Seizures and Epilepsy - Lindsay Schommer (unfinished) Flashcards
what is a seizure
an “electrical storm” in the brain, not all seizures are convulsions
what is epilepsy
recurrent unprovoked seizure associated with abnormal electrical activity in the brain
what is the criteria for epilepsy
two or more unprovoked seizures separated by at least 24 hours
what is the risk of recurrence after first unprovoked seizure
40% - generally not treated
what is the risk of recurrent after second unprovoked seizure
70% - start ASM at this time
what is provoked or not in regards to seizures
example: metabolic disturbance, infectious, impact, surgery - think alcohol withdrawal or low blood sugar
what is isolated or not?
epilepsy should NOT be diagnosed on the basis of a single seizure
exception: if abnormal EEG is present
what are the three main categories of seizure types
focal onset
generalized onset
unknown onset
what is focal onset seizures
seizures start in, and affect, one part of the brain
aware and impaired awareness
what is generalized onset seizures
seizure starts in, affects both sides of the brain at once and happen without warning
motor vs non-motor
where do focal seizures originate
from a paroxysmal discharge in a focal area of cerebral cortex (temporal lobe)
where do primary generalized seizures originate
the diencephalic activating system and spread simultaneously to all area of brain
what are the stages of a seizure
prodrome
aura
ictal phase
post-ictal phase
what is it called when there is a feeling something is off preceding the seizure itself
prodrome
what is an aura
first clinical change recognizable to patient
“warning sign” - typically a very small seizure, may progress or dissipate, focal epilepsy, may help with localization
what is the ictal phase
time from the first symptom (including aura) until the end of the seizure activity - correlated with abnormal electrical discharges in the brain
what are clinical manifestations that are correlated with location of seizure activity
may or may not lose consciousness
automatisms, head or eye deviations/version, hyper-motor
may progress as seizure activity spreads to different areas of the brain
what location of the brain is associated with visual hallucinations
occipital
what location of the brain is associated with somatosensory hallucination
the postcentral gyrus
what locationof the brain is associated with focal motor activity
pre-central gyrus
what location of the brain is associated with hypermotor activity
frontal lobe
what location of the brain is associated with throat tightening and autonomic symptoms
what location of the brain is associated with pain
parietal
what is the post-ictal phase
time between end of seizure and return to baseline - recovery period
what are the different types of focal seizures
focal aware
focal with impaired awareness
focal to bilateral tonic clonic
what is focal aware seizures
starts in one area of the brain
- brief < 2 minutes
- awake/aware/memory intact - seizure “auras” are small focal aware seizures
what is focal with impaired awareness
starts in one area of the brain
duration: 1-3 minutes
Automatism - picking at clothes, bicycling legs, utilization behavior, smacking lips
what is focal to bilateral tonic clonic
used to be Grand Mals
may see head or eye deviation/version
figure 4 or fencing posture (one stiff arm, one bent arm)
what are the types of generalized seizures
absence seizures
myoclonic
clonic
tonic
tonic-clonic
atonic
what is generalized tonic clonic seizures
abrupt onset - symmetric posturing
what is an absence seizure
previously Petit mal
generalized onset
brief loss of consciousness (less than 10 seconds)
prompt recovery
starting, eyelids may flutter
more common in kids - frequently missed
what is myoclonic seizures
brief jerks, involving extremities and trunk
lasting 1-2 seconds
common in juvenile myoclonic epilepsy
more common in the morning/upon waking up
what is atonic seizure
also called “drop seizures”
brief loss of muscle tone (falls if standing, head drops if seated)
usually brief <15 seconds
what are tonic seizures
brief < 60 seconds
sudden increased muscle tone - patient may fall
consciousness may or may not be affected (depending on length)
may or may not have postictal period
what are the imaging/diagnostic tests for seizures/epilepsy
EEG, vEEG, MRI and CT
what is Todd’s paralysis
inability to move half the body
what is vEEG used for
long term inpatient monitoring
goal to illicit and characterize seizure in order to classifying the type of seizure/syndrome - rule out mimics, most frequently PNES
what is an MRI used for
look for structural lesion/tumor
if refractory try to obtain 3 Tesla with epilepsy protocol
what is PNES
psychogenic non-eplieptic seizures
onset typically before 40yo, typically female
highly correlated with history of abuse
cross-cultural phenomenon
what is the treatment for PNES
limited: SSRIs, CBT, ?EMDR
why are frontal lobe seizures often misdiagnosed
exception to every rule and the onset zone is too deep to be appreciated on scalp EEG
how do you differentiate between PNES and frontal lobe seizures
out of sleep (Frontal) vs shortly after awakening (PNES)
Prolactin may be elevated 3-4 fold after epileptic seizure
HISTORY
