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Clin Med - Neuro > Seizures and Epilepsy > Flashcards

Seizures and Epilepsy Flashcards

1
Q

Recurrent, unprovoked seizures

A

Epilepsy

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2
Q

Abnormal electrical actvity in the brain

A

Seizure

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3
Q

Clinical manifestatons: range from sensory symptoms, autonomic changes, psychic experiences, and brief confusion to full-blown convulsions

A

Semiology

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4
Q

Top 4 primary causes of epilepsy in children

A
  1. Unknown (67%)
  2. Congenital (20%)
  3. Trauma (5%)
  4. Vascular (5%)
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5
Q

Failure of greater than/equal to 2 anti-epileptic medications to control seizures

A

Intractability

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6
Q

When should an epileptic patient be evaluated for surgery?

A
  • If the patient is intractable (Failure of greater than/equal to 2 anti-epileptic medications to control seizures)
  • The patient has focal epilepsy (not GENERALIZABLE)
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7
Q

True or false? Generalized seizures involve the entire cortex as shown by imaging and neurophysiological studies

A

FALSE; they DO NOT

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8
Q
  • 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
  • Can be asymmetric
A

Generalized Seizures

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9
Q

True or false?

Generalized seizures must be symmetric

A

False

Generalized seizures can be asymmetric

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10
Q

Define Generalized seizures

A
  • 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
  • Can be asymmetric
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11
Q

True or false?

Generalized seizures must involve the entire cortex

A

False;

networks can include cortical and subcortical structures, but do not necessarily involve the entire cortex

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12
Q

6 types of generalized seizures

A
  1. Absence seizures
  2. Myoclonic seizures
  3. Tonic-clonic seizures
  4. Tonic
  5. Atonic
  6. Clonic

________

myoclonic: sudden, involuntary jerking of a muscle or group of muscles

tonic: In a tonic seizure, the body, arms, or legs may be suddenly stiff or tense. STIFFENING.

clonic: sustained rhythmical jerking

tonic-clonic: tonic first (stiffening), then clonic (rapid, rhythmic jerking)

atonic: type of seizure where. a person suddenly loses muscle tone (also called “drop attack”)

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13
Q
  • Seizures originating within networks limited to one hemisphere, discretely localized or more widely distributed.
  • For each seizure type, ictal onset is consistent from one seizure to another, with preferential propagation paberns that can involve the contralateral hemisphere
A

Focal Seizures

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14
Q

What are the sub-categories of Focal Seizures?

A
  1. Focal dyscognitive/with impaired awareness
  2. Focal without impairment of consciousness or awareness
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15
Q

EEG: 3 Hz Spike-Wave / HV sensitive

A

Absence Seizures/GENERALIZED SEIZURE

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16
Q

When do absence seizures tend to onset?

A

Childhood or teenage

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17
Q

Describe key characteristics of an absence seizure

A

GENERALIZED SEIZURE

  1. Sudden onset, without aura, prompt offset
  2. Momentary loss of consciousness
  3. Eyelid fluber/minor automatisms
  4. 3-15 seconds duration
  5. Family history as indicator

______

EEG: 3 Hz Spike-Wave / HV sensitive

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18
Q

EEG: Flattening/high frequency discharge

A

Tonic Seizure/GENERALIZED SEIZURE

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19
Q

Patient presents with:

  1. Sudden onset, without aura, prompt offset
  2. Momentary loss of consciousness
  3. Eyelid fluber/minor automatisms
  4. 3-15 seconds duration
A

GENERALIZED SEIZURE

___________

Absence seizure

__________

EEG: 3 Hz Spike-Wave / HV sensitive

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20
Q

Describe key characteristics of tonic seizures

A

GENERALIZED SEIZURE

____

  1. Sudden stiffening
  2. Extension maximal in arms
  3. A few seconds in duration
  4. Patient may fall or have injury
  5. Extra-temporal origin
  6. Tend to be refractory to therapy

_____

EEG: Flattening/high frequency discharge

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21
Q

Patient presents with:

  1. Sudden stiffening
  2. Extension maximal in arms
  3. A few seconds in duration
  4. Patient may fall or have injury
A

GENERALIZED SEIZURE

_________

Tonic seizure

_________

EEG: Flattening/high frequency discharge

22
Q

In general, where do Tonic Seizures originate in the brain?

