- respond well to specific anticonvulsants

Quiz 2 epilepsy Flashcards by Adam Gardner

most susceptible areas of the brain to epileptic activity

frontal (particularly limbic) and temporal lobes

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in a generalized seizure, the trigger is outside the cortex in the……

reticular formation or thalamus

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general seizure presentation

initial tonic rigidity with extensors overpowering flexors
stop breathing, air expelled through closed glottis
clonic phase - contraction relaxation
postictal phase - relaxation

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autonomic overflow can occur during seizure causing

emptying of bladder and to a lesser extent bowels

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vitals during ictal phase of generalized seizure

pupils dilated

- HR and pulse elevated

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what is seen on the EEG during the clonic phase?

spike-wave

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what do the spikes and waves represent in spike-wave EEG?

spike - massive depolarization and muscle contraction

- wave - relaxation and massive neuronal inhibition

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how can we distinguish between a primary generalized seizure and one coming from a focal seizure?

when coming from focal seizure, there can be an aura or unusual motor events before seizure

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discuss progression of juvenile myoclonic epilepsy (JME)

starts in childhood with absence seizures
late childhood/adolescence - involuntary jerking in the morning
eventually has generalized seizure which leads to diagnosis

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underlying cause of JME

genetic mutations that affect ion channels

- at least six variations

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a generalized seizure is also known as a

grand mal seizure

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treatment of JME

respond well to specific anticonvulsants

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examples of metabolic grand mal seizures

ionic
sedative withdrawal
hypoglycemia
hypoxia
hyperthermia

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when do absence seizures occur?

mostly childhood

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an absence seizure is also known as a

petit mal seizure

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absence seizure presentation

blank staring
does not remember
may be eyelid fluttering or chewing movements

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petit mal diagnosis markers

spike wave of 3 per second

- can almost always be brought on by hyperventilation

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when focal seizure involves sensory cortex it usually presents as…

positive symptom (presence of sensation)

hallmark of “complex partial seizures”

more complicated emotions, feelings or perceptions

- clouding of consciousness

what is Todd Paralysis?

focal paralysis due to post-ictal depression of function in area affected by seizure
can be difficult to distinguish from a stroke

explain characteristics of focal seizure in motor area

contralateral clonic jerks
if it spreads, jerks spread to adjacent areas
jacksonian march

presentation if focal seizure in somatosensory cortex

contralateral paresthesia

- can also “march”

what is on the differential for simple partial seizure of the somatosensory cortex?

- migraine transient dysfunction

giveaways of TIA over simple partial seizure

old age
artery stenosis
no “march”
history of cardiovascular disease

giveaways for migraine over simple partial seizure

- followed by unilateral headache (but headache CAN come after seizure on rare occasions)

"march" of migraine vs simple partial seizure

- migraine - minutes | - seizure - seconds

presentation of auditory-vestibular partial seizure

- tinnitus (hallucination of sound) | - vertigo

auditory-vestibular seizure can be mistake for.... if no convulsion occurs

- inner ear disease (Meniere syndrome)

audiometric tests in AV-seizure

- normal in seizure | - abnormal in Meniere syndrome

presentation of visual partial seizure

- hallucination in contralateral visual field

foci in primary vs association visual cortexes

primary - unformed flashes | association - more formed shapes, people talking etc.

where do complex partial seizures start?

- frontal or temporal lobes | - to a lesser extent parietal association

explain possible presentation of seizure isolated to limbic system

- leaves reticular formation and neocortex intact so can carry out complex activities and not remember them

the behavior of unremembered complex activities associated with limbic complex partial seizure is more often explained by

ischemia trauma migraine

most common cause of status epilepticus

withdrawal of medication

what is the mechanism of danger with status epilepticus?

- hyperthermia from muscle contraction causes irreversible damage to neurons - hypoxia from inadequate ventilation - severe lactic acidosis - death ultimately results from overtaxation of cardiorespiratory reserve

focal counterpart to status epilepticus

epilepsia partialis continua - not as life threatening - can generalize to status epilepticus

most common causes of epilepsia partialis continua

- neoplasm | - ischemia/infarction

treatment of seizures from underlying systemic metabolic disorders

treat underlying condition

qualities of an ideal anti-convulsant

- decreases abnormal excitability - minimal sedating effect - minimal other deleterious effects

emergent treatment of status epilepticus

- intravenous benzos | - phenytoin, phenobarbital

percent of epileptic patients who see results with medication

80% 50% with negligible symptoms 30% complete resolution of symptoms

preferred imagine technique for looking for tumors that are epileptic foci

MRI, with and without contrast, due to bone obfuscation in CTs