NP: Lecture 7 Epilepsy + Flashcards
epilepsy=
continuous tendency for sudden recurring episodes of electrical discharges
epilepsy op 3 levels
electrical discharge - brain level
behavioural manifestations - behaviour level
epileptic seizures - terminology
hoeveel mensen ooit een seizure in hun leven
10%
prevalence epilepsy
4%
bij wie komen seizures het vaakste voor
< 10 en > 65 jaar
hoeveel epilepsy start voor 18 yr
50%
seizure types based on onset
focal
generalised
unknown
epilepsy types
focal
generalised
combined generalised and focal
unknown
hoe gaat het vanaf seizure
seizure types -> epilepsy types -> epilepsy syndrome
ethiology
structural
genetic
infectious
metabolic
immune
unknown
4 dingen waarop epilepsy classifications gebaseerd zijn
- altered consciousness
- involuntary movements
- perceptual and autonomous changes
- behavioural changes
2 ways you can classify epilepsy
A. seizure classification: focus on symptoms
B. epilepsy syndrome classification: seizure symptoms + additional clinical factors
focal/partial
starts in one area
generalised
whole brain
vanaf focal verdeeld in
simple - retains awareness
complex - altered awareness and behaviour
vanaf simple kan hij naar
complex, of secondary generalised
generalised naar…
Absences
Myoclonic seizures
Tonic-clonic seizures
Tonic seizures
Clonic seizures
Atonic seizures
tonic =
sudden tension in muscles, stiffening
clonic =
stiffening and relaxing of muscles alternates repeatedly
atonic=
loss of muscle strength
myoclonic=
muscle twitching, jerking/spasms
3 vragen bij focal
aware or impaired awareness?
motor onset or non motor onset?
progress to bilateral tonic-clonic?
2 vragen bij generalised
motor (tonic-clonic or other)?
non-motor (absences)?
unknown 2 vragen
motor/non motor?
unclassified? dus niet de other categories fitting of insufficient information
aware during seizure means
knowledge of self and environment, consciousness intact
B: epilepsy syndrome classifications 3 soorten hierbij
location related
generalised
epilepsy special
location related 3 soorten
ideopathic (cause is unknown)
cryptogenic (strong suspicion of cause)
symptomatic (cause is known)
generalised B criteria 3 soorten
ideopathic (cause unknown)
cryptogenic (strong suspicion of cause)
symptomatic (cause is known)
epilepsy special
-
welke classificatie laat de onset zien
alletwee, A en B
welke classificatie laat de cause zien
alleen B
childhood absence epilepsy =
generalized idiopathic
temporal lobe epilepsy=
location related symptomatic
bij tumoren waarschijnlijk
location related symptomatic
hoe heet epilepsy voor flitsen
photosensitive epilepsy
prevalence photosensitive epilepsy
3% of people with epilepsy, dus heel weinig eigenlijk
who is affected by photosensitive epilepsy
mainly children and teens with generalized epilepsy
vb van generalised epilepsy bij teens
juvenile myoclonic epilepsy, can be triggered by a lack of sleep
Epilepsy is also a classification in DSM-5, ICD-10: Very detailed scoring
oke
3 motor symptoms of epilepsy
o Tonic: Muscle contractions and body movements
o Clonic: Semi-rhytmic muscle movements
o Myclonic spasms: Very short muscle contractions (limbs)
autonomic effects of epilepsy
seating, flushing
visual effects of epilepsy
flashes, blurring, scotomas
auditory effects
ringing, hissing
somatosensory effects
tingling
pre-ictal and post-ictal
time before onset of seizure and time after seizure
pre-ictal hoe lang
several hours to days
post-ictal hoe lang
several minutes to hours (sometimes days)
dus welke periode is korter
post-ictal is meestal korter, pre-ictal kan lang duren
wat zie je bij pre-ictal vaak
behavioural restlessness or other changes in behaviour
post-ictal symptoms
restlessness
increased appetite/thirst
disorientation
agression
door epilepsy increased risk of…
psychological, psychiatric and cognitive impairments
mowrers two factor model
Mowrer’s theory of conditioning according to which
(1) fear is attached to a neutral stimulus by pairing it with a noxious unconditioned stimulus, and
(2) a person learns to avoid the conditioned
stimulus and so extinction of the conditioning
is prevented.
mowrer critiques
many people with anxiety cannot remember exposure to threatening event. many people with threats do not develop anxiety
but explanations for mowers critique
does not have to be direct
can also develop via modeling
can develop via verbal instruction (mom afraid of spiders)
risk of impairments is determined by 3 clinical factors…
- stable -> brain anomaly, age of onset, seizure type
- dynamic -> frequency, timespan, duration of dyscharges
- treatment -> drugs, neurosurgery
biopsychosocial mdoel of epilepsy
- Biological: stable/dynamic/treatment factors & it’s cognitive consequences.
- Psychological: how one deals with having epilepsy and it’s consequences.
- Social: how one’s environment deals with the person with epilepsy.
over welke vorm van epilepsy weten we meer
we weten meer over symptomatic than idiopathic (duh)
5 symptomen bij beiden idiopathic en symptomatic
attention
information processing speed
psychomotor
visuo-spatial skills
executive dysfunctions
symptomatic symptoms
location is belangrijk:
temporal = memory
frontal = executive functions
parietal/occipital = no specifics
psychological consequences of epilepsy
depression
anxiety
low self esteem
psychoses
lack of social support
stigma
voor heoveel procent is drugs genoeg
70%-75%
hoeveel van die mensen hebben poly drugs
5-10%
hoeveel hebben monodrugs
65%
hoeveel is drug resistant
20-30%
option voor drug resistance?
surgery
hoeveel mensen seizure free na surgery
70%
hoeveel mensen seizure reductions na surgery
30%
dus hoeveel mensen hebben er iets minder last van
iedereen (60% vrij van seizures, 30% seizure reductions)
antiepileptic drugs effects psy
Cognitive side effects are hard to determine,
but always CHECK what is prescribed
can Impact Quality of Life
tonic clonic details
These used to be known as “grand mal” seizures and are the ones generally portrayed in the movies. These involve convulsions and are very noticeable. The muscles stiffen, including vocal chords which may cause the person to cry out or groan. A person may lose bladder or bowel control during a Tonic Clonic seizure. A person can also get hurt from falling when having a Tonic Clonic seizure.
complex focal seizures
These types of seizures can start with an aura which might allow time to get to
a safe place. The person having a Complex Partial Seizure is not aware of their surroundings and can
stare into space, repeatedly tug at their clothing or smack their lips. If they are standing when a seizure
hits, it is possible they will lose their balance and fall leading to a possible injury
simple focal seizures
These can include motor seizures or sensory seizures. The sensory seizures are
particularly difficult for the person with epilepsy if people (including medical professionals) are not educated about seizures. Sensory seizures can include hallucinations and a feeling of dizziness or spinning which can be extremely uncomfortable
absence seizures
Absence seizures can last only a few seconds and may go unnoticed. Sometimes it
will seem as if the person is not paying attention or is staring into space. It is very common for parents or teachers who are not familiar with seizures to assume a child having absence seizures is deliberately not
paying attention. This is not the case. Complex Absence Seizures can include various movements such as blinking or chewing.
myoclonic seizures
These seizures are characterized as brief, jerks of movement or twitching. Sometimes there are several at once but generally there is only one that lasts a second or two.
