Seizure

Question 1

Seizure

Answer 1

Sudden change in behavior caused by electrical hyper synchronization of neuronal networks in the cerebral cortex

Question 2

Unprovoked seizure

Answer 2

. Occurring in absence of precipitating factors and may be caused by static or progressive injury

Question 3

Provoked seizure

Answer 3

. Seizures provoked by acute conditions

Question 4

Acute symptomatic seizure

Answer 4

. In assoc. w/ transient CNS or systemic insult presumed to be an acute manifestation of the insult

Question 5

Focal seizure

Answer 5

Originate w/in networks limited to one hemisphere
. Described according to whether or not consciousness and/or awareness are impaired
. Ictal onset consistent from one seizure to another
. Rarely does patient have more than 1 type of seizure

Question 6

Generalized seizure

Answer 6

Initial activity is consistent w/ rapidly engaging networks distributing in bilateral cerebral hemispheres
. May begin w. Body movements, impaired consciousness, or both
. Onset of tonic-clonic seizures begins after the age of 30 suspect partial seizure that has become generalized or a provoked seizure

Question 7

Aura

Answer 7

. Sensation perceived by a patient that precedes a condition affecting the brain

Question 8

Ictal

Answer 8

Period during seizure

Question 9

Postictal

Answer 9

State of consciousness following seizures

Question 10

Automatism

Answer 10

. Unconscious movement that may resemble simple repetitive tics or may be a complex. Sequence of natural-looking movement

Question 11

Epilepsy

Answer 11

. Chronic neurologic disorder
. 2+ unprovoked seizures separated by over 24 hrs
. One unprovoked seizure w/ underlying predisposition to seizures
. Diagnosis of an epilepsy syndrome

Question 12

Provoked seizure from metabolic disturbance

Answer 12

. Cause: hyponatremia, hypo/hyperglycemia, hypo/hypercalcemia, uremia
. Confusion, lethargy, myoclonic jerks

Question 13

Provoked seizure by drug intoxication

Answer 13

. CausE: cocaine, phencyclidine, methamphetmaines, ETOH

. Altered awareness, hyperactivity, incoordination

Question 14

Provoked seizure from drug withdrawal

Answer 14

. Cause: alcohol withdrawal, Benzo withdrawal, barbiturate withdrawal, baclofen withdrawal
. Anxiety, agitation, sweating, hallucinations

Question 15

Provoked seizure from medications

Answer 15

. Tricyclics antidepressants, clozapine,, cyclosporine

. Anything with low seizure threshold

Question 16

Provoked seizure from infection

Answer 16

. Cause: meningitis, encephalitis

. Fever, headache, stiff neck

Question 17

Provoked seizure from vasculopathy

Answer 17

. Cause: eclampsia, hypertensive encephalopathy

. Headache, blurred vision, edema

Question 18

Febrile seizures

Answer 18

/ generalized, last less than 15 minutes
. Not recurring during 24 hr period
. Occur in children 6 mo-5 yrs
. Fever over 38 C
. Usually 24 hrs of febrile illness
. They are otherwise benign (recur in 1/3 children during early childhood)
. Risk of future epilepsy that is only slightly higher than general population

Question 19

Causes of seizure disorder

Answer 19

. Genetic
. Structural: congenital or acquired through stoke or trauma
. Unknown

Question 20

Jacksonian seizure

Answer 20

. Focal
. Tonic than clinic movements that start unilaterally in hand, foot, or face and spread to other parts of same side
. Post ictal: normal consciousness

Question 21

Other motor focal seizures

Answer 21

. Turning head and eyes to one side

. Post ictal normal consciousness

Question 22

Autonomic focal seizures

Answer 22

. Rare
. Funny feeling in epigastric, nausea, pallor, flushing, lightheaded
. Post ictal: normal consciousness

Question 23

Subjective sensory of psychic phenomenon focal seizure

Answer 23

. Very rare
. Numbness, tingling, simple visual, olfactory, auditory hallucinations
. Anxiety or fear, deja vu, rage
. Post ictal: normal consciousness

Question 24

Focal seizures w/ impairment of consciousness

Answer 24

. May start w/ autonomic or psychic symptoms
. Consciousness is impaired and patient appears confused
. Automatisms (chewing, smacking lips, walking about, unbuttoning cloths)
. Patient may recall psychic or autonomic symptoms
. Amnestic for rest of seizure
. Temporary confusion and headache may occur

