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149 Cards in this Set
- Front
- Back
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What is a seizure?
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Temporary alteration of brain function caused by paroxysmal, abnormal cerebral neuronal discharge
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What is an ictus?
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another name for seizure
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What is a convulsion?
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A seizure causing abnormal muscle contractions
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What is epilepsy?
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Continuing tendency to spontaneous recurrent seizures, resulting from a persistent pathologic process
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What is a seizure disorder?
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synonymous with epilepsy
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What is a provoked seizure?
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Seizure occurring in an otherwise normal brain as a result of some transient alteration, such as changes in glucose or sodium
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What is status epilepticus?
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Continuing or recurring seizures without return of normal consciousness
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Most common type of seizure?
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Complex partial
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How are seizures classified?
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On the basis of observable clinical manifestations by the International League Against Epilepsy
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What are the two main categories of seizures?
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generalized and focal
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What is the defining clinical difference between generalized and partial seizures?
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Consciousness is lost in generalized and preserved in partial seizures
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What is the pathophysiologic significance of focal vs. generalized seizures?
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Preservation of consciousness implies seizures from a localized area, LOC implies that all or most of the cortex is involved
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Name two categories of seizure that may make the patient unable to respond to questions.
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Generalized and complex partial
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What is another name for partial seizures?
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focal seizures
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What are the subdivisions of partial seizures?
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simple partial seizures, complex partial seizures
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What characteristic distinguishes simple partial from complex partial seizures?
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Consciousness is normal in simple partial, impaired in complex partial (patients awake but not interactive)
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How was simple partial seizures divided (4 categories)
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based on symptoms being 1) motor 2) sensory 3) autonomic 4) psychic
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List 4 types of simple partial MOTOR seizures
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1) repetitive jerking of a body part (primary motor cortex)
2) Versive eye or head movements (frontal eye field involvement) 3) Posturing of a limb (supplementary motor involvement) 4) Phonatory (involvement of Broca's area) |
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What is the localizing value of simple partial motor seizures?
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They imply involvement (usually origin) in the frontal lobe
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6 types of simple partial sensory seizures
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1) tingling of a body region from primary somatosensory cortex in the parietal lobe
2) Visual hallucinations- primary visual cortex in occipital lobe 3) Auditory hallucinations of noises from primary auditory cortex in temporal lobe 4) Olfactory hallucinations from primary olfactory cortex in uncus of temporal lobe 5) Gustatory sensations from temporal lobe 6) Vertigo/dizziness- usually from temporal lobe but not very localizing |
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2 symptoms of autonomic simple partial seizures
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1) Sympathetic overdrive (tachycardia, sweating, pupillary dilation)
2) Abdominal or epigastric sensations ("rising feeling") |
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List 6 types of symptoms from psychic simple partial seizures
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1) Aphasia/dysphasia
2) Memory (deja/jamais vu) 3) Cognitive (dreamy state) 4) affective (fear, anger) 5) illusions (macropsia) 6) Structured hallucinations |
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What is an aura?
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simple partial seizure occurring as a prelude to a more widespsread seizure; ie the focal start of a seizure
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What is the significance of an aura?
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It occurs ONLY in seizures with focal onset and can help localize the site of seizure onset
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Describe a typical complex partial seizure.
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Impaired alertness and responsiveness with amnesia for the event; sometimes there is aura and postictal state
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Name a seizure that originates in one brain area and then spread throughout the brain
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partial seizure with secondary generalization
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Name the eight types of generalized seizures
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absence, atypical absence, myoclonic, tonic, clonic, generalized tonic clonic, atonic, infantile spasm
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Describe the essential features of a GTC seizure
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Generalized stiffness for a few seconds, followed by rhythmic muscle contraction (clonic), followed by postictal state
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What type of seizure is described by sudden staring unresponsiveness of a few to several seconds duration, which interrupts ongoing activities; resumption of activity immediately upon termination of seizure
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Absence
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What symptoms can accompany absence seizures?
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automatisms, similar to complex partial seizure
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How do atypical absence seizures differ from regular absence seizures?
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In atypical, you have staring unresponsiveness, but it continues for hours to days and is usually accompanied by static encephalopathy
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Name an epilepsy syndrome in which atypical absence seizures are common?
