Paroxysmal Disorders (epilepsy)

Question 1

What are paroxysmal disorders?

Answer 1

Disorders in which the nervous system functions normally between episodes, such as seizures, headaches, and fainting

Question 2

What is another name for paroxysmal disorders?

Answer 2

Episodic disorders.

Question 3

What are common triggers for paroxysmal disorders?

Answer 3

Stress and fatigue.

Question 4

What is a seizure?

Answer 4

• A paroxysmal hyper-synchronous abnormal activity of neurons
• Sudden and transient interruption of brain function due to disruption of electrochemical processes in transmitting information from one nerve cell to another

Question 5

What is epilepsy?

Answer 5

A condition diagnosed by at least two unprovoked (idiopathic) seizures more than 24 hours apart.

Question 6

How common is epilepsy globally?

Answer 6

It is the most common neurological disorder worldwide.

Question 7

What percentage of people will experience a one-off seizure in their lifetime?

Answer 7

Approximately 1 in 20 people.

Question 8

At what stages of life is epilepsy more likely to begin?

Answer 8

In childhood or later life.

Question 9

What impact does epilepsy have on children’s education?

Answer 9

It can significantly impact education, with one-third of affected children experiencing ongoing seizures.

Question 10

What is idiopathic epilepsy?

Answer 10

Epilepsy with no identifiable cause.

Question 11

What is symptomatic epilepsy?

Answer 11

Epilepsy caused by identifiable factors like brain injury, infection, or tumours

Question 12

What are some common causes of seizures in adults and elderly individuals?

Answer 12

Vascular diseases, head trauma, infections, tumors, and alcohol or drug misuse.

Question 13

What percentage of stroke patients develop seizures?

Answer 13

About 10%.

Question 14

What is the seizure risk after a subarachnoid bleed?

Answer 14

Around 30%

Question 15

What are the two main types of seizures?

Answer 15

Focal (partial) and generalised seizures.

Question 16

What are focal seizures?

Answer 16

Seizures starting in a specific brain region; they can be simple (consciousness preserved) or complex (altered consciousness).

Question 17

What are generalized seizures?

Answer 17

Seizures affecting the entire brain, leading to a loss of consciousness.

Question 18

Name 4 common types of generalized seizures.

Answer 18

Tonic-clonic, absence, myoclonic, and atonic seizures.

Question 19

Where do focal seizures usually start?

Answer 19

In a specific part of the brain, such as the temporal, frontal, occipital, or parietal lobe.

Question 20

What happens in a simple focal seizure?

Answer 20

Consciousness is preserved, and the person may experience unusual sensations or twitching.

Question 21

What happens in a complex focal seizure?

Answer 21

There’s altered consciousness, strange behaviors, and possible confusion after the seizure.

Question 22

What characterizes tonic-clonic seizures?

Answer 22

Stiffening (tonic phase) followed by rhythmic jerking (clonic phase), often with cyanosis and incontinence.

Question 23

What is an absence seizure?

Answer 23

A brief seizure where a person stops activity and stares into space, common in children.

Question 24

What is a myoclonic seizure?

Answer 24

A seizure involving sudden, involuntary muscle jerks.

Question 25

What is an atonic seizure?

Answer 25

A seizure resulting in a sudden loss of muscle tone.

Question 26

What questions are helpful to diagnose the type of seizure?

Answer 26

Ask about how the seizure starts, how it evolves, duration, consciousness loss, how it stops, post-seizure symptoms, and recovery time.

Question 27

What role does EEG play in diagnosing epilepsy?

Answer 27

It records electrical activity in the brain to support diagnosis, although it can be normal in 60-70% of epilepsy cases.

Question 28

When is a brain scan indicated in epilepsy?

Answer 28

To detect causes like scarring or tumors, typically using MRI.

Question 29

When should treatment for epilepsy begin?

Answer 29

After a diagnosis of epilepsy, defined by more than two unprovoked seizures.

Question 30

What is the primary goal of epilepsy treatment?

Answer 30

Complete seizure control with minimal side effects.

Question 31

What are the main treatments for epilepsy?

Answer 31

Anti-epileptic drugs (AEDs), surgery, ketogenic diet, and complementary therapies.

Question 32

What percentage of epilepsy cases achieve good seizure control with AEDs?

