Neuroscience Week 6: Seizures Flashcards
1
Q
Objectives
A
2
Q
Seizure definition
A
clinical manifestation of abnormal and excessive activity of cortical neurons
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
4
Q
Epidemiology of Epilepsy
A
5
Q
Age-related incidence and prevalence rates of epilepsy
A
6
Q
Impact of epilepsy
5 listed
A
7
Q
Top 5 primary questions of seizure evaluation
A
8
Q
How is a seizure classified?
3 listed
A
9
Q
Why is seizure classification important?
4 listed
A
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
11
Q
Layman grand mal
A
big bad - large convulsive seizures
12
Q
Layman petit mal
A
small bad seizure - absence seizures (staring spells) any non-convulsive seizure
13
Q
organization to classify seizures
A
Internation league against epilepsy
14
Q
Generalized seizures types
6 listed
A
- tonic-clonic
- clonic
- absence (brief staring)
- myoclonic (muscle jerks)
- tonic (sudden stiffening)
- atonic (drop seizures)
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
16
Q
What percentage of seizures are generalized seizures?
A
25%
17
Q
EG
A
18
Q
Tonic to clonic transition on eeg
A
19
Q
Absence seizure AKA
A
Petit mal seizure
20
Q
Absence seizure Age of onset
A
common in children
21
Q
Absence seizure features
A
brief stare and loss of awareness
can be accompanied by automatisms such as:
- blinking
- chewing
- hand gestures
22
Q
Absence seizure duration
A
typically <10 seconds but can last to 30 seconds
23
Q
which condtion?
A
3 Hz spike and discharge pattern
3 of these per second
24
Q
Myoclonic seizure EEG characteristics
A
- can appear one at a time or cluster
- during myoclonic buildup and then burst of muscle activity
25
Myoclonic seizure features
* Brief shock-like jerks of muscle
* person usually awake and oriented
* can be singular or multiple
* may build to GTC
26
Myoclonic seizure duration
1-2 seconds
27
Atonic seizure features
sudden loss of tone of all muscles without myoclonus
28
Atonic seizure duration
\<2 seconds
29
Atonic seizure AKA
Drop seizure
30
Tonic seizure features
* sudden stiffening of muscles
* loss of consciousness
31
Tonic seizure duration
lasts seconds to minutes
32
Question 1
B. Tonic seizure
33
Question 2
A. Tonic-clonic seizure
34
Partial seizures AKA
focal seizures
35
Types of Partial seizures
* Simple
* Complex
* secondarily generalized
36
Simple Partial seizure features
without impairment of consciousness or awareness
37
Complex partial seizures
with impairment of consciousness and awareness
38
Secondarily generalized partial seizures
evolving to a bilateral convulsive seizure
39
Types of simple partial seizures
* Motor (SPS)
* Autonomic (SPS)
* Subjective sensory (aura)
* Subjective psychic phenomena only (aura)
40
Partial Seizures overview
41
contrasting generalized seizures from partial seizures
* 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
simple partial seizures: motor signs
7 listed
* 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
Simple Partial Seizures: Sensory symptoms: Temporal onset
Temporal lobe onset
auditory (hear music, ringing, voices)
olfactory (often a rotten smell: eggs, sulfur, rubber)
Gustatory (often a metallic taste)
44
Simple Partial Seizures: Sensory symptoms: Parietal onset
* somatosensory (unusual sensations)
* Vertiginous (dizzy, spinning, unsteady feeling)
45
Simple Partial Seizures: Sensory symptoms: Occipital onset
* Visual (lights, darkness, simple lines)
* Formed visual hallucinations occur in the Parieto-Temporal-Occipital junction
46
Simple Partial Seizures: Autonomic signs: Insula (temporal) onset
5 listed
* Epigastric (rising sensation, nausea)
* Pallor
* Sweating
* Flushing
* Piloerection (goose bumps)
47
Simple Partial Seizures: Psychic symptoms: Temporal or Frontal lobe onset
* Broca's aphasia - difficulty producing fluent speech
* Wernicke's aphasia - difficulty understanding speech
48
Simple Partial Seizures: Psychic symptoms: Temporal lobe onset
* 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
Simple Partial Seizures: Psychic symptoms: Amygdala onset
* Cognitive (dreamy, time distortions, etc.)
* Affective (fear, anger)
* illusions
50
EEG of simple partial seizure
51
Complex Partial Seizure AKA
Focal dyscognitive
52
Complex Partial Seizures characteristics
* 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
secondary generalization
Partial seizure becomes a Generalized Tonic-Clonic seizure
54
complex partial seizure start
Spread from focal (simple partial) seizure to involve the entire unilateral hemisphere
55
Complex Partial EEG
blue right side is affected while the red is mostly unaffected
56
Focal seizures identified according to region of onset
6 listed
57
Frontal lobe seizures onset
Often nocturnal (during sleep)
58
Frontal lobe seizures duration
15 seconds to 2 minutes
59
Frontal lobe seizures characteristics
5 listed
60
Frontal lobe seizures semiology
* Vocalizations
* hypermotor activity
* violent (non-directed)
61
Semiology definition
the study or the signs of ...
62
Frontal lobe seizures post Ictal
* Rapid recovery
* sometimes amnestic for the event but may recall some details
63
Frontal lobe seizures may be mistaken for
nonepileptic events (pseudoseizure) or parasomnias
64
Ictal definition
in the seizure
65
Question 3
C. Right frontal lobe
66
Question 4
B. Simple partial seizure (retained awareness)
67
Unknown category of seizure
* formerly unclassified
* not clearly focal and/or generalized
* include epileptic spasms
68
Epileptic spasms AKA
Infantile spasms
69
epileptic spasms age of onset
Rare seizure type typically seen by age 1
70
epileptic spasms features
sudden myoclonic convulsions, often flexor
nodding of head
71
epileptic spasms forms
both symptomatic and idiopathic forms
72
epileptic spasms associated with
developmental regression (typically develop normally up until the spasms start and then experience developmental delay)
73
epileptic spasms EEG
* 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
Status Epilepticus definition
* Single seizure lasting \>30 minutes
* Multiple seizures without return to full function between events
75
Status Epilepticus Features
* Neurologic emergency
* Prolonged seizure increases risk of "irreversible" neuronal death
* long-term cognitive/functional consequences
76
Status Epilepticus mortality
77
Status Epilepticus EEG
78
Non-epileptic Events AKA
4 listed
* Pseudoseizures
* Psychogenic seizures
* Non-epileptic seizures (NES)
* Psychogenic non-epileptic seizures (PNES)
79
Pseudoseizures AKA
Non-epileptic Event
80
Psychogenic Seizure AKA
Non-epileptic Event
81
Non-epileptic seizure AKA
NES
or
Non-epileptic Event
82
Psychogenic Non-epileptic seizures AKA
PNES
or
Non-epileptic Event
83
Non-epileptic Events epidemiology
84
Non-epileptic Events indicative considerations
6 listed
* 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
Non-epileptic Events semiology
* 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
Question 5
C. Left temporal lobe
87
Question 6
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
Question 7
B. Several complex partial seizures
because of the loss of consciousness and regain full consciousness
