Psych - 1 Flashcards
T/F - seizures are always unprovoked
false … epislepy are recurrent unprovked seizures
***generalized vs partial onset seizure
**simple vs. complex? (chx of _______ category)
1-GENERALIZED = start “everywhere” (or spread everywhere quickly) … may just stare (absence) , contact (clonic), lock-up (tonic)
2- PARTIAL ONSET = start in certain focal area (SIMPLE = no impairment in consciousness; COMPLEX = w/ impairment)
type of seizure? 38 yo presents after suddenly losing ability to speak, preceeded w/ feeling of intense fear, can respond but incoherent, says they are aware of all of it but can’t control
SIMPLE (does not lose consciousness) PARTIAL (aura before)
what is “secondary generalization” in epilepsy patient
start as partial simple»_space; complex (lose awareness)»_space; secondary generalization (spread to rest of brain) = fall/shake etc (tonic/clonic)
***important to know if it starts as partial becuase rx varies compared to tonic/clonic
generlized seizure chx
- mech/cause?
- more common in ______(kids/adults)
- caused by channel-opathies (Na/Cl)
- usually earlier onset
- if genetic etiology, usually generalized type
incontinence is chx of _____ seizures
- TONIC = lose bladder/bowel control (contracts»_space; incontinence)
- or TONIC/CLONIC
location of seizure? 9 year old with partial seizures that describes “feeling of anxiety / scared” at onset
mesial temporal lobe (specifically amygydala - very common focal area)
dx? 15 yo M presents w/ parents after “losing consciousness” preceded by smelling burnt rubber and feeling of pins and needles in right arm; not able to talk; twitching of his right hand
dx? 45 yo M present w/ episodes of uncontrolled twitching in right hand, preceeded by feeling of deja vu, does not lose consciousness can respond appropriately, wipes nose w/ right hand afterwards
1- PARTIAL COMPLEX (lose consciouness) in left temporal lobe (aphasia in dominant lobe)
2 - PARTIAL SIMPLE right temporal (ipsilateral post-ictal nose scratching + repetative movements on ipsilateral side = AUTOMATISM)
_____ lobe is most common focal area of seizures
temporal
tests to dx epilepsy (2)
- 3T MRI brain w/ seizure protocol
- EEG (electrocephalogram)
mesial temporal sclerosis
- def
- chx of ______ seizure
mesial temporal lobe sclerosis = hippocampus is smaller w/ high signal … chx of TEMPORAL LOBE SEIZURE
dx? 22 yo PMH of “febrile seizures” presents after recurrent 1-2 minute episode raising right arm and right hand scratching at chest, unresponsive, lip smacking, afterwards has no memory of event and was confused, remembers seeing someone in the room beforehand who was not there, MRI is negative
*where in brain is the seizure?
right temporal lobe epilepsy (complex partial?)
TEMPORAL LOBE EPILEPSY
- age of onset
- PMH of _______
- EEG findings
- MRI findings
T/F - often refractory to mediccation
7-30 // febrile seizures as infants // focal epileptiform discharges over temporal lobe // mesial temporal lobe sclerosis (BUT OFTEN MRI IS NEGATIVE)
TRUE!
dx? 29 year old F presents after husband reports that around once a week his wife will have ~30 seceonds of kicking up her right leg and groaning in her sleep 3-4 times (back to back at night), hard to wake up from sleep, wakes up afterwards w/ no memory, slightly confused
FRONTAL LOBE EPILEPSY (often happen at night) … present same REPETATIVE motor signs (repetative “same” is KEY to disntiguish from REM behavior disorder)…. often CLUSTERED
dx? 8 yo presents after 2 months of “spells” in class and at home 2-3 times a day, for 5-10 seconds just stop what hes doing and stares, no warning signs, comes “out of it” quickly and continues what he’s doing
generalized “absence” seizure
dx? 21 yo w/ uncontrolled spells of jerking limbs w/ no memory of events, usually after “going out” night before, lasting only few seconds, father and aunt has similar symptoms,
JUVENILE MYOCLONIC EPILEPSY (onset in teens/early 20s , myoclonic seizures in 100%, generalied tonic-clonic seizures in 90%) , provoved by sleep deprivation / EtOH)
dx? 40 yo F w/ “spells” w/ pelvic thrusting, head moving side to side, bilateral limb movements without alteration in awareness, eye closure, crying
psychogenic nonepileptic spells … these symptoms NOT common in epilepsy
***2 clinical clues distinguishing epilepsy from psychogenic nonepileptic spells
pelvic thrusting, head moving side to side, bilateral limb movements without alteration in awareness, eye closure, crying
***Treat someone for epilepsy after _____(#) of unprovoked seizures
T/F - generally do NOT treat person after 1st unprovoked seizure
T/F - Most first time seizures WON’T recur, but after a second, most WILL
- after 2 or more unprovoked or someone 1 one seizure with HIGH (>60%) recurrence risk
- TRUE (except if old/drivers/pregnant women etc)
- TRUE (recurrence ~39% after 1; ~75% after 2nd)
what is T/F regarding treating a FIRST seizure
- should be considered if in elderly patient
- does NOT reduce short-term / overall seizure recurrence
- does NOT prevent chronic epilelsy
- leads to increased use of AEDs
- True
- FALSE
- TRUE
- True
*factors associated with increased seizure risk (promting early treatment)
T/F - previous/current use of AED is important when considering seizure recurrence
**Focal neurological deficit on examination
**Abnormal imaging with reasonable lesion
((Mesial temporal sclerosis, cortical dysplasia, tumor))
**Abnormalities on EEG (Epileptiform discharges)
FALSE!!! - AED does NOT have long term effect on recurrence risk
Which do NOT prompt AED rx initiation after a seizure:
- -structural lesion
- -metabolic disturbance
- -recent head trauma
- -epileptic EEG pattern
- -family history
-metabolic disturbance / drug /Etoh / acute infection/head trauma … anything that indicates “provoked” seizure
dx? 35 yo M w/ spells of deja vu and weird pain in stomach weekly, followed (about every other time) by unreponsive staring spells, and rubbing fingers on left hand, convulsions every 2-3 months
-simple partial (deja vu) followed by complex partial (every other time) … + secondarily generalized tonic-clonic seizure
T/F - benzodiazepines aren’t true AED but have antiepiletic properties and are appropriate mediacation for epilepsy maintenance
FALSE … has antiepileptic properties but are BAD for maintenance
