PATH: Epilepsy

Question 1

Seizure activity restricted to a single region is ___________ seizure

Seizure activity that spreads rapidly through the network (e.g. via thalamus) is a ________ seizure

Answer 1

Seizure activity restricted to a single region is focal (partial)

Seizure activity that spreads rapidly through the network (e.g. via thalamus) is a generalized seizure

Question 2

Acute vs. Chronic Epilepsy?

Answer 2

Question 3

______________________________:

• Brief contractions or “jerks” in muscles or groups of muscles.
• Usually brief (~1-2 seconds) but several can occur in a short time

Answer 3

Myoclonic Seizure

Treatment:

• Valproate first-line for newly diagnosed myoclonic seizures
• Topiramate and Levetiracetam alternatives

Question 4

_____________________________:

• Sudden loss of muscle tone
• May be localized or whole body
• Typically lasts <15 seconds.
• Partial atonic seizures are associated with motor cortical regions.

Answer 4

Atonic Seizure

Question 5

_____________________________:

• Generalized onset
• Characterized by loss of awareness.
• Usually brief (<10 seconds)
• More common in children, can often go unnoticed.
• Can be staring, or eyes turn upwards and eyelids flutter.

Answer 5

Absence Seizure (Petit Mal)

Treatment:

• Ethosuximide/Valproate are the drugs of choice
• Lamotrigine is a suitable alternative

Question 6

_________________________:

• After resolution, followed by post-ictal state characterized by sleep or drowsiness, confusion, or headaches.
• Post ictal symptoms result from changes in metabolic and ionic status of the neurons after an extended period of high-frequency activity.
• Assc w/ ____________ (or post-ictal paresis) is a temporary loss of function in the region affected by the seizure.

Answer 6

Tonic-Clonic Seizure (Convulsion/Grand mal)

Treatment:

• Valproate first-line
• Lamotrigine alternative (exacerbates myoclonic seizures)

Question 7

_____________________________: Seizure lasting more than 10 minutes or three seizures in a row with no recovery between

Answer 7

Status Epilepticus: Seizure lasting more than 10 minutes or three seizures in a row with no recovery between

Benzodiazepines are first-line:

• Threatened status: rectal diazepam or buccal midazolam

• Established status: IV lorazepam and add IV phenytoin

Question 8

Mechanisms of Seizures?

Answer 8

Question 9

Tonic Vs. Clonic Phases of Seizure?

Answer 9

Question 10

Differential Diagnosis of Epilepsy?

Answer 10

Question 11

Non-Pharmaceutical Treatment of Epilepsy?

• Open vs. Closed Loop?
• Steps in Planning of Neurostimulation Therapy?

Answer 11