NP ch.16: Epilepsy

Question 1

What is a seizure?

Answer 1

Abnormally excessive or synchronous neuronal activity in the brain

Question 2

What is the definition of Epileptic seizure?

Answer 2

An Epileptic seizure occurs when one experiences a seizure and that manifests in that person’s behavior

Question 3

What are the criteria for diagnosing an epilepsy?

Answer 3

• 2 or more unprovoked seizures >24 hours
• If a person experiences 1 seizure –> 60% chance of experiencing another seizure in the next 10 years
• Diagnosis of epileptic syndrome

Question 4

What is the epidemiology of seizures?

Answer 4

• 1/10 experience a seizure in their lifetime
• Prevalence: 5-9/1000
• Ages in which it occurs most commonly: <10years old, >65 years old
• 50% of eplipsies starts before 18 years
• 80% of epilepsies: In non-Western countries (because of different diseases in those countries)

Question 5

What are some ways to classify Seizures?

Answer 5

• Focal
• Generalized
• Unknown

Question 6

What are Focal seizures?

Answer 6

Patient:
- is aware/ has partially impaired awareness
- has motor/non-motor symptoms
- Can progress to bilateral tonic-clonic
(tonic: sudden tension in muscles)
clonic: involuntary and rhythmic muscular contractions and relaxations)

Question 7

What are generalized seizures?

Answer 7

• Always unaware
• Specific motor difficulties always (tonic-clonic)
• Some non-Motor difficulties

Question 8

What are unknown seizures?

Answer 8

Unclassified –> Can have any combination of all the above symptoms

Question 9

What is Status Epilepticus?

Answer 9

Breathing stops
- Duration: sec-min
!!! Can lead to death !!!

Question 10

What are some observable characteristics of somebody undergoing a seizure?

Answer 10

• Movement/Motion:
  ~ Tonic
  ~ Clonic
  ~ Atonic
• Awareness: During Seizure
  ~ Knowledge of self and environment
  ~ Consciousness intact and can respond or act
  ~ Or Absence: No consciousness

Question 11

How do you determine the type of an epilepsy?

Answer 11

Combine info from type of seizure and location of brain affected through EEG

Question 12

What are the types of epilepsies?

Answer 12

• focal (1 area affected)
• generalized (whole brain)
• Combi (starts from focal and goes to generalized)

Question 13

How can we determine an epilepsy syndrome?

Answer 13

Combine info about:
- Seizure type
- Age of onset
- Co-occurring problems

Question 14

What are the 3 types of etiologies for symptoms (in general, not epilepsy-specific)

Answer 14

• Idiopathic: Cause for symptoms is unknown
• Symptomatic: Cause for symptoms is known
• Cryptogenic: Strong suspicion for cause of symptoms.

Question 15

What is photo-sensitive epilepsy?

Answer 15

• 3% of people with epilepsy are sensitive to specific frequencies
• Occurs mainly in teens and children with generalized anxiety

Question 16

Epilepsy - Clinical Picture

Question 17

What are the resulting symptoms from epilepsy?

Answer 17

Motor:
- Tonic: Muscle contractions and body movements
- Clonic: Semi-rhythmic muscle movements
- Myoclonic spasms: Very short muscle contractions (limbs)
Autonomic effects: sweating, flushing etc.
Visual effects: Flashes, blurring,
Auditory effects: Ringing, hissing etc.
Somatosensory: Tingling feel

Question 18

What is pre-ictal and post-ictal?

Answer 18

• Pre-ictal: Time period before onset of seizure
  ~ lasts hours to days
  ~ Behavioral restlessness/ other behavioral changes others or the patient might notice
• Post-Ictal: Time period after onset of seizure
  ~ Can last several minutes to hours (sometimes days)
  ~ Restlessness
  ~ Increased appetite/thirst
  ~ Disorientation
  ~ Aggression

Question 19

What are 3 clinical factors that determine the risk of epilepsy?

Answer 19

• Stability of epilepsy (age of onset, brain anomaly etc.)
• Dynamic of epilepsy (timespan of a seizure)
• Treatment of epilepsy (if it works and which treatment)

Question 20

What does the CNP (Biopsychosocial model of epilepsy) state?

Answer 20

• Biological aspect: takes into consideration the 3 clinical factors and the cognitive consequences of a patient according to these factors
• Psychological: Assesses how one deals with epilepsy and its consequences
• Social: How one’s environment deals with the person with epilepsy.

Question 21

What is the role of the CNP model?

Answer 21

• Assessment
• Indication for Treatment

Question 22

Assessment

Answer 22

Frequency of seizures is not the most predictive factor for cognitive difficulties. Other pathological factors and onset of seizures predict this.
Domains affected (possibly) by epilepsies:
- Intelligence usually doesn’t decline
- Memory: Encoding & retrieving problems/problems in autobiographical memory
- Speed: Slower
- Attention & EF problems
- Language: Specific problems only in children
- Social cognition
Psychological consequences
- Depression, anxiety, psychosis
- Low self-esteem, lack social support, stigma

Question 23

Indication for Treatment

Answer 23

• 70-80% of people that experience a seizure: drugs are sufficient
• 20-30%: resistant to medication: need surgery
• Anti-epileptic drug: Cognitive side-effects are hard to determine.
• Polytherapy is always better
• Other treatment methods:
  ~ DBS
  ~ Vagues Nerve Stimulation
  ~ Ketogenic diet