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35 Cards in this Set
- Front
- Back
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Epilepsy definition and 3 subtypes
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Symptom of chronic, unprovoked seizures resulting from underlying neurologic condition
Symptomatic epilepsy - KNOWN lesion Cryptogenic epilepsy - unknown but SUSPECTED lesion (can't ID location) Idiopathic Epilepsy - unknown etiology/genetic (no definite cause, may be genetic) |
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Common positive and negative symptoms of epilepsy
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Positive - convulsions, perception of flashing lights
Negative - depression of consciousness, temporary paralysis, blindness Can affect sensory, psychic, motor or autonomic systems |
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Seizures definition
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Individual event of sudden excessive synchronized semirhythmic and progressive sequence of electrical discharge within the brain that escapes normal inhibitory mechanisms
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Ictal, Interictal, Postictal
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Ictal - pertaining to seizure
Interictal - in between seizures Postictal - time following a seizure, i.e. symptoms after a seizure such as unresponsiveness/comatose state etc. |
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Semiology
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Clinical description of seizure
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Incidence of convulsive disorders
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Bimodal peak early in life and late (60-80yrs old)
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2 main classes of seizures and subclasses of both
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Generalized
Generalized tonic-clonic (grand mal) Absence (petit mal) less commonly can be tonic, atonic, myoclonic, febrile) Partial simple partial Complex partial Complex partial with 2nd generalization |
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Tonic, Atonic, Myotonic, Frebrile seizures
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Subclasses of less common generalized seizures
Tonic - stiff body the entire seizure Atonic - fall crumpling to ground in seizure Myotonic - jerky single movements or repetitive bursts Febrile - temperature changes (children more) |
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Generalized Seizures Presentation and Types
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Involves entire brain at onset (IMPACTS ALL EEG LEADS), awareness and behavioral response low at onset = impairment, motor activity is SYMMETRIC, more common in children
Tonic-clonic (grand mal) - prototypical convulsion (MOST COMMON TYPE), whole body tonic and clonic phases. Repetitive clonic then thonic phase where body moves TOWARD midline and becomes stiff. NO breathing in tonic phase, may lose bladder control, unresponsive. As inhibitory factors try to take over see repetitive relaxation (clonic) phases Absence (petit mal) seizure) - brief staring spells, patient unaware of surroundings and then picks back up where left off. Abrupt onset with NO associated motor activity, more common in children. Quinn complex EEG very quick. 3Hz spike and wave discharge. FRONTAL predominance Less common Tonic - stiff entire seizure Atonic - pt crumbles to ground Myoclonic seizures - brief jerks, single or many Febrile - temperature change |
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EEG of generalized seizure
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impact of all leads at onset
large, high amplitude, sharp, slow wave, rhythmic activity |
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Most common type of seizure
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Tonic-clonic (grand mal)
type of generalized seizure |
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Quinn complex
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Very quick rhythmic activity of slow and spike waves in a Absence seizure
3Hz spike and wave discharge |
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Partial Seizures Presentation and Subtypes
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Come from one area of brain, most common type of epilepsy, Seizures are focused to one area with manifestations of what hitting Can spread to get secondary generalized seizure of tonic-clonic.
Simple partial - NO cognitive effects, does not alter awarenes or lose consciousness. Twitching, pt can maintain function Complex partial - some ALTERED awareness. Impairs ability to interact normally with environment. 2nd Generalization - Partial seizure spreading to entire brain and manifesting as tonic-clonic seizure Partials affect whichever system seizure is in: Motor, Sensory, Psychic, Autonomic |
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Most common type of epilepsy
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Partial seizures (no subtype is more than generalized tonic-clonic seizures)
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Seizure localization based on lobes & most common partial seizure
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Frontal - motor, bizzare, often brief and nocturnal
Temporal - Fear, loss of consciousness, amnesia, automatisms (messing with stuff, interacting with environment, smacking, chewing, pretending to do stuff) Parietal - Somatosensory manifestations (feel like burning or tingling), dizziness Occipital - visual, often propogate with false localization. Temporal lobe partial seizure is most common |
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Occipital lobe partial seizure at occipital pole, middle moving anterior and forward on visual tract, most anterior
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occipital pole - bright white lights
more forward - colored lights most anterior - forms that can become more clear farther forward even becoming contralateral |
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Seizure type with automatisms
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Partial temporal lobe seizures - start mouthing things, chewing, interacting with environment, etc.