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Lennox-Gastaut syndrome
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Describe a myoclonic seizure
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A single, sudden, lightening-like jerk of the whole body or a group of muscles, which may cause the patient to drop or throw something held in the hand
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Epilepsy syndrome in which myoclonic seizures are common?
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Juvenile myoclonic epilepsy
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Rhythmic muscle contractions describes what type of seizure
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clonic
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How is clonic different from myoclonic seizure?
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clonic is multiple rhythmic jerks, myoclonic is one jerk or more than one but not rhythmic
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Sudden sustained whole body muscle contraction of several seconds, typically back and extremities extend, may be accompanied by expiratory moan
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Tonic seizure
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Sudden loss of whole body tone, associated with unprotected falling limp to the ground
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Atonic seizure
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Name a childhood epilepsy syndrome in which atonic seizures are common
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Lennox-Gastaux syndrome
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Sudden contraction of the trunk and arms, flexing the trunk forward and extending the arms is called?
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Infantile spasm
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Name a childhood epilepsy syndrome in which infantile spasms are common
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West's syndrome
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What is a pseudoseizure
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non-epileptic event mimicking an electro-convulsive seizure
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What are 4 common causes of pseudoseizures?
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conversion reaction, depression, adjustment disorder, malingering
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4 clinical characteristics that can help differentiate a pseudoseizure from a real one?
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bizarre behavior, pelving thrusting, obvious purposeful behaviors, long duration
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Prolactin levels will be elevated after what types of seizures?
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almost always after generalized tonic clonic, and fequently after complex partial
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What is the prevalence of epilepsy?
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10% of population will have a seizure, on 3-5% have epilepsy
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How are epilepsy syndromes categorized?
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Based on whether they are localization-related or generalized, and then whether the process is idiopathic, symptomatic, or cryptogenic
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What does symptomatic epilepsy mean?
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result from a known histopathologic abnormality in the brain
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What does cryptogenic epilepsy mean?
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presumably have a structural basis, but it is not known
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What is an idiopathic epilepsy?
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usually inherited, presumably due to abnormalities of neurotransmission without associated structural abnormalities
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On what six characteristics are epilepsy syndromes based?
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type of seizure, EEG, age at onset, neuroimaging, physical exam, natural history
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What are the "idiopathic generalized epilepsies"?
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Childhood absence, juvenile absence, juvenile myoclonic, and GTCs on awakening; there is overlap between them
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What is a mixed seizure disorder?
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Syndrome characterized by both partial and generalized seizures; can't be determined whether the primary pathology is focal or generalized
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What is the most common epilepsy syndrome?
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temporal lobe epilepsy
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What type of epilepsy syndrome is temporal lobe epilepsy?
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localization-related symptomatic epilepsy syndrome
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What is the main seizure type in TLE?
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complex partial seizures
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What is the most common interictal EEG finding in TLE?
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spikes or sharp waves originating in the temporal region of the head
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What is the most common MRI abnormality associated with temporal lobe epilepsy?
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atrophy and high T2 signal intensity of the hippocampus and other mesial temporal lobe structures
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What is the most common histopathologic finding in the temporal lobe?
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mesial temporal sclerosis,consisting of neuronal loss and gliosis in the hippocampus, specifically cell loss in CA3, CA1, and dentate
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What is the cause of mesial temporal sclerosis?
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Unknown; may be acquired from febrile convulsions, status epilepticus, head trauma, and CNS infection; may also be congenital
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What is lateral TLE?
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Disease in areas of the temporal lobe other than the mesial area, basically
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What is the most common etiology of lateral TLE?
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tumors; esp. ganglioglioma and other glial tumo
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What type of epilepsy syndrome is benign rolandic epilepsy syndrome of childhood?
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localization-related idiopathic epilepsy syndrome
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What is the age of onset of BREC?
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80% have onset between 5 and 10 years; peak at 9 years old
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What is the associated family history with BREC?
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Autosomal dominant, variable penetrance, so found in less than 50% of siblings
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Why is BREC considered benign?
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Seizures almost always stop by age 14
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What is the classic EEG finding in BREC?
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Spikes in the centro-temporal region of the head; the rolandic area is around the central sulcus, which contains the primary motor cortex
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Describe a typical seizure due to BREC
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Simple motor seizure in the face region of the motor cortex, consisting of drooling, inability to speak, clonic facial movements; may secondarily generalize
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Is there associated structural pathology in BREC?
