Seizures Flashcards
Where in the cortex do generalize myoclonic seizures arise?
In the frontal lobe, especially the SMA region.
EMU studies of patient recall of seizures have found what about memory?
There is a greater incidence of loss of memory in left temporal lobe seizures.
In EMU studies what was found concerning awareness?
Greater likelihood of retained awareness of patients with right hemisphere ictal onset compared to left hemisphere onset.
What percentage of newly diagnosed patients with epilepsy ultimately achieve seizure freedom for 1 year or more on AEDs?
68%
What is the point prevalence of epilepsy in the USA nursing home population?
60 per 1,000 residents or 6%
What is the most common cause of epilepsy in the elderly?
Stroke, it represents 30% of the total number of cases.
What temperature range for induced systemic hypothermia to terminate status epilepticus?
31-35 degrees centigrade
What Systemic temperatures are associated with unacceptable morbidity?
30-31 degrees centigrade
Can seizures associated with focal epilepsy be forecasted by patients?
No
Seizures associated with focal seizures are usually singly or in clusters?
Clusters
What medications have class I evidence in the treatment is convulsive status?
Lorazepam, diazepam, and phenytoin or fosphenytoin
What is the preferred AED in CAE without convulsions?
ETX
In CAE which drug has a smaller effect on ADHD?
ETX
In CAE did ETX, VPA, or LTG differ in intolerable side effects?
No
What is the incidence of childhood epilepsy?
0.5 and 0.7 per 1,000 persons per year
What is the percentages of focal epilepsies?
60%
What proportion of childhood epilepsies are symptomatic focal epilepsies?
80%
When is the usual onset of childhood onset of focal symptomatic epilepsies?
Infacy
After 2 seizures what is the probability of additional seizures at 1 year and 4 years?
57% at 1 year and 73% at 4years
After the first unproved seizure in adults, what is the risk for seizure reoccurrence over the next 2 years if the EEG and MRI are normal?
25%
Does treatment after the first seizure in adults improve the prognosis for seizure remission?
Likely not
Chronic epilepsy in the elderly and what other factors may contribute to cognitive deficits?
Vascular, inflammatory, and lifestyle factors.
Although accumulation of tau and amyloid are found are there any characteristic associated with the Braak score?
No
Panayiotopoulos syndrome semiology?
Out of sleep, pallor, nausea, retching, and repeated emesis and normal past history
On EEG Panayiotopoulos looks like?
Posterior often occipital predominant discharges, elicited by eye closure while awake (fixation- off sensitivity)
How does Gastaut type benign epilepsy differ from Panayiopoulos in semiology?
Brief visual hallucinations or transient loss of vision
In Panayiopoulous the EEG can be seen with other locations of spikes?
Yes, 23% can have multi focal discharges
Can primary generalizedepilepsies have focal clinical and electrographic findings?
Yes, up to 50% of patients
What is the most effective AED for primary generalized epilepsy?
VPA although LTG and TPM are also effective
In the SAND study which AED was better tolerated for primary generalized seizures?
VPA was better tolerated than TOM and LTG
What AED was recently, 2015, was approved in the US for adjunctive treatment of primary generalized epilepsy?
Perampanel
What semiology is seen in seizures arisin from the SMA?
Seizures coming out of sleep, short (10-20sec), with bikateral stiffness and abduction of all extremities, often with a loud tonic vocalization.
What are independent determinants of mortality following status epilepticus?
Age, duration of status, etiology (e.g.- anoxia)
Midline spikes are associated with what type of seizures?
70% of patients with midline spikes have generalized seizures
At what age does idiopathic myoclonic epilepsy of infancy/childhood begin?
Between 4 months and 3 years
In idiopathic myoclonic epilepsy of childhood is there a sex difference?
Slightly more common in boys
How common are seizures in idiopathic myoclonic seizures of infancy?
Seizures often multiple times per day but not usually in clusters, seizures are brief lasting less than 1-3 seconds, and epileptic fall or head drop is not seen.and not associated with clinic or tonic movements.
What does the EEG usually show during the myoclonic seizure in idiopathic myoclonic epilepsy if infancy?
2.5 - 4 Hertz spike wave
What are dacrystic seizures?
Paroxysmal, stereotyped crying, usually with tears and sad face
What is the usual etiology of dacrystic seizures?
With gelastc seizures- hypothalamic hamartoma and without gelastc seizures- temporal lobe
What are the common features of the epilepsy syndrome of eyelid myoclonic with absences?
Photosensitivity with clinical events of repetitive eyelid blinking usually around 4-6 Hz.
In the syndrome of eyelid myoclonic with absences, what is a potent precipating factor?
Eye closure is more potent than photic stimulation without eye closure.
The eyelid myoclonic seizures in eyelid myoclonic with absences, what is the EEG correlation?
Most but not all eyelid myoclonic associated 3-6 Hz mixed spike, polyspike, spike wave. Some eyelid myoclonic events do not have an EEG correlate,
Hypothermia in newborns with HIE will produce less or more seizures?
Less seizure burden
What percentage of patients with stroke have at least a single seizure?
10%
What is the percentage of stroke patients develop epilepsy?
2-5%
When do seizures usually occur after a stroke?
A few weeks after the stroke
What percentage of JME patients will be able to come off medications?
10% - 20%
What causes loss of consciousness in focal seizures?
Seizure spread to subcortical structures-thalamus- which inhibits subcortical arousal systems and disruptions of normal cortical-thalamus and widespread neocortical interactions
Insular seizure semiologies
Viscerosensory, somatosensory phenomena
