Seizures

Question 1

Epilepsy is a CNS disorder in which the brain activity becomes abnormal and causes seizures. A seizure results when a sudden imbalance occurs between the ______________ and ________________ forces within the network of __________________ in favor of a ______________

Answer 1

excitatory, inhibitory forces
cortical neurons
sudden onset net excitation

Question 2

Epilepsy is a medical disorder marked by recurrent, _______________ seizures. Therefore, a repeated seizure with an identified provocation e.g. alcohol withdrawal DO NOT constitute epilepsy.

Answer 2

unprovoked

Question 3

The diagnosis of epilepsy requires the occurrence of at least ________________ seizures. It is also diagnosed when ____________ seizure occurs in the setting of a predisposing cause, such as a focal cortical injury or a generalized interictal discharge that suggests a persistent genetic predisposition.

Answer 3

2 unprovoked.
1 unprovoked

Question 4

Etiologies of epilepsy
1.
2.
3.
4.
5.
6.

Answer 4

1. genetic
   -can be autism
2. structural
   -blood vessel pathology (stroke, vascular lesions, abnormal blood vessels in the brain)
   -developmental abnormalities (arnold chiari malformation)
   -postsurgical changes
   -TBI
   -Tumors
3. metabolic
   -metabolic/electrolyte shifts, hypoxic insults, endocrine disorder, meds/toxins, alcohol, drug abuse, complicated seizures with high fever
4. autoimmune
   -lupus, sjogren, sarcoidosis, hashimoto, bechet disease
5. infectious
   meningitis, human immunodeficiency virus, toxoplasmosis, neurocysticercosis
6. unknown

Question 5

An absence seizure causes a ________ period of __________. Like other seizures, they are caused by brief abnormal electrical activity in a persons brain. An absence seizure is a ____________________ which means that it begins in ______________ of the brain at the same time. They only affect a persons awareness of whats going on at that time with immediate recovery.

Answer 5

short, blanking out
generalized onset seizure, both

Question 6

These types of seizures are the most common. the person suddenly stops all activity and it may look like he/she is staring off into space or just has a blank look. The seizures last less than 10 seconds.

Answer 6

typical absence seizure

Question 7

Atypical absence seizures are called atypical because they may be longer, have slower onset and offset, involve different symptoms. The seizure still starts with staring into space, usually with a blank look. There is usually a change in ______________ and _________. You may see
1.
2.
3.
An atypical absence seizure lasts up to ____________ or more.

Answer 7

muscle tone, movement.
1. blinking over and over, looks like fluttering
2. smacking of the lips or chewing movements
3. rubbing fingers together or making other hand motions
20

Question 8

Who is at risk to develop absence seizures and why is there a delay in diagnosing? What is the first clue that a child may be having absence seizures?

Answer 8

most common in children ages 4-14 but teens/adults can also develop it. Theres a delay in dx because since it is typically present in childhood, people mistaken it for daydreaming.The first clue is that the child will have trouble in school.

Question 9

T/F in an absence seizure….
1. The person is not aware of what is happening when the person has the seizure
2. If a person is speaking, they will keep talking however it will sound like mumbling
3. A child can have multiple absence seizures in a row
4. An observer may not see the beginning or end of a seizure the person may just look confused and now know what has happened.
5. When an absence seizure ends, the person does not continue whatever they were doing before the seizure.
6. In about 7 out of 10 children, the seizures may go away by the age of 18

Answer 9

1. T
2. F, they will stop talking in the middle of a sentence- may see like a pause to an observer
3. T
4. T
5. F, they do
6. T

Question 10

How are absence seizures diagnosed and what is the treatment?

Answer 10

EEG is used to diagnose. For treatment, ethosuximide is always the answer and second line is valporate AVOID VALPROATE/VALPORIC ACID IN PREGNANT WOMEN

“When youre absent, into the ether you vanish”

Question 11

Myoclonic seizures are characterized by _______________________ or _______________. The person experiences an increase in __________________ as they have been jotled with electricity.

Answer 11

brief jerking spasms of a muscle or muscle group.
muscle tone.

Question 12

In epilepsy, myoclonic seizures usually cause abnormal movements on ______________ of the body at the same time. They occur in a variety of epilepsy syndromes that have different characteristics:
1.
2.
3.

Answer 12

both sides
1. Juvenille myoclonic epilepsy
2. Lennox Gastaut
3. Progressive myoclonic epilepsy

Question 13

1. The hallmark of juvenile myoclonic epilepsy is ……
2. _______________ appears a few months after onset of myoclonic jerks
3. _________________ is usually the first symptom to present around 5 and 16 years of age
4. __________________ is considered to be the most concerning problem of juvenile myoclonic epilepsy. What is it?

