Nsp Week 2: Seizures And Epilepsy (Hashimi)

Front 1

Define "seizure."

What's the difference between a seizure and epilepsy?

Back 1

Clinical manifestation of an abnormal and excessive synchronization of a population of cortical neurons

*Epilepsy applies to two or more recurrent seizures UNPROVOKED by any systemic or acute neurological insult

Front 2

Which type of epilepsy has well-defined genetics, clinical courses, and responses to medicaton?

Back 2

Juvenile monoclonic epilepsy

Front 3

Incidence of epilepsy are most common in which age groups?

Back 3

1. Eldery (65+)
2. Children (0-9 yo)

*Incidence of seizures in the elderly is twice as common as in children

Front 4

What is the most common cause of epilepsy?

Back 4

Structural causes are the most likely--> most common cause is STROKE
(other causes: brain tumor, head injury, or Alzhemier's)

Front 5

Which is more common-- partial onset seizures or generalized seizures?

Back 5

Partial onset seizures

Front 6

What are the major NT involved in CNS excitation and inhibition?

Which neurotransmitters are increased in seizures?

Back 6

Excitation --> Glutamate and aspartate
Inhibition --> GABA

*Excitatory NTs are increased

Front 7

List the 3 types of partial onset seizures

Back 7

1. Simple partial
2. Complex partial
3. Secondarily generalized

Front 8

List the 5 types of generalized seizures

Back 8

1. Absence
2. Myoclonic
3. Atonic
4. Tonic
5. Tonic-clonic

Front 9

What is the difference between partial and generalized seizures?

Back 9

Generalized seizures involve the entire cortical region of the brain all at once, at the same time. Partial seizures begin at one focus of the brain and then spread to another location

Front 10

What is the typical duration of absence seizures?

Back 10

About 10 seconds or less

Front 11

What are some characteristics of absence seizures?

Back 11

1. Vacant stare
2. Subtle automatism (not always)
3. Lack of response
4. Unaware of seizure, and back to normal as soon as it's over

Front 12

Which type of seizure often occurs soon after waking, and often cause objects to be dropped or thrown?

Back 12

Myoclonic seizure

Front 13

List some characteristics of myoclonic seizures?

Back 13

1. Sudden muscle jerks
2. Preserved awareness
3. Often drop or throw objects
4. Often occur soon after awakening
5. Very brief-- about 1 second

Front 14

How long do myoclonic seizures last?

Back 14

Very briefly-- about 1 second

Front 15

How long do tonic seizures usually last?

Back 15

2 - 20 seconds

Front 16

List some characteristics of tonic seizures

Back 16

1. Symmetric, tonic muscle contraction of extremities with tonic flexion of waist and neck
2. Consciousness usually impaired
3. Duration 2-20 seconds
4. Often cause falling

Front 17

How long do atonic seizures usually last?

Back 17

Usually seconds
(rarely more than 1 minute)

Front 18

Describe some characteristics of atonic seizures

Back 18

1. Sudden loss of postural tone
2. When severe, often results in falls
3. When milder, produces head nods or jaw drops
4. Consciousness usually impaired
5. Duration usually seconds

Front 19

A "grand mal" seizure is also known as..?

Back 19

Generalized tonic-clonic seizure

Front 20

Which type of generalized seizure involves complete loss of consciousness?

Back 20

Generalized tonic-clonic seizure

Front 21

Awareness is preserved in which class of generalized seizures?

Back 21

Myoclonic

Front 22

Consciousness is impaired (but not completely lost) in which classes of generalized seizures?

Back 22

1. Tonic
2. Atonic
3. Absence

Front 23

Describe the 3 phases of tonic-clonic seizures

Back 23

1. Tonic phase--> symmetrical tensing of muscles, back is arched, **Epileptic cry
2. Clonic phase--> jerking limbs, body, and head
3. Post-ictal confusional fatigue

Front 24

Is consciousness preserved in simple partial seizures?

Back 24

YES

Front 25

How long do simple partial seizures last?

