Seizures and Epilepsy Flashcards
Seizure
Clinical event - Paroxysmal episodes of brain dysfunction manifested by stereotyped alteration in behavior
Epilepsy
Syndrome that includes recurrent seizures
What receptors propagate seizure activity?
NMDA (glutamate) receptors
What receptors inhibit seizure activity?
GABA receptors
What are the populations most at risk for seizures?
- Young children and infants
- Elderly
Partial Seizure
Seizure has a focal onset in the brain
Simple Partial
Seizure with no alteration of consciousness
Complex Partial
Focal seizure with impaired consciousness
Partial with Generalized Tonic-Clonic
Focal onset with bilateral convulsive seizures
Generalized Seizure
The entire brain seizes at once
What is the most common partial seizure?
Temporal Lobe Seizure
What are the symptoms of temporal lobe seizure?
- Epigastric aura - rising sensation
- Staring and unresponsiveness with some possible contralateral limb posturing
What are the characteristics of frontal lobe seizures?
- Complex movements
- Often occurs at night
- Versive movement of eyes away from a seizure location
Todd’s Paralysis
Weakness for up to 24 hours after a seizure
Parietal Lobe Seizure
Uncommon but can have numbness in lips/fingers/toes with some visual hallucinations
Occipital Lobe Seizures
Darkness or sparks of light with red as the most common color seen
What is a young child who stares off into space at school often a classical example of?
Absence Seizures
What is seen on EEG of absense seizures?
3 Hz spike and wave pattern
What are absence seizures treated with?
Ethosuximide
Juvenile Myoclonic Epilepsy
Myoclonus: shock-like or
lightening-like contraction of
a group of muscles that occurs in the morning in teenagers
What is juvenile myoclonic epilepsy treated with?
Valproic Acid
Atonic Seizures
Sudden loss of tone that can cause head drop or all involved muscles with a brief loss of consciousness
Generalized Tonic-Clonic Seizures
“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
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.
Simple Partial - Left Motor Cortex
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.
Complex Partial - Left Temporal Lobe
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.
Complex Partial - Right Frontal Lobes (eye fields)
Pseudoseizures
Seizures of non-epileptic origin and is psychiatric in nature
What is a typical sign of pseudoseizures?
Head turning
Status Epilepticus
– 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
What is the treatment for status epilepticus?
- Lorazepam OR Phenytoin