Answer 13

1. myoclonic jerks or seizures which are described as quick jerks of the arms and legs
2. generalized tonic-clonic seizures
3. absence seizures
4. myoclonic status epilepticus. It is when multiple seizures DO NOT readily stop and after sleep deprivation or missing medications.

Question 14

What is the workup and treatment for juvenile myoclonic epilepsy?

Answer 14

MRI, EEG, Genetics is the workup. The treatment is valproic acid as mainstay

Question 15

Lennox Gastaut syndrome is characterized by __________________________ that begins early in life (3/5 of age). Those affected have a particular pattern of brain activity called _____________________ measured by an EEG and ___________________.

Answer 15

recurrent seizures (epilepsy)
slow pike and wave
impaired mental abilities- have intellectual disabilities or learning problems before the seizures begin. many have delayed motor skills such as sitting/crawling

Question 16

In Lennox Gastaut the most common type of seizure is ____________ seizures which causes the muscles to stiffen (contract) uncontrollably. The seizures typically occur during ________________ they may also occur during _____________ and cause sudden falls also called ___________

Answer 16

tonic
sleep
wakefulness
drop attacks

Question 17

T/F Seizures associated with Lennox Gastaut syndrome….

1. Often respond well to therapy with anti-epileptic meds
2. Have a higher risk of death than their peers of the same age due to poorly controlled seizures and injuries from falls
3. Most cases are NOT caused by existing neurological abnormality
4. many people with lennox gastaut syndrome have a history of epilepsy beginning in infancy (infantile spasms) before developing features of lennox gastaut syndrome

Answer 17

1. F, do NOT
2. T
3. False, they ARE
4. True

Question 18

What is the triad of symptoms to diagnose lennox gastaut syndrome?

Answer 18

1. multiple seizure types
2. cognitive impairment
3. slow spike and wave pattern on EEG

Question 19

What is the treatment for someone with lennox gastaut syndrome?

Answer 19

Anti-epileptic drugs (AEDs), dietary therapy, device/surgery,

Question 20

Progressive myoclonic epilepsies (PME)(VERY RARE) is a group of more than ______________ rare type of epilepsies that are progressive. People with PME have a decline in
1.
2.
These individuals eventually need a wheelchair and have a shortened lifespan.

Answer 20

10
motor skills
balance and cognitive function

Question 21

Tonic-clonic seizure(grand mal) is comprised of two stages: a tonic phase and a clonic phase.
What are the phases and describe them.
1.
2.
3.
4.

Answer 21

1. Aura
   -partial seizure, person may experience abnormal sensations such as smell, vertigo, nausea, anxiety.
2. Tonic
   -person loses consciousness and may fall - foam/saliva from mouth. stiffness of the chest wall muscles may impair breathing and the persons face may appear bluish or gray and he or she will make gasping or gurgling sounds.
3. Clonic
   -jerking movements affect the face, arms and legs and becomes intense and rapid. after 1-3 minutes the jerking movements slow down and the body relaxes, sometimes including bowel or bladder . person may let out a deep sigh and return to normal breathing
4. Post ictal
   -person may remain unconscious for several minutes as the brain recovers (sleeping/snoring) person regains awareness and may feel confused,exhausted, physically sore, sad/embarrased. can have abnormal/combative behavior

Question 22

What is the workup for tonic-clonic seizures?

Answer 22

MRI
EEG

Question 23

Atonic seizures are a type of seizure that causes sudden loss of _________________. These seizures are also called _______________, ________________ or_________________. This causes the person to fall to the ground.

Answer 23

muscle strength
akinetic seizures, drop attacks, drop seizures

Question 24

What are the symptoms of someone experiencing an atonic seizure ?
1.
2.
3.
4.
5.
6.
Usually atonic seizures affect __________ sides of the brain. These are called generalized onset atonic seizures.

Answer 24

1. going limp and falling to the ground
2. remaining conscious
3. experiencing a brief loss of consciousness
4. drooping eyelids
5. head nods
6. jerking

both

Question 25

What is the workup and treatment for someone with atonic seizures?

Answer 25

EEG, MRI rule out cardio etiology, AEDS (dont usually help), VNS, split brain surgery

Question 26

Simple partial- Focal seizures begin in _______ area of the brain. The patient _______________ lose consciousness during the episode.
Four areas of focal seizures, describe each:
1.
2.
3.
4.

Answer 26

one, DOES NOT.

1. motor
   -jerking of a foot, ankle, face, an arm or another part of the body
2. sensory
   -hearing problems, hallucinations, olfactory, etc.
3. psychic
   -triggers emotions or memories of previous experiences causing feelings of fear, anxiety, deja vu
4. autonomic
   -changes in BP, heart rhythm, bowel/bladder function

Question 27

Complex partial - Focal impaired awareness seizure starts focally within the brain and causes impairment of ________________. It represents underlying _______________________. They typically last _____________________. Longer seizures can occur.

