Seizure and Epilepsy

Question 1

what is an epilepsy?

Answer 1

chronic cerebral disorder characterized by recurrent seizures

Question 2

what is a seizure?

Answer 2

• a clinical manifestation which stays for sec - mins
• can be: motor, somatosensory, autonomic, psychatric, cognitive
• is a lesion affecting the cortical neurons leading to hyperexcitability, focal or general

Question 3

what is the main difference between generalized and focal seizures?

Answer 3

in generalized seizures: loss of consciousess

in focal seizures: patient stays conscious

Question 4

which are types of generalized seizures?

Answer 4

• tonic-clonic seizure (grand mal)
• absent seizure (petit mal)
• myoclonic seizure
• atonic seizure

Question 5

which are the types of focal seizures?

Answer 5

• simple focal seizure
• complex focal seizure
• simple/complex seizure with secondary tonic-clonic generalized seizure

Question 6

how are generalized tonic-clonic seizures?

Answer 6

sudden loss of consciousness
apnea/cyanosis, wide open eyes
autonomic signs (salvation, sweating, tachyc., HTN)
incontinence
bites on tounge

tonic phase: 40s
clonic phase: 20s

postictal coma, patients has no recall of event

Question 7

how are absence seizures?

Answer 7

sudden, abrupt loss of consciouness
motor arrest, but patient doesnt fall
some activities might still continue during attack
fine myoclonic, rhythmical contrations (3Hz)

Question 8

how are simple focal seizures?

Answer 8

conscious patient

paresthesia, vertigo, visual disturbances, olfactory disturbance, aphasia

Question 9

how are complex focal seizures?

Answer 9

first event is aura
temporal epilepsy, increasing epigastric sensation and fear
behavioral changes and responsiveness during attack, patient is amnesic to event
motor component (automatism) occurs later

Question 10

classification of epilepsy

Answer 10

localized epilepsy
generalized epilepsy
epilepsy with unknown location

Question 11

characteristics of localized epilepsy

Answer 11

presence of lesional zone aquired at some point in life

early lesions can have an effect on development and cognitive delay

Question 12

characteristics of generalized epilepsy

Answer 12

idiopathic or genetic disorders: onset before 18 yoa
no lesion seen on MRI but typical EEG pattern
very sensitive to sleep depriviation

childhood absence epilepsy, 6-8 yoa, good prognosis
jevenile myoclonic epilepsy, in adolescence, bad prognosis

Question 13

which are the most common etiologies for seizure and epilepsy?

Answer 13

trauma, toxins, tumors, metabolic, infectious, vascular

Question 14

treatment of seizures and epilepsy

Answer 14

• acute:

vital functions, IV benzodiazepene

in tonic-clonic seizure (emergency):
vital support, O2, IV benzodiazepene, IV phenitoin, IV phenobarbital

• chronic:

in focal epilepsy:
first line: carbamezapine
second line: lamotrigine, levetiracetam, oxcarbamezapine

in idiopathic generalized epilepsy:
first line: valporate
second line: lamotrigine, levetiracetam, etosuximid

Question 15

etiology of seizures and epilepsy, according to age groups

Answer 15

trauma
vascular
metabolic
infectious

idiopathic ( 0-3, 3-18)
toxic (0-3, 18-40, >40)
tumors (3-18, 18-40, >40)
degenerative (>40)