer than 5 minutes or repeated seizures lasting more than 5 minutes.

(can be generalized tonic clonic, simple partial, complex partial, absence etc.)

Question 25

Which status epilepticus is considered a life threatening emergency?

Answer 25

Generalized Tonic Clonic

Question 26

Convulsive status epilepticus is the most dangerous and easiest to recognize and diagnose. What makes Non-convulsive Status Epilepticus (NCSE) difficult to diagnose?

Answer 26

It can present as:

coma, confusion, lethargy, singing, staring, psychosis, nystagmus, laughter, anorexia, aphasia, amnesia etc.

Question 27

What is the cornerstone to diagnose NCSE?

Answer 27

EEG
-most of the presentations of NCSE can appear as other pathologies but only NCSE will have abnormal brain electrical activity.

Question 28

What is the treatment for Status Epilepticus?

5 things

Answer 28

1. ABCs
2. IV lorazepam or Diazepam
3. if seizures continue: IV phenytoin/fosphenytoin
4. ” “ : IV phenobarbital, midazolam, or propofol (induced coma)
5. Find the cause using lab tests and treat the cause

Question 29

When treating seizures what is important to remember about Depakote?

Answer 29

It is teratogenic