SM_92b: Epilepsy Flashcards
Seizure is a ___
Seizure is a clinical manifestation of an abnormal, excessive excitation and synchronization of a population of cortical neurons
Seizure semiology is ____
Seizure semiology is signs and symptoms of epileptic seizures
- Subjective symptoms: feelings, specific memories, aura
- Objective signs: motor signs, change in behavior, shaking, loss of awareness, and autonomic signs (goosebumps or hypoxia)
Post-ictal period is ____
Post-ictal period is period after seizure during which there may be a period of confusion or lethargy
Epilepsy is ____
Epilepsy is recurrent seizures (typically two or more) which are not provoked by systemic or acute neurologic insults
(excludes seizures due to exogenous factors)
Epilepsy incidence is highest at ____
Epilepsy incidence is highest at beginning life and end of life
Describe the ILAE classification of seizures
ILAE classification of seizures
Focal/partial seizure starts from ____, while generalized seizure starts from ____
Focal/partial seizure starts from one side/region, , while generalized seizure starts from both sides
_____ seizure involves preserved consciousness and alertness, person can respond to questions and commands, person can remember what occurred during the seizure
Without impairment of consciousness/awareness (simple partial) seizure involves preserved consciousness and alertness, person can respond to questions and commands, person can remember what occurred during the seizure
____ seizure involves loss of consciousness and ability to pay attention / respond to questions / commands and often no memory of what happened
With impairment of consciousness/awareness (complex partial) seizure involves loss of consciousness and ability to pay attention / respond to questions / commands and often no memory of what happened
____ seizure ultimately involves motor activity on both sides of the body and can be difficult to distinguish from primary generalized seizures
Bilateral convulsive (secondary generalized) seizure ultimately involves motor activity on both sides of the body and can be difficult to distinguish from primary generalized seizures
Focal seizures with impairment of consciousness / awareness (complex partial seizures) involve ____, often originate in ____, and have clinical manifestations of ____
Focal seizures with impairment of consciousness / awareness (complex partial seizures) involve impaired consciousness, often originate in the temporal lobe, and have clinical manifestatiosn of aura / automatisms / other motor activity
Focal seizure evolving into a bilateral convulsive seizure (secondary generalized seizure)
- ____
- ____
- ____
- ____
Focal seizure evolving into a bilateral convulsive seizure (secondary generalized seizure)
- Begin focally w/ or w/o focal neurological symptoms
- Variable symmetry, intensity, and duration of tonic (stiffening) and clonic (jerking phases)
- Postictal confusion and somnolence w/ or w/o transient focal deficits
- Patients may recall an aura prior to convulsive activity or witness may observe a focal seizure prior to generalization
Generalized seizures affect ____ and produce ____
Generalized seizures affect both cerebral hemispheres from the beginning of the seizure and produce loss of consciousness
Generalized seizures can be divided into ____, ____, ____, ____, and ____
Generalized seizures can be divided into tonic-clonic, abscence, clonic, tonic, and atonic
Abscence seizures are ____
Abscence seizures are brief staring spells with impairment of awareness and responsiveness
- Sudden onset and resolution
- Accompanying motor phenomena
- Often provoked by hyperventilation
- Person is alert and attentive immediately afterward
Abscence seizure has ____ on EEG
Abscence seizure has generalized 3 Hz spike-wave discharges on EEG
A seizure produces ___ on EEG
A seizure produces a sudden rhythmic change that evolves over time on EEG
Generalized tonic and atonic seizures most commonly occur in people with ____
Generalized tonic and atonic seizures most commonly occur in people with additional neurologic abnormalities
Tonic seizures are ____
Tonic seizures are symmetric tonic muscle contraction of extremities with tonic flexion of waist and neck
EEG: sudden attenuation with generalized, low-voltage fast activity (most common) or generalized polyspike-wave