Answer 32

Around 40% remit and are controlled with AEDs.

Question 33

What is the prognosis for spontaneous remission of epilepsy?

Answer 33

Approximately 30% remit spontaneously.

Question 34

Name some conditions that may resemble epilepsy.

Answer 34

Sleep disorders, hyperventilation, migraines, panic attacks, and syncope (fainting).

Question 35

How can epilepsy vary among individuals?

Answer 35

Seizures differ widely in type, frequency, and triggers.

Question 36

What are common one-off seizure triggers?

Answer 36

Binge drinking, high fever, and sudden head injury.

Question 37

What are general characteristics of seizures

Answer 37

Seizures are usually brief, self-limiting, and involve overactivity in the brain's electrical signals.

Question 38

What symptoms might someone experience in a simple focal seizure?

Answer 38

Strange sensations like unusual smells or tastes, twitching, and awareness during the seizure.

Question 39

How does awareness change in a complex focal seizure?

Answer 39

There’s partial loss of awareness, time disorientation, and potentially unusual behavior like lip-smacking or wandering.

Question 40

What is the ketogenic diet’s role in epilepsy?

Answer 40

It may help reduce or control seizures, particularly in drug-resistant cases.

Question 41

How does a vagal nerve stimulator work?

Answer 41

It sends electrical pulses to the brain to help reduce seizure frequency.

Question 42

What is symptomatic epilepsy?

Answer 42

Epilepsy with a clear cause, like brain scarring from an injury or infection.

Question 43

What is idiopathic epilepsy?

Answer 43

Epilepsy with no obvious cause, sometimes linked to genetic factors

Question 44

What is an EEG and how does it help in diagnosing epilepsy?

Answer 44

An EEG records brain electrical activity and can show disruptions during a seizure.

Question 45

Why might brain scans be used in epilepsy diagnosis?

Answer 45

To identify physical causes like scarring or tumors with MRI or CT scans.

Question 46

How does vascular disease contribute to seizures?

Answer 46

It increases seizure risk, particularly in elderly patients, often following strokes or cerebral bleeds.

Question 47

What is the risk of seizures after an ischemic stroke?

Answer 47

Approximately 5%.

Question 48

What is the risk of seizures following a cerebral bleed?

Answer 48

Approximately 20%

Question 49

What is the seizure risk after a skull fracture?

Answer 49

Approximately 15%.

Question 50

What is the seizure risk with an intracranial hematoma?

Answer 50

Around 30%.

Question 51

How soon after head trauma do most seizures occur?

Answer 51

Roughly 75% of trauma-induced seizures happen within the first year after injury

Question 52

Which infections are linked to seizures?

Answer 52

Viral encephalitis and bacterial meningitis are two common infections that increase seizure risk.

Question 53

What is the seizure risk after viral encephalitis?

Answer 53

Up to 25%.

Question 54

What is the seizure risk following bacterial meningitis?

Answer 54

Up to 10%.

Question 55

How can brain tumors lead to epilepsy?

Answer 55

Tumors disrupt normal brain function and can trigger abnormal electrical activity, leading to seizures.

Question 56

How does alcohol use contribute to seizures?

Answer 56

Alcohol can cause seizures through toxic effects during binge drinking or during withdrawal.

Question 57

When are withdrawal seizures most likely to occur after stopping alcohol use?

Answer 57

They typically occur 6–72 hours after cessation, with a peak around 24 hours.

Question 58

Can drug misuse cause seizures?

Answer 58

Yes, especially with stimulants or drugs that alter brain activity, either directly or through withdrawal.

Question 59

What are cryptogenic seizures?

Answer 59

Seizures with no identifiable cause, making up approximately 70% of all cases.

Question 60

How does age influence the causes of seizures?

Answer 60

In older adults, seizures are often caused by strokes or dementia; in younger individuals, genetic and idiopathic factors are more common.

Question 61

How does stroke lead to epilepsy?

Answer 61

Strokes damage brain tissue, which can create areas of scar tissue that disrupt normal electrical activity, leading to seizures.

Question 62

What percentage of epilepsy cases are thought to have a genetic component?

Answer 62

While it varies, certain types of epilepsy are thought to have a genetic link, especially idiopathic epilepsy.