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OS9.2 - Neuro > Seizures > Flashcards

Seizures Flashcards

1
Q

What’s the difference between a seizure and epilepsy?

A

Seizure is an episode of abnormally synchronized and high frequency firing of neurons

Epilepsy is a chronic brain disorder of recurrent, unprovoked seizures

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2
Q

Partial vs. generalized seizures

A

Partial are focal in onset, may impair consciousness but won’t lose it like in generalized.

Generalized are primarily general, thought to emanate from brainstem and spread to both hemispheres at the same time, will involve a LOC.

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3
Q

Simple vs. Complex partial seizures

A 
Simple = no LOC; one focal location
Complex = impaired consciousness; emanates from temporal or frontal lobes

If either type progresses they will cause secondarily generalized seizure with LOC and bilateral cerebral involvement

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4
Q

Signs/Sx of simple partial seizure (localized)

A
  • motor: Jacksonian march distal to proximal
  • somatosensory: numbness/tingling
  • autonomic: rising epigastric sensation, nausea
  • psychic (temporal cortex): sensations of fear, deja vu, or jamais vu
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5
Q

Signs/Sx of complex partial seizure

A
  • impairment of consciousness lasts ~1min (*this is longer than absence)
  • oral, ipsilat hand automatisms
  • contralat dystonic posturing (from sz spreading temporal lobe to ipsilat BG)
  • amnesia for ictal event
  • focal abnormality on EEG
  • comes with aura (which is a simple partial seizure)
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6
Q

Types of primary generalized seizure

A
  • Absence: LOC 10-20sec (*shorter than complex partial), halt current task, staring spell; subtle myoclonic movement; no post-ictal confusion
  • Tonic-clonic: LOC, muscle rigidity and rhythmic jerking, +/- incontinence
  • Myoclonic: shock-like muscle contractions, brief, bilateral, head/UE, no LOC
  • Atonic: loss of muscle tone, brief
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7
Q

Epileptiform EEG abnormalities

A
  • sharp waves, spikes, sharp-and-slow wave discharges

- seen in initial EEGs of 30-55% of epileptic patients

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8
Q

Seizure provoked by a metabolic cause are typically

A
  • not focal in onset

- generalized

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9
Q

EEG abnormalities that are typical of primary generalized seizures

A
  • bilateral burst of spike and slow wave discharges

- discharge occurs simultaneously and symmetrically in both hemispheres

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10
Q

Recent-onset epilepsy in adults should be worked up by

A
  • MRI, including gadolinium-DPTA enhanced sequences to find primary/secondary tumors, infection, or inflammation
  • T1 MRI with 3mm sections to look for hippocampal sclerosis
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11
Q

Pathophysiology of seizures

A

failure of GABAergic circuits to adequately suppress glutamatergic excitability

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12
Q

MOA of anti-epileptic drugs (AEDs)

A

Phenobarbital: enhance GABA activity receptor; reduce Na/K conductance
Phenytoin: block Na channels and inhibit Ca/Cl conductance

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13
Q

Intractable epilepsy

A
  • recurrent disabling seizures despite optimized therapy
  • optimized therapy = at least 2 AEDs, at MTD, with good compliance
  • seizures are effectively controlled in 70-80% of patients, so only about 20-30% of patients have intractable epilepsy
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14
Q

Therapy for refractory epilepsy

A
  • polytherapy
  • vagus nerve stimulator (40-50% have >50% sz reduction)
  • epilepsy surgery: lobectomy, lesionectomy, corpus callosotomy, etc.
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15
Q

Status epilepticus

A
  • continuous, generalized convulsive seizure lasting >5min, or 2 sequential seizures without full recovery of consciousness
  • non-convulsive SE is an EEG dx
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16
Q

Various types of pediatric seizures

A
  • Absence

-

17
Q

Epileptic vs. Non-Epileptic seizures

A

Epileptic are the seizures you think of.
Non-Epileptic are psychogenic, aka pseudoseizures, aka the person is faking.
Can be hard to tell the difference, but Epileptics will have EEG changes and Non-Epileptics will not. Can’t fake an EEG.

18
Q

Generalized 3Hz spike-and-wave discharges

A

Absence seizure

19
Q

Hyperventilation may trigger?

A

seizure - Absence is most likely

20
Q

What’s the MC type of childhood seizure and at what age does it peak?

A

Febrile seizure

peaks @18mo

21
Q

Types of Febrile seizures

A

Simple - 15min, >1 per 24hr; focal

22
Q

How to approach a first-time SIMPLE febrile seizure in a child?

A
  1. LP - do in 18mo if meningitis suspected
  2. labs to find source of fever
  3. diazepam/diastat
  • DON’T do EEG or neuroimaging
  • anti-pyretics don’t prevent febrile seizure
23
Q

What causes FSE? (Febrile status epilepticus)

A

1/3 cases are from HHV-6B and HHV-7 (6B>7)

24
Q

How to approach a first-time non-febrile seizure in a child?
(this is not epilepsy)

A
  1. stabilize the kid
  2. make sure it’s a seizure
  3. determine the cause:
    - labs, tox screen, LP if concern re meningitis/encephalitis
    - EEG recommended
    - MRI
25
Q

Epilepsy

A

multiple unprovoked seizures separated by >24hr

26
Q

Infantile spasm

A

GENERALIZED

  • a generalized-onset epilepsy syndrome
  • MC are flexor spasms; parents report as “stomach crunches”
  • may also have extensor spasms
  • EEG shows hypsarrhythmia (high voltage chaotic activity btw seizures)
  • can be 2/2 nutritional deficiencies, genetic issues
  • treat with ACTH, nutritional stuff, others
27
Q

Lennox-Gastaut

A

GENERALIZED

  • triad of specific seizure types, a specific EEG, and mental deficiencies
  • onset age 1-8yrs; lifelong, hard to control
28
Q

Childhood Absence Epilepsy (CAE)

A

GENERALIZED

  • absence sx’s multiple times a day
  • Ethosuximide is preferred treatment
  • onset age 4-8; tx 2-3yrs; benign outcome
29
Q

Juvenile Myoclonic Epilepsy

A

GENERALIZED

  • sz can be tonic-clonic (13-20yo), myoclonic (12-18yo), or absence (7-13yo)
  • sz are brief, bilateral but not always symmetric
  • myoclonic jerks most often occur in the AM; consciousness retained during jerks
  • can be triggered by photic stimulation, sleep deprivation, stress, etc.
  • requires lifelong tx; hereditary linked to Chr 6
30
Q

Benign Rolandic Epilepsy (BRE)

A

PARTIAL

  • arise from Rolandic area of brain
  • onset 4-12yr; most commonly focus is facial motor; most common presentation is tonic-clonic seizures
  • may or may not need tx; usually respond well
  • characteristic EEG: central-temporal spikes

OS9.2 - Neuro (10 decks)

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