A

Extra-temporal origin

23
Q

In general, how do tonic seizures respond to therapy?

A

In general, refractory to therapy (GENERALIZED SEIZURE)

24
Q

EEG: Slow spike-wave/flattening

A

Atonic Seizures/GENERALIZED SEIZURE

25
Q

Describe key characteristics of an atonic seizure

A

GENERALIZED SEIZURE

____

  1. Abrupt onset
  2. Sudden loss of tone
  3. Head drop/falls/injuries
  4. A second or two in duration
  5. Poor response to AEDs
  6. Poor prognosis

_____

EEG: Slow spike-wave/flattening

26
Q

Patient presents with:

  1. Abrupt onset
  2. Sudden loss of tone
  3. Head drop/falls/injuries
  4. A second or two in duration
A

GENERALIZED SEIZURE

____

Atonic Seizure

_____

EEG: Slow spike-wave/flattening

27
Q

Which type of seizure has a poor overall prognosis and poor response to AEDs?

A

Atonic Seizures

28
Q

EEG: generalized polyspike-wave burst

A

Myoclonic Seizure/GENERALIZED

29
Q

Describe key characteristics of Myoclonic Seizures

A

GENERALIZED

_____

  1. Sudden jerks
  2. Usually bilateral, maximal in arms
  3. One second in duration
  4. Often multiple
  5. May be photic or sensory triggered
  6. Often maximal on awakening

_____

EEG: generalized polyspike-wave burst

30
Q

Patient presents with:

  1. Sudden jerks
  2. Usually bilateral, maximal in arms
  3. One second in duration
  4. Often multiple
  5. May be photic or sensory triggered
  6. Often maximal on awakening
A

GENERALIZED

_____

Myoclonic Seizures

_____

EEG: generalized polyspike-wave burst

31
Q

Which type of seizure may be photic or sensory triggered?

A

Myoclonic Seizures/GENERALIZED

32
Q

EEG: Variable, often obscured.

A

Tonic-Clonic Seizure/MAY BE GENERALIZED OR FOCAL ONSET

33
Q

What are the key characteristics of Tonic-Clonic Seizures?

A

MAY BE GENERALIZED OR FOCAL ONSET

______

  1. Loss of consciousness
  2. May have focal or generalized onset
  3. Tonic extension of limbs (about 20-40 secs)
  4. Evolves to rhythmic clonic jerking of extremities (about 30-50 sec)
  5. Cessation of breathing, tongue biting, incontinence
  6. Post-ictal sleep (altered state of consciousness after a seizure)

____

EEG: Variable, often obscured

34
Q

Patient presents with:

  1. Loss of consciousness
  2. Tonic extension of limbs (about 20-40 secs)
  3. Evolves to rhythmic clonic jerking of extremities (about 30-50 sec)
  4. Cessation of breathing, tongue biting, incontinence
  5. Post-ictal sleep (altered state of consciousness after a seizure)
A

MAY BE GENERALIZED OR FOCAL ONSET

______

Tonic-clonic seizures

____

EEG: Variable, often obscured

35
Q

EEG: Interictal-focal sharp or slow; ictal- rhythmic discharge or often normal

A

Focal seizures without impairment of consciousness/FOCAL

36
Q

Describe key characteristics of Focal Seizures without impairment of consciousness?

A

FOCAL SEIZURE

____

  1. Motor, sensory, psychic or autonomic signs or symptoms
  2. Preservation of consciousness & awareness
  3. May progress to dyscognitive seizures or tonic-clonic seizures

____

EEG: EEG: Interictal-focal sharp or slow; ictal- rhythmic discharge or often normal

37
Q

Patient presents with:

  1. Motor, sensory, psychic or autonomic signs or symptoms
  2. Preservation of consciousness & awareness
A

FOCAL SEIZURE

____

Focal Seizures without Impairment of Consciousness

____

EEG: EEG: Interictal-focal sharp or slow; ictal- rhythmic discharge or often normal

38
Q

Focal seizures without impairment of consciousness may progress to what?

