seizures, epilepsy

Question 1

define epilepsy

Answer 1

2 unprovoked/unpredicted seizures w/ neuronal activity

Question 2

how are seizures classified?

Answer 2

by onset and spread

Question 3

Compare focal/partial and general seizures

Answer 3

focal– one hemisphere or lobe; may or may not lose consciousness
general–both hemispheres + lose consciousness

Question 4

what are the two types of focal/partial seizures?

Answer 4

simple partial seizures
complex partial seizures

Question 5

Differentiate between simple & complex partial seizures

Answer 5

simple partial remains conscious
complex partial is impaired consciousness

Question 6

Shared characteristics of focal/partial seizures

Answer 6

strange sensations including visual hallucinations
rhythmic jerking movements
Jacksonian march– spreading to other muscles
could have todd’s paralysis

Question 7

characteristics specific to complex partial seizures

Answer 7

behavioral arrest or staring < 3 mins where person is unaware/unresponsive
automatism–repetitive behavior
olfactory hallucinations

Question 8

Secondarily generalized seizure

Answer 8

started out as partial seizures that became generalized
ie. it started out in one lobe and moved to the other

Question 9

List the 6 Primarily generalized seizures

Answer 9

atonic
tonic
tonic-clonic
myoclonic
absence
atypical absence

Question 10

what does a Tonic seizure look like?

Answer 10

muscles become STIFF/FLEXED and person falls BACKWARD

Question 11

what does an Atonic seizure look like?

Answer 11

muscles become RELAXED and person falls FORWARD

Question 12

what does Tonic-clonic look like?

Answer 12

muscle tenses up (tonic phase) then contracts & relax (convulse)
eyes stay open w/ loss of consciousness

Question 13

what does myoclonic look like?

Answer 13

short muscle twitches
no loss of consciousness

Question 14

how are absence seizures diagnosed?

Answer 14

EEG!
NO imaging

Question 15

what do absence seizures look like?

Answer 15

person lose & regain consciousness– blank stare w/ pause
NO postictal phase
happens in kids a lot but they grow out of it
eg. they suddenly stop walking

Question 16

what is the first and second line medications for absence seizures?

Answer 16

1. Ethosuximide
2. Valproic acid

Question 17

what is status epilepticus?

Answer 17

seizure >5 mins OR multiple seizures w/o going back to normal in between
usually tonic-clonic
this is a medical emergency

Question 18

how do you treat status epilepticus

Answer 18

BZD– they enhance inhibitory effects of GABA

Question 19

what are some sx AFTER seizures?

Answer 19

postictal confusion
todd’s paralysis

Question 20

Define todd’s paralysis (paresis)

Answer 20

unilateral limb paralysis that lasts about 15 hrs and goes away in 2 days

Question 21

what are methods of diagnosing epilepsy

Answer 21

Hx– can diagnose using event hx alone
brain imaging to look for abnormalities after first seizure (MRI, CT)
EEG for electrical signals (for epilepsy syndromes)

Question 22

what is the most common generalized seizure?

Answer 22

tonic-clonic seizure

Question 23

Benign Febrile Seizure

Answer 23

generalized seizure (tonic-clonic) + fever in kid under 5yo lasting under 15mins
not caused by CNS infection

Question 24

how do you diagnose Benign Febrile Seizure?

Answer 24

no imagine
diagnose cause of the fever

Question 25

which seizures have postictal phase

Answer 25

tonic-clonic

Question 26

which seizures DON'T involve loss of consciousness

Answer 26

simple partial atonic myoclonic

Question 27

which seizures can be diagnosed w/ Neuroimaging?

Answer 27

focal seizures (esp if first one) MOST generalized seizures status epilepticus

Question 28

which seizures do you not need neuroimaging?

Answer 28

absence myoclonic juvenile seizure

Question 29

how do you decide between CT and MRI

Answer 29

CT is for acute syndromes or trauma MRI is the epilepsy protocol; its the best option unless you're short on time

Question 30

what lab studies are associated w/ generalized seizures

Answer 30

elevated CK and lactate

Question 31

How are EEGs used?

Answer 31

its diagnosis for absence seizure adds to prognosis after single seizure and defining epilepsy syndrome

Question 32

when to treat seizuers

Answer 32

one provoked seizure one unprovoked seizure w/ abnormal EEG or structural cause 2+ unprovoked seizures

Question 33

name some imitators of seizures

Answer 33

Psychogenic nonepileptic events (PNES) convulsive syncope migraines clonus malingering

Question 34

what is psychogenic nonepileptic events and how is it diagnosed?

Answer 34

PNES is done as diagnosis of exclusion biting TIP of tongue, CLOSED eyes, pelvic thrusting, back arching sx > 2 mins