S1_L4: Seizure & Epilepsy Flashcards
In the resolution of epilepsy, the patient has remained seizure-free for the last (1)— and off (2)— for at least the last (3)—
- 10 years
- Anti-seizure medications
- 5 years
Seizure lasting for 1-2 seconds involving the head, trunk, and limbs and the pt falls unexpectedly
Atonic seizure
Match the type of seizure to its characteristics / features
- Occurs in less than 30 seconds
- Shocklike contractions
- Generalized stiffening, clonic movements
- Falling unexpectedly
- Brief jerks of the body without impairment of consciousness
Choices:
A. Atonic seizure
B. Myoclonic seizure
C. Tonic-clonic seizure
D. Absence seizure
- D
- B
- C
- A
- B
Generalized seizures originate at some point within and rapidly engage (1)— distributed networks
- Bilaterally
An important structure that can be part of the network of seizures
Thalamus
Seizure is (1)—-, while epilepsy is (2)—-.
- Event
- Disease
Differentiate provoked and unprovoked seizures.
Provoked: Presence of transient (temporary, reversible) factors that lowers seizure threshold of a normal brain
Unprovoked: Absence of temporary or reversible factors that can lower seizure threshold
Enumerate the 3 conditions of seizure generation
- Population of pathologically excitable neurons
- Increase in excitatory activity through recurrent connections in order to spread the discharge
- Reduction in the activity of the normally inhibitory projections
“Creation of seizure”; Sequence of events that turns a normal neuronal network into a hyperexcitable network in the brain
Epileptogenesis
In normal CNS function, there must be a (1)—- between (2)—- and (3)—- of neurotransmitters.
- balance
- excitation
- inhibition
Glutamate is the major (1)—- neurotransmitter in the CNS, while GABA is the major (2)—- neurotransmitter in the CNS.
- excitatory
- inhibitory
Seizure vs Epilepsy
- Temporary disruptions of brain function, paroxysmal
- Requires extended additional care
- Abnormal event but it does not necessarily depict a disease
- Require chronic treatment
- Repeated and has complications
Choices
A. Epilepsy
B. Seizure
- B
- A
- B
- A
- A
Analogy
fast synaptic transmission : (1)—- ::
slow synaptic transmission : (2)—-
- Ionotropic
- Metabotropic
GABA Receptors
- Ionotropic
- Metabotropic
- Inhibition mediated by K+ current
- Inhibition mediated by Cl- current
- Presynaptic reduction in calcium influx
Choices:
A. GABA A Receptor
B. GABA B Receptor
- A
- B
- B
- A
- B
What are the 2 main glutamate receptors?
AMPA & NMDA receptors
Ancillary procedure / diagnostic tool of choice for seizures?
Electroencephalogram (EEG)
TRUE OR FALSE: Seizures are mainly affecting the cerebral cortex, thus they are cortical.
True.
Originate within networks limited to one hemisphere
Focal Seizures
TRUE OR FALSE: Patients can experience aura before a seizure.
True.
Enumerate the 4 epilepsy types.
Focal, generalized, combined, unknown
Match the EEG finding to its epilepsy syndrome
- Generalized 2 to 2.5 Hz spike and wave discharges
- EEG generalized spike wave discharges that are faster than 3 Hz (4-6)
- Bilateral generalized 3 Hz spike & wave discharges
- Focal spike and wave in the central, parietal and temporal areas
- Bilateral generalized 4-6 Hz spike-wave or polyspike-wave activity
Choices:
A. Juvenile Absence Epilepsy
B. Juvenile Myoclonic Epilepsy
C. West Syndrome
D. Lennox-Gastaut Syndrome
E. Benign Rolandic Seizure / Epilepsy
F. Absence / Petit Mal Epilepsy
- D
- A
- F
- E
- B
This epileptic syndrome is more common in girls
Absence / Petit Mal Epilepsy
Enumerate the 2 epileptic syndromes where boys are more commonly affected.