Answer 27

consciousness
temporal lobe epilepsy
30s - 2 min

Question 28

There are 8 varieties of auras recognized, somatosensory, visual, auditory, gustatory, olfactory, autonomic abdominal and psychic. Auras precede ________________. The most common are ____________ and _____________.

Parietal lobe seizure may begin with ___________________ usually of the positive type (electrical sensation, tingling)

Occipital lobe seizures begin with ________________________ usually of the positive type (colored lines, spots or shapes) or a loss of vision.

Answer 28

temporal lobe seizures in most cases, abdominal, psychic

contralateral SENSATION changes

contralateral VISUAL changes

Question 29

What are automatisms?

The most common automatisms, at least in temporal lobe epilepsy are ____________ and _____________.

Bizarre automatisms such as __________________ may occur with frontal lobe seizures.

Answer 29

non-purposeful, stereotyped, and repetitive behaviors that commonly accompany complex partial seizures (focal impaired seizures) the behavior is inappropriate for the situation.

oral (lip smacking, chewing, swallowing) and manual (picking, fumbling)

bizarre- alt limb movements, right to left head rolling

Question 30

Status epilepticus is defined as a seizure that lasts longer than _________ or having more than __________ within a 5 minute period without returning to a normal level of consciousness between episodes. This is a medical emergency that may lead to permanent brain damage or death.

Answer 30

5 minutes, 1

Question 31

Status epilepticus can occur as:
1.
2.

Answer 31

1. Convulsive status epilepticus- convulsions like jerking motions, grunting sounds, drooling, rapid eye movements.
2. Nonconvulsive status epilepticus- may appear confused or like theyre day dreaming may be unable to speak and may behave in an irrational way

Question 32

1. In children, the main cause of status epilepticus is __________________

In adults, the common causes include:
1.
2.
3.

Answer 32

1. an infection with a high fever
2. stroke, low blood sugar, drinking too much alcohol/ alcohol withdrawl

Question 33

What is the workup with status epilepticus?

Answer 33

continuous EEG, MRI

Question 34

A corpus collosotomy is a surgical procedure used to treat ________________ also called drop attacks. How is this done?

Answer 34

atonic seizures.
It is done by dividing all or part of the corpus collosum, the corpus collosum is the bundle of nerve fibers that connects the two brain hemispheres.

Question 35

T/F
1. EEGs can be normal in someone with a seizure disorder
2. The recommendation for new onset seizure is EEG but this rarely happens inpatient

Answer 35

1. true
2. true

Question 36

The most common psychiatric mechanism of psychogenic nonepileptic seizures (PNE) is thought to be a conversion disorder. What is this?
What are the risk factors of PNE’s?
A disproportionate number of patients with PNEs have training in ________________ carers.

Answer 36

a conversion disorder implies that the person isnt aware and is not consciously feigning events.

Risk factors:
history of sexual abuse- majority are adult women

healthcare

Question 37

What is the workup and treatment for psychogenic nonepileptic seizures (PNE)?

Answer 37

epilepsy monitoring unit, intensive behavioral therapy, AED- the longer you keep pt on these, the worser it gets, reassurance

Question 38

What are the complications of having seizures?
1.
2.
3.
4.
5.

Answer 38

1. falling
2. drowning
3. car accidents
4. pregnancy complications
5. emotional health issues

Question 39

Todd’s paralysis is a neurological condition experienced by individuals with epilepsy in which a __________________ is followed by a brief period of temporary __________________ which may be partial or complete but usually occurs just one side of the body.

Answer 39

seizure, paralysis

Question 40

A vagal nerve stimulator is used for medically refractory epilepsy which may prevent or lessen seizures. How does it do this?

Answer 40

by sending regular, mild pulses of electrical energy to the brain via the vagus nerve.

Question 41

What is the goal of epilepsy surgery? Surgical results can be curative or restrict the spread of the seizure.

Answer 41

1. remove the seizure producing area of the brain
2. limit the spread of seizure activity

Question 42

Who is eligible to receive epilepsy surgery?

Answer 42

1. seizures that are uncontrolled with medications or severe side effects to meds
2. focal (partial seizures that always start in one area of the brain)
3. seizures that significantly affect your quality of life
4. seizures caused by a lesion
5. seizure discharge that spreads to the whole brain

Question 43

What is the workup needed for epilepsy surgery?

Answer 43

neuropsych testing: WADA test- used to determine which side of brain is dominant for language/memory.

FMRI- determines the location of brain abnormalities. sometimes this is used instead of the WADA test.

Question 44

What is the first line treatment for status epilepticus?

Answer 44

benzo’s (diazepam, lorazepam, midazolam)
phenytoin is second line
Phenobarbital is 3rd

“he had to update his tetanus status when ben caught his toe in barb wire”