N: Sleep And Epilepsy

Front 1

Can circadian physiologic and behavioral cycles can continue even w/o zeitgebers?

Back 1

yes, though it is closer to 25 hrs in that case.

Front 2

What are of the brain functions as the "brain clock"?

What nt do these regions use for neuron-to-neuron communication?

Back 2

suprachiasmatic nuclei (SCN) small structures on either side of the midline of the hypothalamus (also important).

GABA (gamma aminobutyric acid)

Front 3

What is the main thing that generates the voltages seen on EEG?

Back 3

synchronous firing of thousands of pyramidal nuerons in the cortex.

Front 4

What EEG parameter is correlated with the level of attentiveness, e.g., waking vs. sleeping?

Back 4

frequency.

Front 5

EEG amplitude is directly related to both # of neurons firing and their synchronicity. What neuroanatomical structure controls the synchronicity?

Back 5

thalamus

Front 6

What type of brain activity causes seizures?

What are the two categories of general seizures?

Partial?

Back 6

high-amp, low freq, high synchronicity brain activity.

tonic-clonic or absence

simple or complex

Front 7

What are hallmarks of general seizures (both types)?

Back 7

entire cortex is involved and consciousness is lost.
- muscles either show ongoing (tonic) or rhythmic (clonic) actv
- in an absence seizure, the person seems unaware of the environment and is unable to respond to stimuli, w/ only subtle motor signs.

Front 8

What are hallmarks of partial seizures? (3 types)

Back 8

only one particular area of the cortex is involved.
- simple don't affect awareness or memory
- complex affect awareness or memory
- secondarily generalized may have rapid onset, may have accompanying scream, has postictal confusion (like complex), usually has tonic then clonic component

Front 9

What can be used to tx seizures?

Drugs that block GABA do what to seizures?

Back 9

Anticonvulsants like benzodiazepines prolong the inhib action of GABA, and things like carbamazepine and phenytoin decrease the excitability of neurons.

promote seizures

Front 10

mutations in the prion protein gene (PRNP) leads to degeneration of the thalamus that results in the inability to sleep.

What is this dz?

Back 10

Fatal familial insomnia.

Front 11

Give me the the EEG characteristics of the following stages of sleep:
- REM
- Stage 1
- Stage 2
- stages 3 and 4

What are the deepest stages of sleep?

Back 11

- Beta and alpha waves
- theta
- sleep spindles and K-complexes
- slow wave or delta sleep (d waves)

3 and 4

Front 12

Increased levels of what nt in which area of the brain increase both total sleep time and REM sleep?

Increased levels of which nt decrease total sleep time?

Increased levels of which nt decrease BOTH total sleep time AND REM sleep?

Increased lvls of which nt *increase* both total sleep time and REM sleep?

Back 12

Ach in the reticular formation.

DA

NE

5HT.

Front 13

Sleep architecture changes with age and what else?

Back 13

depression.

Front 14

Which nucleus is associated with the production of serotonin?

Main areas of the brain for NE?

Histamine?

Back 14

Raphe nuclei

locus ceruleus and lateral tegmental area of Pons

tuberomamillary bodies of the hypothalmus and the reticular formation of the midbrain.

Front 15

Differentiate between dyssomnias and parasomnias.

Back 15

dyssomnias: problems in the timing, quality, or amount of sleep (insomnia, sleep apnea, narcolepsy, etc.)

parasomnias: abnormalities in physiology or in behavior associated w/ sleep.

Front 16

What is the definition of insomnia?
- psychological causes?
- physical causes?

Back 16

difficulty falling asleep or staying asleep that occurs 3x per week for at least 1 month.
- major depressive disorder (wakes up too early), bipolar disorder (increased sleep latency, sleep fewer hours, often exhausted), and anxiety (^ sleep latency).
- CNS stimulants (most common cause)
- withdrawal of sedatives
- medical conditions causing pain, endocrine or metabolic malfunctioning.

Front 17

What is sleep apnea?
- two types?
- related conditions?
- can sleep apnea result in sudden death?

Back 17

pt stops breathing while sleeping --> awakens the pt repeatedly.
- central & obstructive
+ central is more common in the elderly, and is a result of decreased respiratory effort.
+ obstructive is associated with increased effort and snoring.
- depression, HA, respiratory acidosis, pulmonary HTN.
- yes, particularly in infants and elderly.

Front 18

What is Pickwickian syndrome?

Back 18

excess Body mass causes airway obstruction --> pt falls asleep during the day.

Front 19

What is narcolepsy?
- sleep latency? REM latency? do REM periods continue uninterrupted?

Back 19

pts have "sleep attacks".
- greatly reduced nighttime REM
- weird illusions/hallucinations that occur right before falling asleep or after waking up (hypnagogic or hypnopompic)
- decreased, short, and REM is interrupted.

Front 20

What are cataplexy and sleep paralysis?

Back 20

- Cataplexy is a sudden physical collapse cause by the loss of all muscle tone after a strong emotion stimulus.
- inability to move the body after awakening

--> both involve the characteristic paralysis of REM sleep @ inappropriate time.

Front 21

What is Kleine-Levin syndrome?
- alleviated by daytime naps?

Bruxism?

Back 21

a form of primary hypersomnia:
= recurrent periods of ecvessive sleepiness occuring almost daily for at least 1 month.
- no.

tooth grinding during sleep.

Front 22

What are the sx of the following types of partial seizures?
- temporal lobe
- frontal lobe
- parietal lobe
- occipital lobe

Which are the most common (and most asked about)?

Back 22

- autonomic, psychic, or olfactory hallucinations, epigastric rising sensation, oralimentary automatisms
- turning, bicycling, posturing, vocalization, speech arrest, head turning, eye deviation, tonic and clonic actv
- somatosensory illusions, metamorphopsia, rotatory sensations
- visual hallucinations, hemianopsia, scotoma, sparks, forms colors and even faces of family and well-known people

temporal

Front 23

Name the type of seizure associated with the following:

episodes of starring, last only seconds, may have hundreds a day, associated with 3/sec Spike-Wave discharge, *NO* postictal confusion, most likely in kids.

Back 23

primary generalized absence seizures

Front 24

Characterize Primary Generalized Tonic-clonic seizures.
- duration?
- postictal confusion?
- incontinence, vomiting, HA?

Back 24

^ mus tone followed by clonic activ.
- <5min
- yes
- yes

Front 25

If a pt has a quick, single muscle jerk, involving a part or their entire body, w/ no postictal confusion, what type of seizure have they had?

Back 25

primary generalized myoclonic seizure

Front 26

Is it true that anything that causes Grey matter dysfunction can cause a seizure?

Back 26

yes.

Front 27

Most common causes of seizures in infancy and childhood?

Adolescence?

Elderly/Older adults?

Back 27

birth injury, inborn error of metabolism, congenital malformation

head trauma, drug intox/withD

stroke, tumor, acute metab disturbances, acute sx seizures

Front 28

An epileptic seizure is defined as what?

Back 28

abnormal recruitment of neurons into a synchronous firing pattern, displayed on an EEG as a monomorphic rhythm that has a beginning, middle, and end.

Front 29

Can laboratory data help dx Epilepsy?
- which labs are required?
- optional?
- when do a lumbar puncture?

Back 29

it's only supportive of the dx
- Head imaging & EEG
- CBC, electrolytes, glucose, Ca, Mg, hepatic and renal function.
- only if meningitis or recepthalitis is suspected AND potential for brain herniation is ruled OUT. (2 conditions)