Lennox-Gastaut Syndrome & Benign Childhood Epilepsy with Centrotemporal Spikes or Benign Rolandic Seizure/Epilepsy
West Syndrome Triad
- Infantile spasms
- Mental retardation (Intellectual disability)
- Hypsarrhythmia on EEG
Lennox-Gastaut Syndrome Triad
- Mixed seizure types
- Developmental disabilities/Mental Retardation (Intellectual disabilities)
- EEG <2.5 Hz spike and wave discharges
A population of pathologically excitable neurons
Hypersynchronizaton
An increase in excitatory activity through recurrent connections in order to spread the discharge and a reduction in the activity of the normally inhibitory projections
Hyperexcitability
increased excitation, decreased inhibition
Hyperexcitability
most common neurological disease globally
Headache
TRUE OR FALSE: Seizures and epilepsy have a bimodal occurrence or distribution, meaning it occurs most frequently in both childhood and old age.
True.
Epilepsy in childhood years was formerly called?
Idiopathic or Primary
Epilepsy in elderly, adult years was formerly called?
Symptomatic or Secondary
TRUE OR FALSE: Epilepsy is a chronic and non-communicable disease.
True.
Intracellular depolarization that far outlast the depolarization of normal action potentials
Paroxysmal Depolarizing Shift (PDS)
Duration of Paroxysmal Depolarizing Shift
Around 50-200 ms
Paroxysmal depolarizing shift is highly dependent on?
AMPA and NMDA receptors
Activation of (1)— leads to hyperpolarization in the paroxysmal depolarizing shift
- GABA receptors
An abnormal neuronal firing leading to clinical alteration of neurological functions
Seizure
TRUE OR FALSE: Electrical activity underlying seizure is the net product of biochemical processes at the cellular level occurring in the context of large neuronal networks and likely involving key cortical and subcortical structures.
True.
Enumerate the 3 criteria for diagnosing epilepsy
With any of the following:
* At least 2 unprovoked seizures (or reflex seizures) occurring 24 hours apart
* 1 unprovoked seizure (or reflex seizure) with high probability of recurrence occurring over the next 10 years
* Epilepsy syndrome
Cluster of signs and symptoms that occur for a particular type of seizure or epilepsy disorder
Epilepsy syndrome
Group of epilepsy syndromes in which a certain trigger or stimulus brings on seizures
Reflex epilepsies
Enumerate the 5 reflex epilepsies
Photosensitivity, Eye closure sensitivity, Orofacial reflex myoclonia, Praxis induction, and Musicogenic epilepsy
In seizures, the (1)— pathway is increased, while the (2)— pathway is decreased
- Glutamate
- GABA
TRUE OR FALSE: Generalized seizures can affect only one part of the cortex and involve the corticothalamic circuitry.
True.
Analogy
Grand Mal : (1)—- :: Petit Mal : (2)—-
- Tonic-Clonic Seizures
- Absence Seizures
Exceptionally rare acquired childhood-onset epileptic aphasia in the setting of clinical seizures or an epileptiform EEG that is activated in sleep
Landau-Kleffner Syndrome
Source: Merritt’s
Match the clinical feature to its seizure type
- Postictal event
- Loss of consciousness
- Todd’s Paralysis
- No postictal state
- Epileptic cry/scream
Choices:
A. Generalized (Motor)
B. Focal
C. Focal w/ Impairement / Dyscognitive Symptoms
D. Tonic-Clonic Seizures
E. Both A and B
F. None of the above
- E
- E
- C
- F
- D
When the GABA pathway is dysfunctional, a decrease in the inhibitory reaction occurs. This leads to a decrease in negative cells that combats the positive cells, thus resulting in?
Increase in action potentials
Source: Ninja Nerd
TRUE OR FALSE: Seizures are the cardinal manifestation of epilepsy, but not all seizures imply epilepsy.
True
Source: Merritt’s
A (1)—- seizure is a reliable marker of epilepsy
Second unprovoked
Source: Merritt’s
Weakness on one side of the body; transient paralysis of the affected limbs
Todd’s Paralysis / Paresis
Sources: Ninja Nerd, Adams
Enumerate the 3 main classifications of seizures
Focal onset, Generalized onset, Unknown onset
Muscle jerks induced by visual motor
Praxis Induction
TRUE OR FALSE: Jeavons Syndrome triad: eyelid myoclonia (eyelid fluttering) with and without absence seizures, eye closure–induced seizures and EEG paroxysms, and photosensitivity.
True
most common seizure type among newly diagnosed cases
Focal impaired awareness seizures
Source: Merritt’s
AMPA/kainate channels conduct (1)—-,
NMDA: channels conduct (2)—-.