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no; presumably due to transient age-related changes in subcellular systems
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What type of epilepsy syndrome is childhood epilepsy syndrome?
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Generalized idiopathic epilepsy syndrome
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What is the typical age of onset of childhood absence epilepsy?
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4-10 years, peak at 6-7 years old
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What type of seizures occur in childhood absence epilepsy, other than absence seizures
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GTC
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What is the associated family hx. in CAE?
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Autosomal dominant with variable penetrance
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What is the classic EEG finding in CAE?
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Generalized 3 Hz spike and wave as isolated asymptomatic brief discharges, or more prolonged discharges associated with unresponsiveness
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What is the fundamental pathology that results in seizures in CAE?
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Inhibition drives recurrent circuits between the thalamus and the cortex, mediated by t-type calcium channels
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How long does childhood absence epilepsy last?
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About 70% ends by 14 years of age
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What is the main difference between the presentation of childhood and juvenile forms of absence epilepsy?
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juvenile form starts later and is more often associated with GTCs
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Why is it important to distinguish between CAE and JAE?
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because JAE is more likely to persist into adulthood; there may also be genetic and pathophysiological differences
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What type of epilepsy syndrome is juvenile myoclonic epilepsy?
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idiopathic generalized epilepsy syndrome
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What is the peak age of onset of juvenile myoclonic epilepsy?
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12-18 years old, but come to medical attention later
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What are the two main types of seizures accompanying JME?
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myoclonic jerks and GTCs
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What is the classic EEG findings in JME?
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generalized multiple spike and wave discharges, occurring as isolated asymptomatic discharges or with myoclonic jerks; may also have generalized simple spike and wave, but usually at faster frequencies
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What is the associated family history with JME?
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Autosomal dominant with variable penetrance
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In JME, how long do seizures persist?
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Often lifelong, but well-controlled
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What type of epilepsy syndrome is West's syndrome?
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Generalized cryptogenic epilepsy syndrome; associated with static encephalopathy but pathophys. is not iedntifiable; in some causes the etiology is known, so it is then considered a symptomatic epilepsy
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What is West's syndroms?
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Infantile spasms occurring with developmental delay and a hypsarrhythmia EEG pattern
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What is the difference between infantile spasms and West's syndrome?
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Infantile spasms just refer to a type of seizure; West's syndrome refers to infantile spasms + developmental delay
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What is the typical age of onset of West's syndrome?
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6 months to 2 years; onset after two years is rare
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Transient neurologic symptoms referable to the brain are due to what three things?
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TIA, migraine, or seizure
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Migraine/seizure are more likely when neurologic symptoms are...
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recurrent and stereotypical
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Complex-partial seizure is more likely when neurologic symptoms are
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associated with or followed by a change in mentation or consciousness
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Neurologic symptoms involving decreased cognition and depressed consciousness localize to where?
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bilateral cerebral hemispheres or brainstem
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Deja vu localizes to where?
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temporal lobe, which is the most common site for seizure foci
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Aura of any kind implies what kind of seizure onset?
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focal
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The aura itself is what?
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a partial seizure
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In what type of seizure does the EEG show focal spikes?
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complex-partial
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Name two things that indicate a seizure is focal in origin?
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1) any aura
2) a post seizure focal deficit like Todd's paralysis |
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Any warning or aura or any post-seizure deficit suggests what?
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focal deficits
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What might you see on EEG with a complex-partial seizure?
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focal spikes in the electrodes recording over the epileptogenic focus
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When abnormal impulses readh both cerebral cortices, what type of seizure ensues?
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tonic clonic
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Do absense seizures have aura?
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no
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Do absence seizures have post-ictal confusion?
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no
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Can you get automatisms in absence seizures?
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yes
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Treatment for absence seizures
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ethosuximide and valproic acid
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When do absense seizures start
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always in childhood
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What is the EEG pattern in absence seizues?
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3 Hz spike and wave pattern
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Syncope is related to hypoperfusion to?
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reticular activating system and bilateral cerebral cortices
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What is the most common idiopathic primary generalized epilepsy?
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juvenile myoclonic epilepsy
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At what age does JME begin?
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Around 15
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What is the first symptom of JME?
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myoclonic jerks in early morning
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What other kinds of seizures can you have in JME?