A

May progress to dyscognitive seizures or tonic-clonic seizures

39
Q

EEG: Interictal- sharp waves or spikes; Ictal- focal or bilateral rhythmic sharp

A

Focal dyscognitive seizures/FOCAL

40
Q

Describe key characteristics of focal dyscognitive seizures

A

FOCAL

_________

  1. Altered consciousness/awareness
  2. Duration 30 sec to 3 min
  3. Purposeless autmatisms (arms, oral)
  4. Amnesia
  5. Semiology can vary with site of origin

______

EEG: Interictal- sharp waves or spikes; Ictal- focal or bilateral rhythmic sharp

41
Q

Patient presents with:

  1. Altered consciousness/awareness
  2. Duration 30 sec to 3 min
  3. Purposeless autmatisms (arms, oral)
  4. Amnesia
  5. Semiology can vary with site of origin
A

FOCAL

_________

focal dyscognitive seizures

______

EEG: Interictal- sharp waves or spikes; Ictal- focal or bilateral rhythmic sharp

42
Q

Describe the differential diagnosis for Generalized Tonic-Clonic Seizures for Primary Generalized v. Secondarily Generalized?

A
43
Q

Describe epileptic v. nonepileptic seizures with regard to:

  1. Age at onset
  2. sex
  3. previous psych history
  4. motor
  5. vocalation at onset
  6. incontinence
  7. duration of seizure
  8. injury
  9. amnesia
  10. suggestion provokes seizure
A
44
Q

Describe epileptic v. PNES status with regard to:

  1. Onset
  2. Seizure course
  3. Motor manifestations
  4. Consciousness
  5. Duration
  6. Cyanosis
  7. Eyes
  8. Pupillary light response
  9. Plantar response
  10. Response to noxious stimuli
  11. Response to benzodiazepines
A
45
Q

a neurological emergency defined as 30 or more minutes of either continuous seizure activity or repetitive seizures with no intervening recovery of consciousness.

A

status epilepticus

46
Q

define status epilepticus

A

a neurological emergency defined as 30 or more minutes of either continuous seizure activity or repetitive seizures with no intervening recovery of consciousness.

47
Q

How is status epilepticus clinically determined?

A

It is clinically determined by the presence or absence of motor activity (generalized or focal) and the presence or absence of intact consciousness.

48
Q

Patients can exhibit paroxysmal or continuous tonic or clonic motor activity that may be symmetrical or asymmetrical. This type of SE includes primary and secondary generalized seizures and is further subdivided into:

(1) overt; or
(2) subtle

A

Generalized convulsive status epilepticus (SE)

49
Q

4 ways of treating epilepsy

A
  1. Anti-seizure medications (44% acheive seizure freedom with 1st anti-seizure monotherapy, additional 9% acheive seizure freedom with 2nd anti-seizure monotherapy)
  2. Epilepsy surgery
    • Resection
    • Transection
  3. Neuromodulation
    • Vagal Nerve stimulation
    • Responsive neurostimulation
  4. Diet therapies
    • Ketogenic
    • Modified atkins
50
Q

Per the epilepsy foundation, what is the goal of treatment?

A

No seizures and no side effects

51
Q

What clinical history is important to diagnose epilepsy? Which additional tests should be ordered for diagnosing epilepsy?

A

History:

  1. Auras/warning signs
  2. Report of witnesses
  3. Postictal symptoms/experiences that follow seizures

Additional tests:

  1. EEG
  2. MRI
52
Q

How does mortality relate to epilepsy? What about comorbidities?

A

Patients with epilepsy have approximately 2-3 x higher rates of premature mortaility than those seen in general population

Clin Med - Neuro (17 decks)

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