NP: Chapter 16 Epilepsy Flashcards
wat voor soort disease is epilepsie
heeeeel breed, veel symptomen! en veel underlying mechanisms
wat is de definitie van epilepsie
recurring episodes of electrical discharges called seizures.
hoewel er ook cognitive and physiological problems kunnen zijn, is niet alleen seizures!
hoeveel mensen hebben een seizure in lifetime
10%
hoeveel mensen epilepsie
50 mil
wanneer komt het het meeste voor
voor 10 jaar age en na 65 jaar age
in 50% van de patients, epilepsy occurs before the age of…
18
the seizure symptoms depend on the ..
localization of the epileptic discharges
4 symptoms van epileptische aanval
- altered consciousness
- involuntary movements
- experiencing perceptual or autonomous changes
- behavioural changes
2 soorten seizures
focal seizures vs generalized seizures
verschil focal seizures en generalised seizures
focal: beginnen in een specifiek, klein deel van het brein (but may spread)
generalised: affects both hemispheres
focal onset seizures kenmerk of hoe ziet het er uit
These seizures can often be subtle or unusual and may go unnoticed or be mistaken for anything from being intoxicated to daydreaming. dus is redelijk mild vergeleken met generalised
hoeveel mensen met epilepsie hebben focal seizures
60%
3 types of focal seizures
- focal aware: person is aware, but may not be able to talk or respond. usually brief, called a warning or aura that a more intense seizure may develop (although these are already part of the seizure!)
- focal impaired awareness: awareness is affected, appears confused/vague/disoriented
- evolving to bilateral convulsive seizures
generalised onset seizures algemeen
Generalised onset means the seizure affects both hemispheres (sides) of the brain from the onset. Because of this, a person may lose consciousness at the start of the seizure. Generalised onset seizures almost always affect awareness in some way
6 types of generalised onset seizures
tonic-clonic
absence
myoclinic
atonic
clonic
tonic
tonic-clonic seizure
tonic = stiffening, clonic =rhythmical jerking
bij tonic-clonic is er complete loss of consciousness for several minutes, muscles on both sides of the body are contracted (tonic). after 30 seconds, bilateral rhythmic jerks start to occur for several minutes (clonic). the seizures end when a person falls asleep or wakes up confused.
status epilepticus
(vgm bij tonic-clonic)
als een seizure immediately follwed by another seizure. requires medical attention.
absence
generalized seizure, meestal during childhood.
blank out or stare into space for a few seconds. usually unaware of the seizure
symptomatic seizures =
type epilepsie waarvan de oorzaak waarschijnlijk bekend is.
- cryptogenic epilepsy: stron suspicion of neurological cause based on the severity
ideopathic generalized epilepsy=
no cause can be determined, probably cellular abnormality
waardoor worden seizures veroorzaakt
door disruption of ion channels in cell membrane or imbalance in neurotransmitters. enough synchronous epileptic discharges = seizure
wat voor drugs voor seizures
inhibit the excitatory effect of glutamate, or increase the effect of GABA
childhood absence should be treated with…
valproate
lamotrigine
ethosuximide
partial/focal seizures treated with…
carmazepine and levetiracetam
likelihood of a patient becoming seizure free
65%
hoe heten mensen die niet van hun symptomen afkomen
refractory epilepsy patients
4 treatments for refractory epilepsy patients
- neurosurgical treatment for focal epilepsy
- vagus nerve stimulation VNS, in chest to vagus nerve in neck. –> EEG desynchronisation
- deep brain stimulation in thalamus -> interrupt or prevent discharges
- ketogenic diet (high in fat, low in protein, starch and sugar_
epilepsy leads to increased risk of…
cognitive impairments and psychosocial problems.
related to:
- stable factors: brain anomaly, age of onset, type of seizures
- dynamic clinical factors: frequency, years, duration of discharges
- the treatment
ideopathic epilepsiesare..
associated with less severe neuropsych. disorders, and easier to treat.
wat voor symptoms bij ideopathic epilepsie
attention deficits
information processing slower
psychomotor
visuospatial skills
executive functions
mood fluctuations
mental speed & flexibility
limited self control
no intellectual decline!
which 3 forms of ideopathic epilepsy are the most common
childhood absence, juvenile absence, juvenile myoclonic
10% of idiopathic epilepsy begins with centrotemporal spikes BECTS
oke
symptomatic epilepsy: wat voor symptomen
ligt aan de localization
syndrome of temporal love epilepsy
70% van de chronic symptomatic epilepsies, loss of memory
frontal lobe epilepsy hoeveel mensen
20% of partial/focal seizures
structural anomalities are not consistent, therefore less specific disabilities
early onset =
meer last van cognitive impairments
the incidence of psychological disorders is higher for people with epilepsy, welke vooral
depression and anxiety (40-60%!)
ook psychosis
personality changes in… epilepsy
both generalised and focal
