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62 Cards in this Set
- Front
- Back
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What are generalized seizures? |
Seizures that rapidly engage bilaterally distributed networks. |
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What are focal seizures? |
Seizures that typically affect limited networks, usually only in one hemisphere. |
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What is are the new terms for: 1. Simple Partial Seizures 2. Complex Partial Seizures 3. Secondary generalized seizures |
1. Seizures without alteration in consciousness or awareness. 2. Seizures with alteration in consciousness or awareness. 3. Evolving to bilateral convulsive seizure |
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What is epilepsy? |
Recurrent unprovoked seizures due to a non-transient and intrinsic property of the brain (whether acquired or congenital). |
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What are seizures? |
a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. |
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What is happening at the neuronal level to cause epilepsy? |
Disruption in the balance of inhibitory and excitatory responses leading to recurrent excitatory circuits. |
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What is the most common site of pathology in adults and adolescents who have seizures with alteration of consciousness or awareness? For Children? |
1. The temporal lobe, especially the hippocampal sclerosis. Accounts for 75% of all seizures.
2. Various malformations of cortical development. |
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What portions of the hippocampus tend to become sclerotic? |
CA1 and CA3 subfields This can be seen on T2 and FLAIR imaging |
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What is the most common seizure classification in children? |
Cryptogenic or Idiopathic About 80% of diagnoses |
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What is an epileptogenic network? |
When surviving neurons engage in synaptic reorganization. |
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How many people have epilepsy worldwide? In the US? |
50 million. 3 million (developing nations have the most new cases, though). |
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What is the most common age of onset for epilepsy? |
Before the age of 5; or after the age of 70 80-85% of seizures with LOC occur before age 15 |
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What is the most significant factor in severity of cognitive impairment in epilepsy? |
Seizure frequency Other factors include type of etiology, younger age of onset, number of AEDs |
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What type of epilepsy is associated with febrile seizures as an infant or toddler? |
TLE with hippocampal sclerosis |
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In addition to frequency of febrile seizures, what are other medical conditions associated with TLE?
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Perinatal complications Hypoxic ischemia CNS infections.
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What percentage of TLE is intractable? |
33% |
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What percentage of TLE results in secondary generalization? |
50% |
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If motor signs occur in TLE, are they ipsilateral or contralateral? |
Ipsilateral The contralateral side goes tonic |
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What are the typical ages of onset for people with history of febrile seizures? |
It's trimodal at ages 5, 15, & 26 |
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What percentage of temporal lobectomies are successful? |
80% Improved mood and QOL usually follow. |
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What is one of the most common generalized seizure epilepsies in childhood? |
Childhood absence seizures. 15% of childhood epilepsy |
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True or False: Childhood Absence Epilepsy is idiopathic and there are no abnormal imaging findings. |
True |
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What are the key features of Landau-Kleffner Syndrome? |
Progressive encephalopathy with progressive aphasia that begins with receptive deficits and verbal auditory agnosia (aka pure word deafness).
May or may not have evident seizures despite abnormal EEG. |
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What are the key features of Lennox-Gastaut Syndrome? |
LGS is not specific to a pathology or seizure type. It is a syndrome characterized by EEG pattern showing bursts of fast activity, especially during slow wave sleep, and slow activity but disorganized spike-and-wave activity.
Cognitive deficits are severe and regress. |
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What are the key features of Rasmussen syndrome? |
Progressive unilateral encephalopathy with deficits related to affected hemisphere.
Premorbid development is normal until ages 3-14.
Hemispherectomy is often indicated. The earlier the better to promote reorganization. |
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What are predictors of low intelligence in seizures? |
Early onset.
Malformation of Cortical DEVELOPMENT (Dysplasias)
Syndromic epilepsies (Lennox-Gastaut; Landau-Kleffner) |
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What percentage of epilepsy patients experience attention deficits? |
30-40%. Inattentive ADHD is common, with no gender differences. |
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What type of ADHD is associated with more severe epilepsy, lower quality of life, and earlier onset? |
Combined type |
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What type of seizures are most associated with attention problems? |
Absence seizures.
Involves frontal operculum and insula |
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Do stimulants to treat attention problems exacerbate seizures? |
No |
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What is a major cognitive side effect of AEDs? |
Slowed processing speed due to an increase in GABA. |
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What factors affect language problems in epilepsy? |
Onset during key language development problems Localization (e.g., TLE) |
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What language and memory deficits are observed in TLE? |
Semantic knowledge deficits
Verbal memory deficits
Confrontation naming deficits
Syndromic epilepsy (LKS or Lennox-Gastaut) leading to regression |
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What are risk factors for visuospatial problems in epilepsy? |
Primary generalized or non convulsive generalized epilepsy (e.g., childhood absence seizures).
