Seizures & Epilepsy

Question 1

Seizure
vs.
Epilepsy

Answer 1

Seizure: transient disturbance in cerebral function due to paroxysmal neuronal discharge
- a symptom: can be caused by genetics, infection, trauma, stroke, infection, etc.

Epilepsy: Any disorder characterized by RECURRENT seizures
- a diagnosis

Question 2

Types of Generalized Seizures

Answer 2

Bilateral initially, widespread cerebral involvement

• Absence (petit mal)
• Myoclonic
• Tonic-Clinic (grand mal)
• Tonic
• Atonic

Question 3

Tonic-Clonic Grand Mal Seizures

Answer 3

• Alternating between stiffening and jerky movement
• loss of consciousness
• respiration inhibited
• 1-5 minute duration
• tongue-biting common
• bladder/bowel incontinence

Question 4

Myoclonic Seizures

Answer 4

• Quick, repetitive jerks
• Bilaterally symmetrical
• CONSCIOUSNESS PRESERVED
• precipitated by awakening or falling asleep

Question 5

Absence (petit mal) seizure

Answer 5

• 3Hz spiking wave on EEG
• childhood/adolescent onset
• Momentary loss of consciousness, presenting as BLANK STARE
• 10-20 sec in duration
• non-convulsive
• no post-ictal confusion

Question 6

Partial (Focal) Seizure

• Simple partial
• Complex partial

Answer 6

• Affect 1 area of the brain
• most commonly originate in medial temporal lobe
• often preceded by seizure aura
• can secondarily generalize

Simple Partial: consciousness intact
- presents as motor, sensory, autonomic, or psychic symptom

Complex Partial: impaired consciousness/CLOUDING (but not loss of consciousness)

• automatisms
• amnesia for ictal event

Question 7

Status epilepticus

Answer 7

• continuous seizure for > 30 minutes, or

- recurrent seizures without regaining consciousness between seizures for > 30 minutes

Question 8

Lennox-Gastaut Syndrome

Answer 8

• Onset before age 8 (peak onset between 3-5 years)

Triad:

1. Mixed Seizures
2. Slow spike and wave on EEG (1-2 Hz)
3. Psychomotor retardation

Question 9

Juvenile Myoclonic Epilepsy

Answer 9

• presents as mild myoclonic seizures + (grand mal or absence) in adolescents
• Fast waves (4-6 Hz)
• Frequently occurs upon awakening
• Very photosensitive
• Runs in families

Question 10

Drugs for Partial Seizures

Answer 10

• Phenytoin

- Carbamazepine

Question 11

Drugs for Absence Seizures

Answer 11

• Ethosuximide

- Valproate

Question 12

Infantile Spasms (West Syndrome)

Answer 12

• Between Ictal event: Chaotic EEG (HYPERARRHYTHMIA)
• During Ictal Event: EEG flattens out

Treatment: ACTH and Vigabatrin