2-3: Brain Sciences - 3/1: Epilepsy

Front 1

Seizure vs Epilepsy

Back 1

Seizure: clinical manifestation of abnormal and excessive excitation of a population of cortical neurons

Epilepsy: tendency toward recurrent spontaneous seizures unprovoked by systemic or neurologic insults

Front 2

What is epileptogenesis?

Back 2

sequence of events that converts neuronal network into a hyperexcitable network

Front 3

What is ictus?
Post-ictus?
Inter-ictal?

Back 3

Ictus: period of a seizure
Post-ictus: period of abnormal behavior that follows ictus (confusion, paresis, lethargy)
Inter-ictal: baseline phase in between seizures

Front 4

What is an aura?

Back 4

Earliest experienced syx that predict an imminent larger seizure to follow (represents early ictal phase)

Front 5

Focal vs Generalized Seizure

Back 5

Focal: seizure arises from particular region of cortex at onset

Generalized: seizure arises diffusely (bilaterally synchronous)

Front 6

Primary Generalized vs Secondarily Generalized

Back 6

Primary Gen: Starts out as Generalized

Secondarily Gen: Starts out focal and propagates

Front 7

Simple vs Complex Partial Seizures

Back 7

Simple: Consciousness preserved (simple partial seizure)

Complex: Loss of Consciousness

Front 8

Describe an absence seizure.

Back 8

Petit mal

Staring spell; non-convulsive seizure

Front 9

Describe a generalized tonic-clonic seizure.

Back 9

grand mal seizure

Convulsive seizure:
tonic (stiffening) phase followed by clonic (twitching) phase

Front 10

Describe a myoclonic seizure.

Back 10

Convulsive seizure with brief twitches

Front 11

Describe a tonic seizure.

Back 11

Convulsive seizure with brief stiffening.

Front 12

Describe an atonic seizure.

Back 12

Convulsive seizure with sudden loss of tone (falls)

Front 13

Symptomatic vs Idiopathic seizures

Back 13

Symptomatic: seizure is secondary (symptomatic) of another problem (ex: head trauma)

Idiopathic: unknown cause, could be genetics

Front 14

What metabolic derangements can cause seizures?

What are other causes of seizure?

Back 14

Hypo/hyperglycemia

Hyponatremia
Hypocalcemia
Hypomagnesia

Other causes:
Toxins
Withdrawal
Fever
CNS Trauma, infection, ischemia, hemorrhage

Neurodegenerative Illnesses (AD)

Front 15

What is DFLE?

Back 15

Autosomal Dominant Frontal Lobe Epilepsy

Genetic cause of epilepsy

Front 16

Effect of age on epilepsy's etiology?

Back 16

First two decades: genetic, early life CNS insults (infection, vascular, CNS dysgenesis)

In the elderly: vascular (stroke), neoplasia, neurodegen, toxic-metabolite, drug/EtOH withdrawal

Front 17

Acute Symptomatic Seizures vs Delayed Seizure

Back 17

Acute Symptomatic: post CNS insult, later epilepsy possible, but variable

Delayed Seizure: silent period of weeks, months, or years after injury

Front 18

What neuronal changes in epilepsy allow for hyperexcitability?

Back 18

-excitatory axonal sprouting
-loss of inhibitory neurons
-loss of excitatory neurons driving inhibitory neurons

Front 19

What does the kindling model of epileptogenesis state?

Back 19

Repeated subconvulsive stimuli result in electrical afterdischarges which eventually:
lead to stimulation-induced clinical seizures
lead to spontaneous seizures (epilepsy)
(applicability to human epilepsy is uncertain)

Front 20

What are the pathological findings in epilepsy?

Back 20

Hippocampal sclerosis (mesial temporal sclerosis)

Cortical dysplasia
Gyral abnormalities (polymicrogyria)

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Front 24

Distribution of epileptiform waves on EEG can help determine _________________

Back 24

type of epilepsy (focal, generalized, lateralized)

Front 25

What EEG abnormalities correlate with seizure?

Back 25

Spikes, sharp waves, spike-wave complexes, polyspikes

Front 26

Differential Diagnosis for Epilepsy

Back 26

Syncope (esp convulsive--syncope = loss of consciousness)

Migraine
Vertigo
Non-epileptic seizures

(Any transient spell associated with confusion)

Front 27

Spell vs Seizure

Back 27

Spell: less specific of pathophysiologic mechanism; preferable if etiology (cause) is unknown

Seziure: disrupted cerebral physiology with hyperexcitable, hypersynchronous neuronal activity

Front 28

Seizure vs Syncope:
Setting
Prodrome
Ictus
Confusion

Back 28

Seizure:
Setting: Random, non-situational
Prodrome (premonitory syx): None or aura (GI, deja vu, sensorimotor)
Ictus: Rigid fall, injuries, incontinence, clonus
Confusion: Prominent, minutes to hours

Syncope:
Setting: Often situational (pain, emotion), upright
Prodrome: nausea, pallor, clammy, visual graying
Ictus: Flaccid fall, rare injury, brief & generalized jerking
Confusion: Mild, fleeting, no paresis, "shaken up"

Front 29

What is status epilecticus?

Back 29

Ongoing seizure activity lasting over 10-15 mins; recurrent seizures without interval recovery to neurologic baseline

Front 30

Treatment of Status Epilecticus?

Back 30

IV Benzos
1st Line AED: phenytoin
2nd Line AED: barbiturates
Sedative agents to put pt in iatregenic coma

Front 31

If a third of patients with epilepsy are refractory to AEDs, what treatment options are available to them?

Back 31

Surgery for well-localized cases to non-eloquent cortex (non-language area): lobectomy, lesion-ectomy

Palliative surgeries: callosotomy (CC: changes seizure to focal), hemispherectomy

Vagal Nerve Stimulation
Ketogenic diet (high fat, low carb, adequate protein) in kids