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GTC or absence seizures
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What kinds of things trigger seizures in JME?
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lack of sleep, alcohol
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What is the characteristic EEG pattern in JME?
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4-6 Hz irregular polyspike and wave
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What is first line treatment for JME?
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valproic acid or lamotrigine
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What meds. make JME worse?
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carbemazepine or phenytoin
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What is intelligence level of JME patients?
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normal
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What is inheritence of JME?
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autosomal dominant, gene found on chromosome 6, mechanism unclear
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What are evaluative tests for partial seizures?
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MRI with contrast, EEG asleep and awake
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Why is MRI preferred to CT for temporal lobe visualization?
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no bony artifact in MRI
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All AEDs are potentially _____ (side effect)
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sedating
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Patients with partial seizures should get MRI how often?
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every 3-5 years
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What EEG pattern often precedes infantile spasms?
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multifocal spikes
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How long does West's syndrome persist?
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Infantile spasms abate in early childhood, but static encephalopathy and other seizure types persist throughout life
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What epilepsy syndrome often evolves from West's syndrome?
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Lennox-Gastaut syndrome
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What type of epilepsy syndrome is Lennox Gastaut syndrome?
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Cryptogenic generalized epilepsy, because it is associated with static encephalopathy; offending histopathology is not identifiable
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What are the two main clinical characteristics of LGS?
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static encephalopathy (mental retardation) and seizures beginning in childhood
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What is the classic EEG finding in LGS?
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slow spike and wave; it is slow because it is less than 3Hz
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What seizure types often accompany LGS?
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tonic, atonic (drop attacks), GTC, atypical absences
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How long does LGS persist?
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Throughout life; seizures difficult to control
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Is EEG indicated in evaluation of seizures?
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Yes, in almost all patients
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Why is EEG indicated to evaluate seizures?
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To distinguish partial from generalized seizures, to localize site of seizure onset, to characterize epilepsy syndrome
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What is the characteristic EEG abnormality in seizure disorders?
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spikes and sharp waves
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What is the difference between a spike and sharp wave?
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a spike is more sharply pointed (20-70 ms) vs. sharp wave (70-200 msec)
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What is the significante of a spike or a sharp wave on EEG?
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signature of a possibly epileptogenic area in that region of the brain
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What is the most common EEG finding in complex partial seizures?
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focal spikes, recorded in the region of the scalp overlying the epileptogenic region
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What percent of patients with complex partial seizures have a normal interictal EEG?
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20-40%
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What percent of patients with generalized seizures have a normal interictal EEG?
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About 10%, but this varies a lot
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What is the most sensitive and specific method to determine whether a spell is a seizure?
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simultaneous video and EEG monitoring during a spell
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What EEG findings during a spell suggest pseudoseizures?
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Normal EEG
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Does lack of EEG change during a spell always exclude a seizure?
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No; simple partial seizures (auras) are not usually accompanied by EEG changes; frontal seizures have subtle EEG changes
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When may intracranial monitoring be indicated in the evaluation of seizures?
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When considering surgery to resect an epileptogenic region
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List two common types of intracranial electrodes
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Depth electrodes- thin coated flexible wires that pierce into brain parenchyma
Subdural electrodes- lie on the brain surface |
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When is neuroimaging indicated in the evaluation of seizures?
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In the evaluation of most types of parial seizures; esp. when there is other evidence of neurologic dysfunction to suggest symptomatic epilepsy
Seizures of adult onset always require neuroimaging |
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Which neuroimaging is the most sensitive and specific for seizures?
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MRI
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What is the difference between PET and SPECT?
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PET- uses radionuclides to detect regional glucose use
SPECT- use radionuclides to detect regional perfusion |
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What interictal PET finding is helpful in localizing site of seizure onset?
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focal hypometabolism; relatively more useful in lateralizing temporal lobe seizures
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What ictal PET finding is helpful in localizing site of seizure onset?
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focal hypermetabolism; ictal PET is hard to obtain though
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What ictal SPECT finding is helpful in localizing site of seizure onset?
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focal hyperperfusion in the area originating the seizure. radionuclide must be injected within 90 seconds of seizure onset
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What interictal SPECT finding is helpful in localizing site of seizure onset?
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focal hypoperfusion, but is there is an anatomic defect, there might be hypoperfusion in a place that's not the site of the seizure focus
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