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Neuroscience > Neuroscience Week 6: Seizures > Flashcards

Neuroscience Week 6: Seizures Flashcards

1
Q

Objectives

A
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2
Q

Seizure definition

A

clinical manifestation of abnormal and excessive activity of cortical neurons

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3
Q

Epilepsy Definition

A

Brain disorder characterized by an enduring predisposition to generate epileptic seizures

and

by the neurobiological, cognitive, psychological and social consequences of the condition

and

requires at least one occurrence of an epileptic seizure

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4
Q

Epidemiology of Epilepsy

A
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5
Q

Age-related incidence and prevalence rates of epilepsy

A
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6
Q

Impact of epilepsy

5 listed

A
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7
Q

Top 5 primary questions of seizure evaluation

A
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8
Q

How is a seizure classified?

3 listed

A
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9
Q

Why is seizure classification important?

4 listed

A
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10
Q

Terms often used to describe seizures

9 listed

A
  • complex partial seizures
  • generalized tonic-clonic seizures
  • diepileptic seizures
  • seizure disorder
  • Alcoholic seizures
  • Grand mal
  • temporal lobe epilepsy
  • Petit mal
  • Epilepsy
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11
Q

Layman grand mal

A

big bad - large convulsive seizures

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12
Q

Layman petit mal

A

small bad seizure - absence seizures (staring spells) any non-convulsive seizure

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13
Q

organization to classify seizures

A

Internation league against epilepsy

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14
Q

Generalized seizures types

6 listed

A
  • tonic-clonic
  • clonic
  • absence (brief staring)
  • myoclonic (muscle jerks)
  • tonic (sudden stiffening)
  • atonic (drop seizures)
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15
Q

Generalized seizures start

A

bilaterally from the brainstem and are distributed throughout the cortex so it reaches the cortex at the same time

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16
Q

What percentage of seizures are generalized seizures?

A

25%

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17
Q

EG

A
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18
Q

Tonic to clonic transition on eeg

A
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19
Q

Absence seizure AKA

A

Petit mal seizure

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20
Q

Absence seizure Age of onset

A

common in children

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21
Q

Absence seizure features

A

brief stare and loss of awareness

can be accompanied by automatisms such as:

  • blinking
  • chewing
  • hand gestures
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22
Q

Absence seizure duration

A

typically <10 seconds but can last to 30 seconds

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23
Q

which condtion?

A

3 Hz spike and discharge pattern

3 of these per second

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24
Q

Myoclonic seizure EEG characteristics

A
  • can appear one at a time or cluster
  • during myoclonic buildup and then burst of muscle activity
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25
Q

Myoclonic seizure features

A
  • Brief shock-like jerks of muscle
  • person usually awake and oriented
  • can be singular or multiple
  • may build to GTC
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26
Q

Myoclonic seizure duration

A

1-2 seconds

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27
Q

Atonic seizure features

A

sudden loss of tone of all muscles without myoclonus

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28
Q

Atonic seizure duration

A

<2 seconds

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29
Q

Atonic seizure AKA

A

Drop seizure

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30
Q

Tonic seizure features

A
  • sudden stiffening of muscles
  • loss of consciousness
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31
Q

Tonic seizure duration

A

lasts seconds to minutes

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32
Q

Question 1

A

B. Tonic seizure

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33
Q

Question 2

A

A. Tonic-clonic seizure

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34
Q

Partial seizures AKA

A

focal seizures

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35
Q

Types of Partial seizures

A
  • Simple
  • Complex
  • secondarily generalized
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36
Q

Simple Partial seizure features

A

without impairment of consciousness or awareness

37
Q

Complex partial seizures

A

with impairment of consciousness and awareness

38
Q

Secondarily generalized partial seizures

A

evolving to a bilateral convulsive seizure

39
Q

Types of simple partial seizures

A
  • Motor (SPS)
  • Autonomic (SPS)
  • Subjective sensory (aura)
  • Subjective psychic phenomena only (aura)
40
Q

Partial Seizures overview

41
Q

contrasting generalized seizures from partial seizures

A
  • the partial seizure will start in a particular focus location somewhere in the brain
  • seizure spreads throughout the brain until it is bilaterally distributed to bilateral convulsive seizure
42
Q

simple partial seizures: motor signs

7 listed

A
  • focal motor signs
  • isolated muscle rhythmic jerking
  • Jacksonian March (motor symptoms spread)
  • Contralateral frontal lobe onset
  • Version (extreme head turn) / eye deviation
  • Contralateral frontal or temporal lobe
  • bilateral tonic (stiff posture)
43
Q

Simple Partial Seizures: Sensory symptoms: Temporal onset

A

Temporal lobe onset

auditory (hear music, ringing, voices)

olfactory (often a rotten smell: eggs, sulfur, rubber)

Gustatory (often a metallic taste)

44
Q

Simple Partial Seizures: Sensory symptoms: Parietal onset

A
  • somatosensory (unusual sensations)
  • Vertiginous (dizzy, spinning, unsteady feeling)
45
Q

Simple Partial Seizures: Sensory symptoms: Occipital onset

A
  • Visual (lights, darkness, simple lines)
  • Formed visual hallucinations occur in the Parieto-Temporal-Occipital junction
46
Q