Back 25

Vary in length- can be seconds to minutes

Front 26

List 5 types of simple partial seizures

Back 26

1. Focal motor
2. Autonomic
3. Auditory
4. Visual
4. Somatosensory

Front 27

Is consciousness impaired in complex partial seizures?

Back 27

yes

Front 28

Which seizures result in a "staring spell," and what is the major difference between them?

Back 28

1. Absence
2. Complex partial

*"Staring spells" in Absence seizures are short (<10 sec), and they can be 1-2 minutes in complex partial seizures
* postictal confusion occurs after complex partial seizure, but not after absence seizure
*Also, automatisms in complex partial seizures are greater than those in absence seizures

Front 29

Describe the clinical manifestations seen in complex partial seizures

Back 29

1. Presence of aura (warning sign)
2. Automatisms
3. Other motor activity (nonsensical movements-- picking at things)
4. Duration usually < 2 minutes
5. "staring spell"
6. postictal confusion

Front 30

Why don't patients remember some seizures?

Back 30

The seizure extend from cortex to involve to hippocampus

Front 31

Describe the characteristics of secondarily generalized tonic-clonic seizures

Back 31

1. Begin focally, then spread to entire cortex
2. Variable symmetry, intensity, and duration of tonic/clonic phases
3. Last 1-3 minutes
4. Postictal confusion, somnolence
5. May have transient focal deficit ("Todd's paralysis")

Front 32

Transient paralysis or weakness may result from which type of seizure?

Back 32

("Todd's paralysis")

Secondarily generalized tonic-clonic seizure

Front 33

How long do secondarily generalized tonic-clonic seizures last?

Back 33

1 - 3 minutes

Front 34

Postictal confusion occurs after which seizures?

Back 34

1. Tonic-clonic seizures
2. Complex partial seizures
3. Secondarily generalized tonic-clonic

Front 35

If a patient is <5yo and experiences a seizure, what should you screen for?

Back 35

Inborn errors of metabolism

Front 36

When should a lumbar puncture be performed on a patient who experiences a first seizure?

Back 36

Only if meningitis or encephalitis is suspected

Front 37

Which test is the msot important neurophysiological study for the diagnosis, prognosis, and treatment of epilepsy?

Back 37

EEG
(electroencephalogram)

Front 38

Which drug is used only for absence seizures?

Back 38

Ethosuximide

Front 39

List 7 broad-spectrum antiepileptic drugs

Back 39

1. Valproate
2. Felbamate
3. Lamotrigine
4. Topiramate
5. Zonisamide
6. Levetiracetam
7. Rufinamide

*These cover all types of seizures

Front 40

List 8 narrow-spectrum antiepileptic drugs

Back 40

1. Phenytoin
2. Carbamazepine
3. Oxcarbazepine
4. Gabapentin
5. Pregabalin
6. Tagabine
7. Lacosamide
8. Ethosuximide

*These tend to only work for partial onset seizures

Front 41

List a few proposed mechanisms of refractory epilepsy

Back 41

1. Pharmacodynamic theory --> altered function of voltage gated ion channels and NT receptors
2. Pharmacokinetic theory --> Overexpression of efflux transports at BBB, which prevents AEDs from reaching brain in sufficient levels
MDR1 gene may influence the functionality of P-glycoprotein

Front 42

List 3 non-medical treatments of epilepsy

Back 42

1. Ketogenic diet
2. "Curative" procedures
3. Palliative procedures

Front 43

What does a ketogenic diet consist of?

Back 43

1. High fat
2. Low carbohydrate
3. Low protein diet

Front 44

What type of palliative procedure is sometimes done to treat atonic seizures (patient frequently falls and hits head)?

Back 44

Corpus callosotomy

*This disrupts interhemispheric pathway for secondary generalization of partial seizure

Front 45

List 3 stimulation procedures which help reduce frequency of seizures

Back 45

1. Vagus nerve stimulation
2. Deep brain stimulation
3. Responsive cortical neurotstimulation