Seizures

Question 1

What is a seizure?

Answer 1

Transient episode with signs/symptoms of excessive synchronous neuronal activity in the brain.

Question 2

What are the characteristic events of a seizure?

Answer 2

May have impaired consciousness
Tonic stiffening / clonic jerking
Tachycardia / mydriasis
urinary incontinence
tongue biting 
mild cyanosis of mouth / distal extremities 
post-ictal fatigue

Question 3

What is Todd’s paresis?

Answer 3

Post-ictal contralateral hemiparesis.

Question 4

What are the types of focal onset seizures?

Answer 4

Primary partial
Complex partial
Secondary generalized

Question 5

Describe a simple partial seizure.

Answer 5

No alteration in consciousness.

Manifestation is related to the brain region involved.
There may be an aura.
Can progress to complex partial or General tonic clonic seizure.

Question 6

Describe a complex partial seizure.

Answer 6

Alteration in consciousness.

Early manifestation is related to brain region involved.
Staring off into space
Unilateral limb involvement, automatism, gaze deviation
Often no recall of the event
May progress into general tonic-clonic seizure

Question 7

Describe a secondary generalized seizure.

Answer 7

This is a seizure that began as a focal seizure (simple or complex partial) and has now spread to involve the entire brain. (Tonic - clonic / whole body is involved)

Question 8

If a seizure was localized to the medial temporal lobe, what kind of symptoms would you see?

Answer 8

Staring
Automatism
Posturing
Fear

Question 9

If a seizure was localized to the lateral temporal lobe, what kind of symptoms would you see?

Answer 9

Staring, vertigo, hearing problems

Question 10

If a seizure were localized to the frontal lobe, what kind of symptomology would you see?

Answer 10

Brief, bizzare, nocturnal

Supplementary motor area = fencing posture

Orbitofrontal cortex = elaborate smells, sounds

Question 11

If a seizure were localized to the occipital lobe, what kinds of symptoms would you see?

Answer 11

Formed visual phenomena

Question 12

Primary generalized seizure.

Answer 12

Entire brain is involved.

Genetic pre-disposition. Family members may not have seizures but can have abnormal EEG.

Question 13

What is an idiopathic seizure?

Answer 13

Don’t know what caused it but its probably genetic.

Question 14

What is a symptomatic seizure?

Answer 14

Know what caused the seizure. Head injury, brain tumor, etc.

Question 15

What is a cryptogenic seizure?

Answer 15

We know something is causing it and something is really wrong with you but we can’t figure out what it is.

Question 16

What are some examples of idiopathic seizures?

Answer 16

Benign Rolandic Seizures (centrotemporal spikes)
Familial Temporal epilepsy
Primary Generalized Epilepsy

Question 17

What are some causes of symptomatic seizures?

Answer 17

Head injury 
meningitis
congenital 
acutely symptomatic - low blood sugar / sodium
tumor

Question 18

Average speed of 3 Hz of spike-and-wave activity gives you what kind of seizure?

Answer 18

Absence seizure

Question 19

Slow spike-and-wave is < 2.5 Hz

Answer 19

Lennox-Gastaut seizures

Drop spells || Stiffening spells at night

Question 20

Rapid spike-and-wave >3.5 Hz (poly spike and wave)

Answer 20

Juvenile myoclonic seizures

Question 21

In an adult with seizures that seem to originate within the temporal lobe, what can we look for on an MRI most times?

Answer 21

Mesial Temporal Sclerosis: Hippocampal area damage due to repetitive seizures in that area

Question 22

What is the mechanism of focal seizure anti-epileptic medications?

Answer 22

Blocking Na+ channels.

Question 23

What is the best medication to give for an absence seizure?

Answer 23

Ethosuximide

Question 24

What is the best medication to give for juvenile myoclonic seizure?

Answer 24

Depakote (Valproic Acid)

Question 25

What is the best medication to give for benign occipital seizures?

Answer 25

Carbamazepine / Oxcarbazepine

Question 26

What is the best medication to give for infantile spasms?

Answer 26

ACTH (steroids as 1st line) / vigabatrin

Question 27

What is the definition of status epilepticus?

Answer 27

One continuous seizure or recurrent seizures without regaining consciousness between seizures for greater than 30 minutes.

Can be either convulsive or non-convulsive.

Question 28

How do you treat status epilepticus?

Answer 28

Diazepam (valium)
ABCs
Establish IV access (start NS)
Labs: CBC, chem-7, LFTs

Question 29

About what percent of patients are responsive to first anti-epileptic medication?

Answer 29

40%

Question 30

What are some additional treatment options for patients that are refractory to AED?

Answer 30

Ketogenic diet

Vagal nerve stimulator (gives signal throughout day and helps cut seizures

Corpus callosotomy –> cut connection b/w left and right brain to stop drop events (lennox gastaut seizures)

Thalamic stimulator

Question 31

What is the wada test?

Answer 31

Inject meds into half a persons brain. Test memory and language and compare each half of the brain to the other.

You can see how much of their memory is intact on the affected side. If its too damaged you are more willing to resect that part of the brain.

Question 32

What are some co-morbidities in epilepsy?

Answer 32

Cognitive impairment
Mood disorders (MDD, schizo, bipolar)
Migranes
etc.

Question 33

What is an eclampsia seizure?

Answer 33

Tonic-clonic seizures that follow pre-eclampsia in pregnancy.