Neuro Exam 4: Epilepsy

Front 1

What is a partial seizure?

Back 1

A focal seizure (e.g., the seizure discharge remains localized)

Front 2

What is a secondarily generalized seizure?

Back 2

A seizure that is first focal, but then spreads to involve the entire brain

Front 3

What is a generalized or primarily generalized seizure?

Back 3

The seizure discharge involves the entire CNS from the start

Front 4

What are the two essential components to seizure classification?

Back 4

1. Behavior (what does patient do?)
2. EEG (what does brain do?)

Front 5

What are the types of generalized seizures?

Back 5

-Absence
-Tonic
-Tonic-clonic
-Myoclonic
-Atonic

Front 6

What are the types of partial seizures?

Back 6

-Simple partial
-Complex partial
-Secondarily generalized

Front 7

Describe absence (aka petit mal) seizures

Back 7

-patient stops normal activity and stares blankly into space; occasionally blinks slightly at frequency of 3/sec
-patient does not react to external stimuli
-seizure lasts 5-20 seconds
-seizure can often be provoked by hyperventilation

Front 8

Describe generalized tonic-clonic (aka grand mal) seizures

Back 8

-patient has sudden LOC and falls to ground
-First phase: patient experiences tonic (stiff, rigid) contraction of somatic musculature (in extensory posture) with pupillary dilation, apnea, often micturition and sometimes defecation
-may be an "epileptic cry" with forced expulsion of air from lungs during tonic discharge
-Final phase: clonic (jerking) contractions or synchronous muscle jerks, alternating with periods of relaxation
-seizure lasts one to several minutes
-tongue biting, bladder & bowel incontinence may occur
-Post-ictal phase with lethargy or sleep, confusion, often Babinski signs

Front 9

Describe simple partial seizures

Back 9

-no abnormality of consciousness
-symptoms relate to part of brain that seizes
-last 1-5 minutes
-may evolve into a complex partial seizure

Front 10

What is a Jacksonian seizure?

Back 10

A speical form of simple motor seizure in which the seizure discharge "marches" along he primary motor cortex.
-Rhythmic jerking might start in the shoulder, spread to the arm and forearm, then to hand, then to face.

Front 11

What is a simple somatosensory seizure?

Back 11

A type of simple partial seizure in which the aptient may experience somatosensory abnormality (especially paresthesia) in one part of the body

Front 12

What is a complex partial seizure?

Back 12

-consciousness impaired, but not completely lost
-epileptic discharges often originate in temporal lobes, cingulate gyrus, orbital frontal cortex, or insula
-patient's seizure always starts from same focus and spreads in same order to adjacent cortical regions, seizures tend to follow a typical pattern
-manifestations can include abnormal consciosness, cognitive, affective, illusions, hallucinations, and automatisms (semipurposeful, repetitive movements or vocalizations)
-last 1-5 minutes
-simple partial or complex partial may spread to become secondarily generalized tonic-clonic seizure

Front 13

What are disorders that may precipitate reactive seizures in individuals with normal brains?

Back 13

-alcohol withdrawal
-uncomplicated febrile, drug induced, and toxic metabolic seizures
-convulsive syncope

Front 14

What are the factors that may cause an increased risk of an epileptic patient having a seizure?

Back 14

-cessation (esp. abrubtly) of anticonvulsant medication or of any sedative drug or medicine
-use of alcohol or certain other drugs/medications
-sleep deprivations
-physical or psychological stress
-hormonal changes related to the menstrual cycle
(in certain very uncommon individuals, specific physiological or psychologic stimuli might trigger seizures -- reflex epilepsy)

Front 15

What is a prodrome?

Back 15

change in mood or behavior preceding a seizure by hours or days (not part of the seizure)

Front 16

What is an aura?

Back 16

subjective symptoms indicating onset of a seizure (is the first part of a seizure).
-not all seizures begin with an aura

Front 17

What is a common postictal finding?

Back 17

-Todd's paralysis or phenomenon (e.g., hemiparesis or aphasia)
-This can be mistakenly diagnosed as a stroke if occurs after an unwitnessed or unrecognized seizure