Atonic seizures are ____
Atonic seizures are sudden loss of postural tone usually with impaired consciousness
- Severe: falls
- Mild: head nods, or jaw drops
- EEG: sudden diffuse attenutation or generalized polyspike-waves
Epileptic drop attacks can occur with ____, ____, or ____ seizures if the legs are involved
Epileptic drop attacks can occur with atonic, myoclonic, or tonic seizures if the legs are involved
Generalized tonic-clonic seizures are ____
Generalized tonic-clonic seizures are associated with loss of consciousness and post-ictal confusion / lethargy
- Tonic phase: stiffening and fall, often associated with ictal cry
- Clonic phase: rhythmic extremity jerking
- EEG: generalized polyspikes, diffuse slowing afterwards
- Drooling / foaming, biting of tongue / cheek / lip, bladder or bowel incontinence
Generalized myclonic seizure involve ___
Generalized myclonic seizure involve epileptic myoclonus that usually causes bilateral synchronous jerks most often affecting the neck, shoulders, upper arms, body, and upper legs
- Epileptic clonus: brief shock-like jerk of a muscle or group of muscles
Describe childhood abscence epilepsy
Childhood abscence epilepsy
- Onset of generalized abscence seizure age 4-8
- Seizure may be provoked by hyperventilation
- EEG: 3 Hz spike and wave
- Normal intellectual function
- Responds easily to medication
- Seizures typically / almost resolve by puberty
Describe juvenile myoclonic epilepsy
Juvenile myoclonic epilepsy
- Onset of generalized myoclonic seizures age 12-18
- Seizre almost always occur upon awakening in the morning
- Cluster of myoclonic seizures can culminate in generalized tonic clonic disorder
- EEG pattern: 4-4.5 Hz generalized spike and wave
- Almost always responds to the right med
- Probably lifelong
Describe mesial temporal lobe epilepsy
- Seizures begin in childhood or adolescence
- Often a history of a predisposing hit
- Often a few focal seizures evolving into a bilateral convulsive seizure early on, followed by typical focal seizures ± altered awareness / consciousness
- Seizures originate in hippocampus and/or amygdala
Mesial temporal lobe epilepsy seizures originate in ____
Mesial temporal lobe epilepsy seizures originate in hippocampus and / or amygdala
Describe temporal lobe epilepsy
Temporal lobe epilepsy
- Most preceded by characteristic aura
- Auras occur frequently in isolation but often proceed into focal seizures with impaired consciousness with automatisms and sometimes dystonic posturing
- Focal temporal spikes on EEG
- Usually CANNOT be medically controlled
- Mesial temporal sclerosis
Describe ILAE 2010 epilepsy etiologies / causes
ILAE 2010 etiologies
- Genetic (idiopathic): direct result of known / presumed genetic defect in which seizures are core symptoms of the disorder
- Structural-metabolic (symptomatic): distinct structural or metabolic condition or disease that has been demonstrated to be associated with a substantially increased risk of developing epilepsy
- Unknown (cryptogenic)
- Infectious
- Immune
____ involves a Jacksonian march
Focal seizure w/o impairment of consciousness / awareness (simple partial) involves a Jacksonian march
- Initiated in primary motor cortex
- Travel in succession
- Often begins in fingers as tingling sensation or feeling of waves through fingers -> affects hand -> more proximal areas on same side of body
- Todd’s paresis / paralysis: focal weakness in part of the body after a seizure
____ may occur after focal seizure without impairment of consciousness / awareness (simple partial)
Todd’s paresis / paralysis may occur after focal seizure without impairment of consciousness / awareness (simple partial)
- Focal weakness in a part of the body after a seizure
____ and ____ etiologies are not seizures
Physiologic and psychogenic etiologies are not seizures
In focal seizures with impairment of consciousness / awareness (complex partial seizures), the person ____ alert and attentive immediately afterward
In focal seizures with impairment of consciousness / awareness (complex partial seizures), the person is NOT alert and attentive immediately afterward
_____ seizure is brief, involves quick return, and has no post-ictal confusion
Generalized abscence seizure is brief, involves quick return, and has no post-ictal confusion