Question 25

Focal seizures that generalize

Answer 25

/ focal seizure evolving to bilateral tonic-clonic seizure . May not recall local onset . Recollection of aura and unilateral neurologic deficits during post-ictal period

Question 26

Tonic clinic seizures

Answer 26

. May start w/ cry . Body stiffs (tonic rigidity) and breathing stops . Clonic phase: rhythmic muscular contractions . Tongue biting and urinary incontinence . Post-ictal: confusion, drowsiness, fatigue, headache, amenstic about seizure and aura . May have temporary UMN signs (hyperactive reflexes)

Question 27

Absence seizures

Answer 27

. Sudden brief lapse in consciousness, . Blinking, or staring or movement of lips . Post-ictal: confusion, no aura recalled

Question 28

Myoclonic seizures

Answer 28

. Sudden brief lapse of consciousness . Sudden brief rapid jerks involving trunk or limbs . Post ictal: variable

Question 29

Myoclonic atonic seizure

Answer 29

. Drop attack . Sudden loss of consciousness w/ falling but no movements . Post ictal: brief period of confusion

Question 30

Psychogenic nonepileptic seizure

Answer 30

. Psuedoseizure . Similar to epileptic seizures but do not have neurologic origin (somatic manifestation) . Frequently are misdiagnosed and treated for epilepsy . 5-10% of outpatient pilepsy patients and 20-40% innpatient have these

Question 31

Seizure diagnostic evaluation

Answer 31

``` . Neuroimaging: CT first, MRI if needed . Labs: serum AED, CMP .lumbar puncture if suspect infection . ECG . EEG ```

Question 32

Syncope vs seizure

Answer 32

. Syncope is sudden, may have prior palpitation or weakness (cardiogenic) . Have prodrome (vasovagal lightheadedness, sweating, pallor) . Occur soon after standing (orthostatic) . Myoclonic jerking may occur but it is super brief . Prompt recovery . Non or minimal post-ictal confusion .

Question 33

Involuntary movement disorders

Answer 33

. Hyper kinetic: tumor, tic, chorea, athetosis, dystopia . Hypokinetic: Parkinson’s . Primary from basal ganglion . Secondary from antipsychotics, dopamine receptor antagonists or postsynaptic blockade of brain dopamine D2 receptor

Question 34

Basal ganglia

Answer 34

. Most often linked to initiation and execution of movements . Act to facilitate desired movements and inhibit unwanted and/or competing movements . Dopamine receptors

Question 35

Tremors

Answer 35

. Rhythmic oscillatory movements . Resting: most prominent at rest, dec./disappear w/ voluntary movement, Parkinsonism . Postural: actively maintaining posture, hyperthyroidism, anxiety, essential tumor . Intention: appears w/ movement

Question 36

Tics

Answer 36

. Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals . Repetitive winking, grimacing, shoulder shrugging . May be temporarily suppressed . Urge to perform tics . Causes: Tourette syndrome, late effects of drugs (phenothiazines)

Question 37

Chorea

Answer 37

. Choreiform movements are brief, rapid, jerky, irregular, and unpredictable . Seldom repeat themselves . Occur at rest or interrupt normal coordinated movements . Faced head, lower arms, and hands are involved . See in huintington’s disease

Question 38

Athetosis

Answer 38

. Twisting and writhing than choreiform . Commonly involves face and distal extremities . Often assoc. w/ spasticity . Cuases: cerebral palsy

Question 39

Dystonia

Answer 39

. Similar to athetoid but involve larger parts of the body including trunk, grotesque, twisted postures . Primary: primary torsion dystonia, spasmodic torticolllis . Secondary: drugs (antipsychotics)

Question 40

Facial dyskinesia

Answer 40

. Arrhythmic, repetitive, biz are movement that chiefly involve the face, mouth, jaw, and tongue . Grimacing, pursing of lips, protrusions of tongue, opening and closing of mouth, and deviation of jaw . Limbs and trunk involves less often . Late complication of psychotropic drugs . Occur in long standing psychoses, in some elderly individuals, or some edentulous person (tardive dyskinesia)