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Clin Med - NEURO > Seizures and Epilepsy - Lindsay Schommer (unfinished) > Flashcards

Seizures and Epilepsy - Lindsay Schommer (unfinished) Flashcards

1
Q

what is a seizure

A

an “electrical storm” in the brain, not all seizures are convulsions

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2
Q

what is epilepsy

A

recurrent unprovoked seizure associated with abnormal electrical activity in the brain

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3
Q

what is the criteria for epilepsy

A

two or more unprovoked seizures separated by at least 24 hours

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4
Q

what is the risk of recurrence after first unprovoked seizure

A

40% - generally not treated

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5
Q

what is the risk of recurrent after second unprovoked seizure

A

70% - start ASM at this time

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6
Q

what is provoked or not in regards to seizures

A

example: metabolic disturbance, infectious, impact, surgery - think alcohol withdrawal or low blood sugar

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7
Q

what is isolated or not?

A

epilepsy should NOT be diagnosed on the basis of a single seizure
exception: if abnormal EEG is present

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8
Q

what are the three main categories of seizure types

A

focal onset
generalized onset
unknown onset

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9
Q

what is focal onset seizures

A

seizures start in, and affect, one part of the brain

aware and impaired awareness

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10
Q

what is generalized onset seizures

A

seizure starts in, affects both sides of the brain at once and happen without warning

motor vs non-motor

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11
Q

where do focal seizures originate

A

from a paroxysmal discharge in a focal area of cerebral cortex (temporal lobe)

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12
Q

where do primary generalized seizures originate

A

the diencephalic activating system and spread simultaneously to all area of brain

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13
Q

what are the stages of a seizure

A

prodrome
aura
ictal phase
post-ictal phase

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14
Q

what is it called when there is a feeling something is off preceding the seizure itself

A

prodrome

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15
Q

what is an aura

A

first clinical change recognizable to patient
“warning sign” - typically a very small seizure, may progress or dissipate, focal epilepsy, may help with localization

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16
Q

what is the ictal phase

A

time from the first symptom (including aura) until the end of the seizure activity - correlated with abnormal electrical discharges in the brain

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17
Q

what are clinical manifestations that are correlated with location of seizure activity

A

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

18
Q

what location of the brain is associated with visual hallucinations

A

occipital

19
Q

what location of the brain is associated with somatosensory hallucination

A

the postcentral gyrus

20
Q

what locationof the brain is associated with focal motor activity

A

pre-central gyrus

21
Q

what location of the brain is associated with hypermotor activity

A

frontal lobe

22
Q

what location of the brain is associated with throat tightening and autonomic symptoms

A
23
Q

what location of the brain is associated with pain

A

parietal

24
Q

what is the post-ictal phase

A

time between end of seizure and return to baseline - recovery period

25
Q

what are the different types of focal seizures

A

focal aware
focal with impaired awareness
focal to bilateral tonic clonic

26
Q

what is focal aware seizures

A

starts in one area of the brain
- brief < 2 minutes
- awake/aware/memory intact - seizure “auras” are small focal aware seizures

27
Q

what is focal with impaired awareness

A

starts in one area of the brain
duration: 1-3 minutes
Automatism - picking at clothes, bicycling legs, utilization behavior, smacking lips

28
Q

what is focal to bilateral tonic clonic

A

used to be Grand Mals
may see head or eye deviation/version
figure 4 or fencing posture (one stiff arm, one bent arm)

29
Q

what are the types of generalized seizures

A

absence seizures
myoclonic
clonic
tonic
tonic-clonic
atonic

30
Q

what is generalized tonic clonic seizures

A

abrupt onset - symmetric posturing

31
Q

what is an absence seizure

A

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

32
Q

what is myoclonic seizures

A

brief jerks, involving extremities and trunk
lasting 1-2 seconds
common in juvenile myoclonic epilepsy
more common in the morning/upon waking up

33
Q

what is atonic seizure

A

also called “drop seizures”
brief loss of muscle tone (falls if standing, head drops if seated)
usually brief <15 seconds

34
Q

what are tonic seizures

A

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

35
Q

what are the imaging/diagnostic tests for seizures/epilepsy

A

EEG, vEEG, MRI and CT

36
Q

what is Todd’s paralysis

A

inability to move half the body

37
Q

what is vEEG used for

A

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

38
Q

what is an MRI used for

A

look for structural lesion/tumor
if refractory try to obtain 3 Tesla with epilepsy protocol

39
Q

what is PNES

A

psychogenic non-eplieptic seizures
onset typically before 40yo, typically female
highly correlated with history of abuse
cross-cultural phenomenon

40
Q

what is the treatment for PNES

A

limited: SSRIs, CBT, ?EMDR

41
Q

why are frontal lobe seizures often misdiagnosed

A

exception to every rule and the onset zone is too deep to be appreciated on scalp EEG

42
Q

how do you differentiate between PNES and frontal lobe seizures

A

out of sleep (Frontal) vs shortly after awakening (PNES)
Prolactin may be elevated 3-4 fold after epileptic seizure
HISTORY

Clin Med - NEURO (13 decks)

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