Early onset of dominant hemisphere epilepsy resulting in crowding. |
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What is crowding? |
When language is reorganized to homologous areas of the nondominant hemisphere, resulting in a reduction of abilities typically managed by the non-dominant hemisphere (e.g., visuospatial abilities) |
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What is the relationship between memory and TLE? |
Verbal memory deficits tend to be greater for dominant hemi, and non-verbal deficits for non-dominant hemi.
List learning is more sensitive to impairment, and is directly related to level of hippocampal sclerosis. |
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What percentage of epilepsy patients fail one or more validity measures? |
20-25% |
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What does Childhood Absence Epilepsy progress into for 15% of those with the condition? |
Juvenile Myoclonic Epilepsy |
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What are the most common type of seizures? |
Complex partial
50-60% |
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Do primary generalized tonic clonic seizures present with an aura? |
No. Only secondary generalized seizures do. |
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What is the course and presentation of Rolandic epilepsy? |
Most common childhood epilepsy, but it resolves around age 15-18.
Abnormalities observed at night.
Often termed benign. |
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What age does Childhood Absance Epilepsy tend to start? |
4-8 |
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What are the primary symptoms of Juvenile Myoclonic Epilepsy? |
Bilateral myoclonic jerks, usually in the shoulders and arms.
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What percentage of Juvenile Myoclonic Epilepsy patients have generalized tonic-clonic seizures, too? |
80% |
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What is the most consistent neuropsychological symptoms of JME? |
Executive functioning THAT IS NOT PRESENT IN CHILDHOOD |
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When age does Landau-Kleffner Syndrome start? |
Age 3, usually after normal language development. |
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Do clinical seizures have to be present for LKS at first? |
No. Language deficits and EEG abnormalities may be the only sign. |
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What age do Lennox-Gastaut Seizures typically start? |
2 years |
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What are the common neuropsychological symptoms of Lennox-Gastaut? |
Mental Retardation Autism Behavioral Problems |
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What is a common surgical intervention for Lennox-Gataut? |
Corpus Callosotomy |
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What are the most common auras in TLE? |
Fear Deja-vu Olfactory Hallucinations Epigastric sensation Dreamy state Memory flashbacks Goose bumps |
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What percentage of epilepsy patients have frontal lobe epilepsy? |
20% |
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What are symptoms of seizures in the supplementary motor area? |
Bilateral tonic posturing of limbs
Head deviation away from the side of the seizure Monotonous vocalization |
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What happens in frontal lobe complex seizures (the most common kind)? |
HYPERMOTOR MOVEMENTS (like swimming, Shouting, Bicycling) |
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What are common signs to differentiate between PNES and ES? |
Tongue biting and Urinary incontinence are related to true epilepsy |
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What are the 5 key neuropsychological deficits in TLE? |
1. Material specific memory 2. Language deficits in CONFRONTATION naming, word reading, semantic verbal fluency 3. Inattention/Dysexecutive problems 4. Visuospatial 5. Slowed processing speed |
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What are the three types of Neuropsychological Profiles in Epilepsy? |
1. Minimally impaired 2. Predominately Memory Impaired 3. Memory, executive, and processing speed impaired |
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What are the best predictors of seizure freedom after temporal lobectomy? |
1. Unilateral EEG findings 2. Focal lesions 3. Younger age at time of surgery 4. Shorter duration of pre-operative epilepsy 5. Impaired VERBAL MEMORY before surgery |
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What factors predict GOOD POST SURGICAL NEUROPSYCHOLOGICAL OUTCOME IN TLE? |
1. Presence of sclerosis in the hippocampus 2. Presurgical memory intact in contralateral hempisphere 3. Higher FSIQ 4. Longer duration of epilepsy 5. Early age of onset 6. Type of surgery |
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Are people with epilepsy prone to suicide? |
Yes. 25 times more prone |
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What predicts poor QOL in epilepsy? |
1. Perceived More frequent seizures 2. Perceived AED side effects 3. Perceived cognitive problems 4. Limitations to independence (e.g., driving) 5. Psychiatric comorbidity |
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What is the best predictor of improved QOL in epilepsy? |
Seizure freedom, typically at least 2-3 years of freedom. |
