Week 6: Seizures, Epilepsy and Status Epilepticus Flashcards
Define epilepsy and seizures.
- Epilepsy: recurrent unprovoked seizures
- Seizures: abnormal excitation of cortical neurons, spreading to adjacent neurons and brain structures
What are the causes of epilepsy?
- 70% idiopathic
- vascular, developmental, trauma, neoplasm, infection, degeneration
List the classifications of epilepsy.
- partial: onset localizes to one area in cortex
- primary generalized: onset is bilateral synchronous, though to arise from thalamic triggers
A. symptomatic: can be related to a prior insult or injury
B. Idiopathic: unknown cause/inherited
What are the characteristics of a tonic/clonic primary generalized epilepsy?
- eyes roll up or to side
- head may turn
- limb rigidity followed by limb jerking
- fall, cry
- may turn blue due to diaphragmatic tightening
- may have tongue biting, urinary incontinence
- post ictal confusion
What are the characteristics of an absence primary generalized epilepsy?
- rapid onset (staring spell), rapid offset
- brief stare for 10-20 sec, eye fluttering
- no post octal confusion, but has amnesia for event
- age: 3-11 yo
- EEG findings: 3/sec generalized spike wave
- autosomal dominant with variable penetrance
Describe juvenile myoclonic epilepsy (a primary generalized seizure)?
- peak age: 12-22 yo
- myoclonic jerks plus: tonic clonic seizures, clonic-tonic-clonic, absence
- frequently occur upon awakening
- good prognosis on anti epileptic drugs, frequency recurrence off AEDs
- triggers: sleep deprivation, stress, EtOH/drug use “college”
- autosomal dominant with variable penetrance
- EEG pattern: 4-6 per second polyspike-waves
How are partial seizures classified?
Based on level of consciousness
- simple partial: normal consciousness
- complex partial: impaired consciousness
Where are partial seizures most common in the brain?
temporal lobe
What are the characteristics of temporal lobe seizures (partial)?
- aura: deja vu, abdominal rising, fear
- followed by: staring, behavior arrest
- lip smacking, automatisms
- post ictal confusion
- duration: 20 secs to 2 mins
What are the signs of extra-temporal onsets by lobes?
- Frontal lobe: brief, early motor activity, seizures cluster frequently. Fencer posturing, head turning early, gesturing
- parietal lobe: sensory phenomena, speech changes
- occipital lobe: visual aura
Compare and contrast complex partial and absence seizures.
Complex partial -2-5 minutes duration -aura -motionless stare -automatisms: lip smacking -confusions 5-20 mins post ictally Absence -brief 10-20 secs -no aura -motionless stare common -eye fluttering, rare jerks -no post ictal confusion
Compare primary and secondary generalized seizures.
PRIMARY -abrupt onset -no aura -tonic-clonic, tonic, clonic -genetic component common -early onset in life SECONDARY -follows partial seizure -can have abrupt onset -tonic-clonic -subjective aspects of partial seizure: visual, tactile, auditory symptoms -later life onset
What are the characteristics of febrile seizures?
- 90% in 6mos-3 years
- occur in up to 5% of children
- during rising phase of fever
- inherited
- simple vs complex
What is the difference between simple and complex febrile seizures?
Simple
- solitary events, 15 mins
- focal features
- family history of epilepsy
- abnormal neuro exam
- multiple seizures in 24 hours
Define status epilepticus.
Continuous seizure lasting 30 minutes or more, or multiple seizures within 30 minutes without recovery of consciousness between seizures