Simple Partial Seizures: Autonomic signs: Insula (temporal) onset

5 listed

A
  • Epigastric (rising sensation, nausea)
  • Pallor
  • Sweating
  • Flushing
  • Piloerection (goose bumps)
47
Q

Simple Partial Seizures: Psychic symptoms: Temporal or Frontal lobe onset

A
  • Broca’s aphasia - difficulty producing fluent speech
  • Wernicke’s aphasia - difficulty understanding speech
48
Q

Simple Partial Seizures: Psychic symptoms: Temporal lobe onset

A
  • Dysmnestic (deja vu, jamais vu, etc)
  • Alice in Wonderland (derealization)
  • feeling of impending doom
  • Broca’s aphasia - difficulty producing fluent speech
  • Wernicke’s aphasia - difficulty understanding speech
49
Q

Simple Partial Seizures: Psychic symptoms: Amygdala onset

A
  • Cognitive (dreamy, time distortions, etc.)
  • Affective (fear, anger)
  • illusions
50
Q

EEG of simple partial seizure

51
Q

Complex Partial Seizure AKA

A

Focal dyscognitive

52
Q

Complex Partial Seizures characteristics

A
  • causes loss of awareness (patient is amnestic to seizure)
  • spread from focal (simple partial) seizure to involve entire unilateral hemisphere
  • secondary generalization: may evolve to a bilateral convulsive seizure (becomes a GTC seizure!)
53
Q

secondary generalization

A

Partial seizure becomes a Generalized Tonic-Clonic seizure

54
Q

complex partial seizure start

A

Spread from focal (simple partial) seizure to involve the entire unilateral hemisphere

55
Q

Complex Partial EEG

A

blue right side is affected while the red is mostly unaffected

56
Q

Focal seizures identified according to region of onset

6 listed

57
Q

Frontal lobe seizures onset

A

Often nocturnal (during sleep)

58
Q

Frontal lobe seizures duration

A

15 seconds to 2 minutes

59
Q

Frontal lobe seizures characteristics

5 listed

60
Q

Frontal lobe seizures semiology

A
  • Vocalizations
  • hypermotor activity
  • violent (non-directed)
61
Q

Semiology definition

A

the study or the signs of …

62
Q

Frontal lobe seizures post Ictal

A
  • Rapid recovery
  • sometimes amnestic for the event but may recall some details
63
Q

Frontal lobe seizures may be mistaken for

A

nonepileptic events (pseudoseizure) or parasomnias

64
Q

Ictal definition

A

in the seizure

65
Q

Question 3

A

C. Right frontal lobe

66
Q

Question 4

A

B. Simple partial seizure (retained awareness)

67
Q

Unknown category of seizure

A
  • formerly unclassified
  • not clearly focal and/or generalized
  • include epileptic spasms
68
Q

Epileptic spasms AKA

A

Infantile spasms

69
Q

epileptic spasms age of onset

A

Rare seizure type typically seen by age 1

70
Q

epileptic spasms features

A

sudden myoclonic convulsions, often flexor

nodding of head

71
Q

epileptic spasms forms

A

both symptomatic and idiopathic forms

72
Q

epileptic spasms associated with

A

developmental regression (typically develop normally up until the spasms start and then experience developmental delay)

73
Q

epileptic spasms EEG

A
  • chaotic background is called hypsarrhythmia and is highly correlated with epileptic spasms
  • the burst of activity with flattening of activity is the seizure (electrodecrement)
74
Q

Status Epilepticus definition

A
  • Single seizure lasting >30 minutes
  • Multiple seizures without return to full function between events
75
Q

Status Epilepticus Features

A
  • Neurologic emergency
  • Prolonged seizure increases risk of “irreversible” neuronal death
  • long-term cognitive/functional consequences
76
Q

Status Epilepticus mortality

77
Q

Status Epilepticus EEG

78
Q

Non-epileptic Events AKA

4 listed

A
  • Pseudoseizures
  • Psychogenic seizures
  • Non-epileptic seizures (NES)
  • Psychogenic non-epileptic seizures (PNES)
79
Q

Pseudoseizures AKA

A

Non-epileptic Event

80
Q

Psychogenic Seizure AKA

A

Non-epileptic Event

81
Q

Non-epileptic seizure AKA

A

NES

or

Non-epileptic Event

82
Q

Psychogenic Non-epileptic seizures AKA

A

PNES

or

Non-epileptic Event

83
Q

Non-epileptic Events epidemiology

84
Q

Non-epileptic Events indicative considerations

6 listed

A
  • concurrent mood disorder or other psychiatric history
  • Stress, anxiety, conflict, depression and H/O abuse
  • H/o chronic pain, fibromyalgia
  • Seizure during clinic visit
  • Multiple Anti-epileptic drug failure
  • woman more likely than men
85
Q

Non-epileptic Events semiology

A
  • long duration >15 minutes
  • Back/arching/pelvic thrusting
  • Multidirectional motion
  • bicycling, asymmetry, head shaking, nodding
  • Waxing and waning
  • Eyelids closed
  • Tearful/crying during or after
86
Q

Question 5

A

C. Left temporal lobe

87
Q

Question 6

A

C. Unable to be determined

because the question is not straight forward, don’t know if she lost awareness or not because can follow with eyes but not respond so there is ambiguity

88
Q

Question 7

A

B. Several complex partial seizures

because of the loss of consciousness and regain full consciousness

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