Seizures and Epilepsy

Question 1

Seizure

Answer 1

Clinical event - Paroxysmal episodes of brain dysfunction manifested by stereotyped alteration in behavior

Question 2

Epilepsy

Answer 2

Syndrome that includes recurrent seizures

Question 3

What receptors propagate seizure activity?

Answer 3

NMDA (glutamate) receptors

Question 4

What receptors inhibit seizure activity?

Answer 4

GABA receptors

Question 5

What are the populations most at risk for seizures?

Answer 5

• Young children and infants

- Elderly

Question 6

Partial Seizure

Answer 6

Seizure has a focal onset in the brain

Question 7

Simple Partial

Answer 7

Seizure with no alteration of consciousness

Question 8

Complex Partial

Answer 8

Focal seizure with impaired consciousness

Question 9

Partial with Generalized Tonic-Clonic

Answer 9

Focal onset with bilateral convulsive seizures

Question 10

Generalized Seizure

Answer 10

The entire brain seizes at once

Question 11

What is the most common partial seizure?

Answer 11

Temporal Lobe Seizure

Question 12

What are the symptoms of temporal lobe seizure?

Answer 12

• Epigastric aura - rising sensation

- Staring and unresponsiveness with some possible contralateral limb posturing

Question 13

What are the characteristics of frontal lobe seizures?

Answer 13

• Complex movements
• Often occurs at night
• Versive movement of eyes away from a seizure location

Question 14

Todd’s Paralysis

Answer 14

Weakness for up to 24 hours after a seizure

Question 15

Parietal Lobe Seizure

Answer 15

Uncommon but can have numbness in lips/fingers/toes with some visual hallucinations

Question 16

Occipital Lobe Seizures

Answer 16

Darkness or sparks of light with red as the most common color seen

Question 17

What is a young child who stares off into space at school often a classical example of?

Answer 17

Absence Seizures

Question 18

What is seen on EEG of absense seizures?

Answer 18

3 Hz spike and wave pattern

Question 19

What are absence seizures treated with?

Answer 19

Ethosuximide

Question 20

Juvenile Myoclonic Epilepsy

Answer 20

Myoclonus: shock-like or
lightening-like contraction of
a group of muscles that occurs in the morning in teenagers

Question 21

What is juvenile myoclonic epilepsy treated with?

Answer 21

Valproic Acid

Question 22

Atonic Seizures

Answer 22

Sudden loss of tone that can cause head drop or all involved muscles with a brief loss of consciousness

Question 23

Generalized Tonic-Clonic Seizures

Answer 23

“Classic” seizure AKA grand mal with contractions leading to extension and arching and alternating contraction and relaxation with possible ictal cry and sometimes loss of bladder control

Question 24

A 38 year old male with
history of a left parietal
cortex oligodendroglioma
presents for episodic right
arm tingling and occasional
hand stiffening. He is aware
of the symptoms when they
occur and does not lose
consciousness when they
occur.

Answer 24

Simple Partial - Left Motor Cortex

Question 25

A 36 year old male presents
for an episodic “burning
smell” and epigastric rising
sensation. His colleagues
report that he “stares off” at
his desk and has difficulty
speaking for several
minutes.

Answer 25

Complex Partial - Left Temporal Lobe

Question 26

A 22 year old female is
brought to the ER by her
roommate. The roommate
noted the patient’s eyes turn
to the left side, followed by
complete body shaking. On
examination, she has blood
on her teeth and her tongue
has been lacerated.

Answer 26

Complex Partial - Right Frontal Lobes (eye fields)

Question 27

Pseudoseizures

Answer 27

Seizures of non-epileptic origin and is psychiatric in nature

Question 28

What is a typical sign of pseudoseizures?

Answer 28

Head turning

Question 29

Status Epilepticus

Answer 29

– Continuous seizure activity (variably defined as more than 5 minutes, with long-term consequences at more than 30 minutes)
– Greater than 2 seizures in a row and patient does not regain consciousness in between

Question 30

What is the treatment for status epilepticus?

Answer 30

• Lorazepam OR Phenytoin