Seizures & Epilepsy

Question 1

Definition of a seizure

Answer 1

paroxysmal episodes of brain dysfunction manifested by sterotyped alteration in behavior

Question 2

How do seizures and strokes compare?

Answer 2

They are opposites. In seizures, brain is hyperactive whereas in stroke, activity is suppressed.
Look away from a seizure and into a stroke

Question 3

What is epilepsy?

Answer 3

A syndrome that implies risk for recurrent seizures

Question 4

What causes a seizure?

Answer 4

Excessive/oversynchronized discharges of cortical neurons

Balance between GABA and glutamate thrown off leading to hyperactivity

Question 5

What populations are at highest risk for seizure?

Answer 5

Neonates/children (developmental causes) and elderly (injury/aging causes)

Question 6

What is the difference between a partial and generalized seizure?

Answer 6

Partial: focal onset
Generalized: entire brain seizes at once

Question 7

What is the difference between a simple partial seizure and a complex partial seizure?

Answer 7

Simple partial seizures do not involve any loss of consciousness, whereas complex seizures have impaired consciousness

Question 8

What is the classical presentation of a temporal lobe seizure?

Answer 8

Epigastric aura: rising sensation, fear, deja vu, olfactory/gustatory sensation
Staring, unresponsiveness, automatisms

Question 9

Classical presentation of frontal lobe seizure

Answer 9

Occur at night
Complex movements, versive movements (head and eyes away from affected side)
Jacksonian march and post-ictal Todd’s paralysis

Question 10

Classical presentation of absence seizures

Answer 10

Childhood diagnosis (age 4-10)
Frequent, brief seizures presenting like staring spells
EEG shows 3Hz spike-and-wave pattern
ETHOSUXIMIDE treatment

Question 11

Classical presentation of myoclonic seizures

Answer 11

Shock-like or lightening-like contraction of a group of muscles
Teenagers (alcohol and sleep deprivation trigger)
Treated with valproic acid

Question 12

Classical presentation of atonic seizures

Answer 12

Sudden loss of tone and brief loss of consciousness

Concern about falling and hitting head

Question 13

Classical presentation of a tonic-clonic seizure

Answer 13

Tonic: contraction producing extension and arching
Clonic: alternating muscle contraction and relaxation
Patient may scream, lose bladder control
Prolonged post-ictal confusion

Question 14

Question to ask to separate seizure from syncopal episode

Answer 14

Whats the last thing you remember?
If waking up on floor: syncopal
If ambulance ride: seizure

Question 15

What drug can cause recurrent seizures?

Answer 15

Buproprion (an antidepressant) lowers the seizure threshold, just increasing the risk for seizure

Question 16

What are pseudoseizures?

Answer 16

Psychiatric/Non-epileptic origin

Clues: to and fro movements, pelvic thrusting, eye closure, hyperventillation, absent post-ictal phase

Question 17

Tests done on unprovoked first seizure in an adult

Answer 17

EEG
Brain imaging (CT or MRI)
lab tests: CBC, glucose, electrolytes, tox screen
LP may be helpful to look at prolactin

Question 18

How is the first unprovoked seizure in a child treated?

Answer 18

Antiepileptic drug not indicated unless benefits of reducing seizure risk outweigh drug side effects

Question 19

What is the most common seizure disorder in children?

Answer 19

Febrile seizure

Do not need to treat this, most children outgrow

Question 20

What is status epilepticus?

Answer 20

Neurological emergency: YOU HAVE TO TREAT!
Continuous seizure activity > 5 minutes with long term consequences after 30 minutes
Treatment: ABCs, check glucose, give thiamine
AEDs: Lorazepam, phenytoin