Seizures

Question 1

What is the pathophysiology of seizures?

Answer 1

Long activation of NMDA receptors by glutamate, or mutation in GABA causing it to be dysfunctional so it cannot inhibit signals.

Question 2

What is this describing?

Seizure linked to one hemisphere and often seen with structural disease.

Answer 2

Focal seizure

Question 3

What is this a presentation of?

Seizure, complete awareness, focal motor/sensory/autonomic/psychic symptoms, no post-ictal state, remembers events.

Answer 3

Focal seizure without impairment on consciousness (simple seizure)

Question 4

What is this a presentation of?
Awareness impaired, either at seizure onset or following a simple partial aura, commonly temporal (post-ictal confusion), may not remember events.

Answer 4

Focal seizure with impairment of consciousness (complex seizure)

Question 5

What can happen in 2/3 of patients with a focal seizure without impairment of consciousness?

Answer 5

Spread to become a generalised seizure (typically convulsive).

Question 6

What is this describing?

Widespread electrical discharge with no localising features, both hemispheres, bilateral at onset, spreads.

Answer 6

Generalised seizure

Question 7

What is this a presentation of?

Brief (<10s) pauses (e.g. suddenly stops talking mid-sentence, then carries on where left off), presents in childnhood.

Answer 7

Absence seizures

Question 8

What is this a presentation of?

Loss of consciousness, limbs stiffen then jerk rapidly, post-ictal confusion and drowsiness.

Answer 8

Tonic-clonic seizure (most common generalised seizure)

Question 9

What is this a presentation of?

Sudden jerk of a limb, face, or trunk lasting for a few seconds and repeats, awareness throughout.

Answer 9

Myoclonic seizure (only generalised seizure with awareness)

Question 10

What is this a presentation of?

Limbs stiffen, typically falls backwards.

Answer 10

Tonic seizure

Question 11

What is this a presentation of?

Sudden loss of muscle tone causing a fall forwards, no loss of consciousness.

Answer 11

Atonic seizure

Question 12

What are the features of a focal temporal seizure?

Answer 12

1. Automatisms - complex motor phenomena with impaired awareness (lip smacking, chewing, swallowing, fumbling, fiddling, grabbing)
2. Can speak but not making sense
3. Dysphasia, deja vu, jamais vu
4. Emotional disturbance (sudden terror, panic, anger, elation, derealisation)
5. Hallucination of smell, taste, or sound.
6. Delusional behaviour

Question 13

What are the features of a focal frontal seizure?

Answer 13

1. Motor features - posturing/peddling movement of legs
2. Jacksonian march often starting in face or thumb
3. Motor arrest

Question 14

What are the features of a focal parietal seizure?

Answer 14

Sensory disturbances - tingling, numbness

Question 15

What are the features of a focal occipital seizure?

Answer 15

Visual phenomena - spots, lines, flashes