Seizures and Epilepsy Flashcards
Seizures originating at some point within and rapidly engaging bilaterally distributed networks; these networks can include cortical and subcortical structures, but do not necessarily involve the entire cortex
May be asymmetric
generalized seizures
Seizures originating within networks limited to one hemisphere, discretely localized or more widely distributed
Ictal onset is consistent from one seizure to another, with preferential propagation patterns that can involve the contralateral hemisphere
Complex partial focal dyscognitive/with impaired awareness
Simple partial focal without impairment of consciousness or awareness
focal seizures
Generalized seizures Childhood or teenage onset Sudden onset, without aura, prompt offset Momentary loss of consciousness Eyelid flutter/minor automatisms 3-15 seconds in duration family history of seizure EEG: 3 Hz spike-wave / HV sensitive
absence seizures
Generalized seizures Sudden stiffening Extension is maximal in arms A few seconds in duration Associated with falls and injury Extra-temporal origin Refractory to therapy EEG: flattening/high frequency discharge
tonic seizures
Generalized seizures Abrupt onset Sudden loss in tone Head drop/falls/injuries 1-2 seconds in duration poor response to anti-epileptic drugs poor overall prognosis EEG: slow spike-wave/flattening
atonic seizures
Generalized seizures Sudden jerks Usually bilateral, maximal in arms One second in duration Often multiple May be photic or sensory induced Often maximal on awakening EEG: generalized polyspike-wave burst (5-6 Hz)
myoclonic seizures
Generalized seizures
Loss of consciousness
May have a focal or generalized onset, focal onset may evolve to become generalized
Tonic extension of limbs (20-40 seconds duration)
Evolves to rhythmic clonic jerking of extremities (30-50 seconds duration)
Cessation of breathing, tongue biting, incontinence
Post-ictal sleep
EEG: variable, often obscured
tonic-clonic seizures
Motor, sensory, psychic or autonomic signs or symptoms
Preservation of consciousness and awareness
May progress to dyscognitive seizures or tonic-clonic seizures
EEG: interictal-focal sharp or slow; ictal-rhythmic discharge; often normal
focal seizures without impairment of consciousness
Altered consciousness/awareness
Duration 30 seconds to 3 minutes
Purposelessness automatisms (arms, mouth)
Amnesia
Semiology varies with site of origin
EEG: intericteral-sharp waves or spikes; ictal-focal or bilateral rhythmic sharp
focal dyscognitive seizures
Neurological emergency defined as 30 or more minutes of either continuous seizure activity or repetitive seizures with no intervening recovery of consciousness
Classification based on both clinical and electrographic features
Clinically determined by the presence or absence of motor activity (generalized or focal) and the presence of absence of intact consciousness
status epilepticus
Patients can exhibit paroxysmal or continuous tonic or clinic motor activity that may be symmetrical or asymmetrical
Includes primary and secondary generalized seizures and is further subdivided into overt and subtle
generalized convulsive status epilepticus
