Neurology: Seizures and Epilepsy Flashcards
What is Todd’s Phenomenon?
(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.
What is a seizure?
Abnormal synchronized discharge of neurons.
Epilepsy is repeated seizures
What are major defining features for a Generalized Tonic Clonic Seizure?
- Loss of Consciousness
- “ictal” cry
- stiff and jerky in all four limbs and axial muscles
- tongue biting and urinary incontinence
What are the defining characteristics of a Generalized Absence Seizure?
- Sudden behavioral arrest w/ staring
- Automatisms (brief unconscious behaviors: chewing, lip smacking)
- no aura or postictal confusion
What does an EEG look like in a patient with a Generalized Absence Seizure?
3Hz spike and wave discharge
exacerbated by hyperventilzation
What are the defining characteristics of Generalized Atonic Seizures?
- sudden loss of postural muscle tone
- drop attacks
- minimal impaired consiousness
What does the EEG look like in patients having an Atonic Seizure?
Low voltage, fast activity, polyspike and wave
What are characteristics of Generalized Myoclonic Seizures?
- sudden brief jerks in arms, legs, or face
- no impaired consciousness or postictal confusion.
What is the major difference between a “simple partial” and a “complex partial” seizure?
Simple - no alteration of consciousness
Complex - altered consciousness
What is a characteristic feature of Simple Partial Seizures and explain it.
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)
Describe Complex Partial Seizures including the most common location.
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)
What are psychogenic non-epileptic attacks (PNEAs)?
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)
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?
Generalized Seizures
What are characteristics of Primary Generalized Epilepsy?
- genetic cause
- neurologically normal though the EEG shows epileptiform actvity
- controlled easily with anti-epileptic meds
Describe Benign Febrile Convulsions.
- occurs in kids (4mo. to 4 yrs.)
- occurs in response to rapid rise in body temp (fever)
- generalized and usually genetic origin
What is treatment for Benign Febrile Convulsion?
- Symptomatic
- rectal valium (diastat)
Describe Childhood Absence Epilepsy.
- age 4-8years
- brief starring
- provoked by HYPERVENTILATION
What does the EEG look like in childhood absence epilepsy?
3Hz spike and wave
just like absence seizure
Treatment for Childhood Absence Epilepsy
Ethosuxamide
valproic acid also
Describe Juvenile Myoclonic Epilepsy.
- genetic
- myoclonic jerks and absence
- stimulated by alcohol, photic stimulation, sleep deprivation
What is the treatment for Juvenile Myoclonic Epilepsy?
Depakote
-prescribed indefinitely
Describe 3 characteristics of West Syndrome and the treatment.
- Infantile Spasms
- Hypsarrhythmia on EEG
- Severe Developmental Delay
Treatment: supportive, this is a Secondary Epilepsy Syndrome that does not respond to medication
Name 3 characteristics of Lennox-Gastaut Syndrome and the treatment.
- Multiple Seizure Types
- EEG has slow spike and wave w/ multifocal spikes
- Mental Retardation
Treatment: supportive, this is a Secondary Epilepsy Syndrome that does not respond to medication
Name 3 characteristics of Mesial Temporal Sclerosis and its treatment.
a Partial Epilepsy Syndrome
- Complex partial seizures
- febrile convulsions
- EEG shows focal temporal slowing or spikes
Treatment: responds well to a temporal lobectomy
What is the definition of Status Epilepticus?
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.)
Which status epilepticus is considered a life threatening emergency?
Generalized Tonic Clonic
Convulsive status epilepticus is the most dangerous and easiest to recognize and diagnose. What makes Non-convulsive Status Epilepticus (NCSE) difficult to diagnose?
It can present as:
coma, confusion, lethargy, singing, staring, psychosis, nystagmus, laughter, anorexia, aphasia, amnesia etc.
What is the cornerstone to diagnose NCSE?
EEG
-most of the presentations of NCSE can appear as other pathologies but only NCSE will have abnormal brain electrical activity.
What is the treatment for Status Epilepticus?
5 things
- ABCs
- IV lorazepam or Diazepam
- if seizures continue: IV phenytoin/fosphenytoin
- ” “ : IV phenobarbital, midazolam, or propofol (induced coma)
- Find the cause using lab tests and treat the cause
When treating seizures what is important to remember about Depakote?
It is teratogenic