- Na+
- Na+ and Ca++
Most common manifestation of a childhood seizure susceptibility syndrome that is age-related and genetically determined
Benign Childhood Epilepsy with Centrotemporal Spikes (BCECTS) or Benign Rolandic Seizure/Epilepsy (RS)
Juvenile Myoclonic Epilepsy: Genetic predisposition, candidate gene on (1)—-
Chromosome 6
Match the epileptic syndrome to its clinical feature
- Chromosome 6
- Chromosome 8 and 5
- Jackknife seizures
- Onset 3-13 years old
- Onset in adolescence, 10-13 years old
A. Juvenile Absence Epilepsy
B. Juvenile Myoclonic Epilepsy
C. West Syndrome
D. Lennox-Gastaut Syndrome
E. Benign Rolandic Seizure / Epilepsy
F. Absence / Petit Mal Epilepsy
- B
- F
- C
- E
- A
highly disorganized with high voltage irregular slow waves intermixed with multifocal spikes and polyspikes
Hypsarrhythmia
Arms abducted, neck and torso flexed, legs extended
Jackknife Seizure
Match the epileptic syndrome to its clinical feature
- Momentary flexion or extension of the body
- During sleep, short bursts of fast rhythmic activity around 10 Hz
- May begin as focal seizures 2-3 hrs after falling asleep
- Triggered by hyperventilation for 3 mins
- 4-6 Hz spike wave provoked by photic stimulation
A. Juvenile Absence Epilepsy
B. Juvenile Myoclonic Epilepsy
C. West Syndrome
D. Lennox-Gastaut Syndrome
E. Benign Rolandic Seizure / Epilepsy
F. Absence / Petit Mal Epilepsy
- C
- D
- E
- F
- B
TRUE OR FALSE: In Lennox-Gastaut syndrome, initial seizures can be atypical absences, myoclonic jerks, atonic, head nods, generalized tonic or tonic-clonic.
True
May be simple, with blank stares, or complex, with associated automatisms, clonic jerks or change in tone
Absence / Petit Mal Epilepsy
Starting seizures are similar but longer in duration and fewer in frequency compared to other epilepsy syndromes
Juvenile Absence Epilepsy
Seizures provoked by: sleep deprivation or arousals from sleep, photic stimulation, alcohol intake
Juvenile Myoclonic Epilepsy
Enumerate the 3 Juvenile Myoclonic Epilepsy seizure types
Myoclonic in AM
Grand Mal
Absence
Sudden onset of staring, interrupting speech or activity that occurs multiple times per day, with short duration
Absence / Petit Mal Epilepsy
Treatment
Valproic acid / Ethosuximide / Zaontin : (1)—-
:: Steroids (ACTH) : (2)—-
- Absence / Petit Mal
- West Syndrome / Infantile Spasms
Prognosis is poor in terms of seizures and mental development. Complete seizure-free recovery is <10%.
Lennox-Gastaut Syndrome
A heterogeneous group of childhood epileptic encephalopathies that are characterized by mental retardation, uncontrolled seizures, and a distinctive EEG pattern
Lennox-Gastaut Syndrome
Source: Merritt’s
Onset between 6-7 years and provoked by hyperventilation and photic stimulation
Absence / Petit Mal
Pharmacoresponsive : (1)—- :: Non-pharmacoresponsive : (2)—-
- Benign Epilepsy Syndrome
- Intractable Catastrophic Epilepsy Syndrome
The movements spread from the part first affected to other muscles on the same side of the body. Typically, the seizure spreads from the hand, up the arm, to the face, and down the leg; or if the first movement is in the foot, the seizure moves up the leg, down the arm, and to the face.
Jacksonian (March) Epilepsy
Source: Adams
TRUE OR FALSE: Epilepsia Partialis Continua is a refractory seizure typically consisting of repeated clonic or myoclonic jerks that may remain focal or regional or may march from one muscle group to another.
True
Source: Merritt’s
Staring & daydreaming, possible automatism, no post-ictal, no loss of musculature
Non-motor / Absence seizure
Brief and typically occur in clusters with flexion at the trunk and flexion or extension of the limbs
Epileptic Spasms
May involve muscles of respiration (epileptic cry or scream), extraocular muscles (upward gaze), tongue biting, incontinence, tachycardia and hypertension.
Motor Generalized Seizures