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Reflex epilepsies
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Seizures triggered by things like flashing lights, sleep deprivation, increased stress, comorbid infection, not taking meds,. etc.
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Aura
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warning of a seizure which is actually just a simple partial seizure (may be sensory or motor)
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Version
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deviations of movement to identify which side a partial seizure is on.
I.e if person's eyes and head jerks right then the seizure is occurring in left hemisphere |
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How to distinguish seizures from sleep disorders, psychological disorders, etc.
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Seizures are much more "stereotyped" Presentation is same seizure to seizure b/c in same location in brain
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Febrile Seizure and Presentation and atypical
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Generalized convulsion in setting of fever (6mo - 5yr old), may be presenting symptom of febrile illness. FAMILIAL, 1/100 get epilepsy. Symmetric
Atypical: lateralized features, prolonged (>15 minutes), more than 1 event in 24 hours, out of age range |
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Mesial temporal sclerosis and seizure that may present
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dysfunction within hippocampus, leads to temporal seizures
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Status Epilepticus Presentation, Types, Treatment
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5 minutes (most seizures only 2-3 minutes) or more of:
a) continuous clinical/EEG seizure OR b) recurrent seizures without full recovery NEUROLOGICAL EMERGENCY - at 5 minutes should intervene to stop Types Generalized convulsive - obvious tonic-clonic Non-convulsive - can't tell unless hooked to EEG, may just be eye or face twitch Focal - continuous seizure in one part of brain (ex. Rasmussen's Encephalitis) |
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Length of most seizures
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2-3 minutes
If over 5 unlikely to resolve spontaneously (status peilepticus) |
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Epilepsy Diagnosis in ED vs Outpatient First seizure eval
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ED - H&P, neuro exam to get brain part involved. Electrolytes, glucose, Ca, Mg, CBC, O2 sat or ABG, tox screen, neuroimage (usually CT)
Outpatient: EEG MRI (CT is usually inadequate) Video - EEG allows for definitive diagnosis |
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DDx for Epilepsy
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Transient seizure
Syncope (cardiac arrythmia) Transient ischemic attack Hypoglycemia Migraine Non-epileptic spells Movement disorder (transient dystonia) Sleep disorder |
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Risk Factors for epilepsy
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Gestational injury
Developmental delay Febrile convulsions Family history substance abuse head trauma meningitis, encephalitis brain lesions Dementia |
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Non-Epileptic Spells Difference, Associations
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Up to 40% referred for video-EEG have this.
Peaks around 20 and 35 yrs old. FEMALES, No risk of brain damage, No injuries variable movements that start and stop Associations: Family history, neurologic history, psychiatric conditions, sexual and physical abuse |
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Epilepsy Treatment goal
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No seizures, no side effects
Long term QOL benefits Tolerability, no interactions |
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Pharmacoresistant Epilepsy
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Seizures resistant to multiple drugs (usually 3 or more)
About 33%, hardest to control and usually partial onset |
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Most recurrent and least recurrent seizure type after medication
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Most recurrent = hippocampal sclerosis (temporal lobe partial), Partials
Least recurrent - idiopathic generalized |
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Treatment for pharmacoresistant epilepsy
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Resective Surgery - partial seizures with localizable focus with PET and SPECT (fixes 3/4)
Vagus nerve stimulator Intracranial stimulators (RNS/DBS). Reactive neurostimulation to stop seizure by cortical stimulation when activity starts Ketogenic Diet Radiosurgery - gamma knife, swelling for a year to 2 years to destroy. Long recovery |
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Process to treat when suspect partial focal seizures
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Video - EEG then medical management if epilepsy or psychiatric eval if something else
Then functional studies with PET and SPECT if uncontrolled. Medical management catered Then if uncontrolled intracranial monitoring. Implantable stimulator to treat or medical management If unresponsive resection surgery |
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Lifestyle issues for epileptic pts
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Driving (symptom free for 6 months)
Pregnancy Employment Social Stigma |
