Seizures

Question 1

Generalized tonic-clonic convulsion

Answer 1

bilateral tonic stiffening of extremities alternating
with clonic jerking
 impaired consciousness
 sympathetic symptoms: tachycardia, mydriasis
 mild cyanosis around mouth, distal extremities
 foaming at the mouth
 urinary incontinence
 lateral tongue biting
 post-ictal fatigue, weakness, and amnesia

Question 2

Briefly describe 
Tonic 
Clonic 
Myoclonic 
Atonic 
Absence

Answer 2

Tonic: only stiffening

Clonic: only rhythmic jerking

Myoclonic: rapid brief jerks

Atonic: loss of postural tone –

Absence: brief staring spells

Question 3

Simple partial vs complex partial

Answer 3

Simple partial – without alteration of consciousness (focal aware)

Complex partial – with alteration of consciousness (focal impaired awareness)

Question 4

Simple partial seizure

Answer 4

may progress into a CPS or GTC seizure

post ictal deficit may be seen

*focused seizure without alteration

Question 5

Complex partial seizure

Answer 5

focused seizure with alteration of awareness
 typically characterized by staring and poor/no responsiveness
 may involve gaze deviation, (forced) head deviation, or unilateral/asymmetric limb involvement
-the asymmetry indicates focal lesion
 may have automatisms
 may progress into a GTC seizure
 often post-ictal
 often amnestic - no recall of (most of) event

Question 6

Secondary generalized seizure

Answer 6

*focal to bilateral tonic-clonic
 seizure activity began in one spot in the brain
then spread to involve the rest
 may spread slowly, starting as a SPS or CPS
 or may spread fast, only manifesting as a generalized tonic-clonic convulsion (aka rapidly secondary generalized)

Question 7

What are important EEG patterns

for focal vs primary generalized

Answer 7

Focal seizure (focal spike and wave)

Primary generalized seizures (general spike and wave activity)

Question 8

Primary generalized epilepsy

Answer 8

characterized by primary generalized seizures
 can be one seizure type or by multiple seizure
types
 Examples:
– Childhood absence epilepsy – absence seizures

– Juvenile myoclonic – myoclonic, tonic-clonic

– Doose syndrome – myoclonic, atonic seizures

– Grand mal on awakening - tonic clonic

Question 9

Childhood absence epilepsy

Answer 9

multiple events daily, can be over a hundred
seizures per day
 unusual to last more than 10 seconds
 often unnoticed
 contribute to poor academic performance
 often triggered by hyperventilation
 prompt return to full awareness
 may have subtle automatisms during spell
 EEG: 3 Hz generalized spike-and-wave

Question 10

How does localization of focal onset seizures manifest in these lobes

Temporal (medial + lateral)
Frontal (dorsolateral, SMA, orbitofrontal)
Orbitofrontal 
Parietal
Occipital

Answer 10

Temporal

• medial - automatisms, posturing, fear, deja vu
• lateral - vertigo, hearing

Frontal - brief, bizarre (bicycling), nocturnal

• dorsolateral - contralateral horizontal gaze (FEF)
• Supplementary motor area - fencing posture
• Orbitofrontal - elaborate, sounds, smell.

Parietal - sensory

Occipital - formed visual phenomenon

Question 11

Benign Rolandic epilepsy

Answer 11

• the most common type of child epilepsy
• benign, usually outgrown so physicians don’t usually treat it.
• treat with first line partial seizure drugs like carbemazepine
• EEG shows individual bilateral centrotemporal spikes

drooling, lack of speech, facial tonic clonic, after awakening is fine.

-nighttime focal onset or rapid secondary generalized seizure

Question 12

Lennox Gasteut syndrome

Answer 12

Most commonly in 2-3 yr old boys.

multiple seizure types: tonic, atonic, absence, experiences cognitive impairment

difficult to treat

*EEG demonstrates slow spike and wave <2.5 Hz

Question 13

INfantile spasms

Answer 13

onset between 3 and 18 months of life** YOUNG
 West syndrome: combination of spasms, hypsarrhythmia, and
developmental regression
 flexor, extensor, or flexor-extensor events occurring in clusters
around sleep-wake transition
 EEG shows hypsarrhythmia: chaotic, high-amplitude, multifocal
spikes, electrodecrement and everything flattens out for a second
 idiopathic, symptomatic, or cryptogenic
 certain populations are more vulnerable such as children affected
with trisomy 21 or tuberous sclerosis
 treatment: ACTH, vigabatrin, steroids, ketogenic diet

Question 14

Describe the mechanism of genetic epilepsies

Answer 14

genetic epilepsies code for proteins in ion channels
 cerebral cortex and hippocampus are particularly prone to synchronized bursts of activity
– strong recurrent excitatory connections
– intrinsically burst-generating neurons – ephaptic interactions among closely spaced neurons
– synaptic plasticity