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12 Cards in this Set

  • Front
  • Back
Epilepsy definition
Chronic seizure condition
-must have had at least 2 seizures not provoked by acute medical illness
Epilepsy prevalence
.5-1%

10% of population will have 1 seizure during lifetime

Susceptible when very young and old
Evaluation of spells
Seizure or other
If Seizure:
-Acute cause?
If Yes:
-Acute symptomatic
If No:
-Unprovoked
-One only:
--Single Seizure
-More than one:
--Epilepsy
Seizure diagnosis
History (most important part)
-patient
-witness
Physical and Neurological Examination
Electroencephalogram (EEG)
Imaging-
-CT
-MRI
Video-EEG monitoring
EEG
The EEG (electroencephalogram) is a tracing of voltage fluctuations versus time recorded from electrodes placed over the scalp in a specific array. These microvolt voltages represent fluctuating dendritic potentials from superficial cortical layers and require amplification. Deep parts of the brain are not well-sampled.
International classifications of seizures
Partial (focal, local) (has aura):
Simple - remains conscious
-sensory
-motor
-psychic
Complex - consciousness altered
-80% temporal lobe origin
Secondarily generalized seizures (grand mal)
-Both hemispheres

Generalized (nonfocal, no aura):
Absence (petit mal)
Myoclonic
Clonic
Tonic
Tonic-clonic (grand mal)
Atonic
Absence vs complex partial seizure diagnosis
Absence:
no aura
no postictal confusion
~10 seconds
EEG generalized spike and wave
no surgical treatment

Complex partial seizure:
aura common
postictal confusion
~1-2 min
EEG focal spikes and sharp waves
surgical treatment available
Principles of seizure treatment
Accurate diagnosis of seizure type
Avoid Trigger Factors
-Sleep deprivation
-Fever
-Alcohol
-Excessive stress
-Heat
Specific drug for seizure type
Strategies for managing newly diagnosed epilepsy
Monotherapy
Patients who do not achieve seizure freedom after a second AED trial are considered refractory to treatment. This population (approximately 40% of patients with epilepsy) may then be evaluated for surgery or polypharmacy1
Rational polypharmacy means choosing a combination of AEDs that will maximize efficacy while minimizing toxicity based on drug characteristics2
The dotted line indicates practices that are commonly employed in the clinical setting but are not necessarily supported in published literature
Background information
Timing of initiation of polypharmacy has been controversial; it has been suggested that combining 2 or more drugs may result in toxicity due to interactions and that moving to polypharmacy too soon does not permit evaluation of the effects of monotherapy3
Criteria for epilepsy surgery
Medically refractory partial seizures
Single cortical seizure focus
Focus resectable with minimal functional impairment
Surgery will improve quality of life
Epilepsy surgical procedures
Lesion resection
Temporal lobectomy
-most common
Extratemporal resection
Hemispherectomy
Corpus callosotomy
Device-vagal nerve stimulator (Cyberonics), responsive neurostimulator (Neuropace)
Presurgical evaluation phase I
Video-EEG monitoring to capture seizures and localize their focus on the brain
Ictal SPECT
Neuropsychological testing
MRI scanning
PET scanning
-look for hypometabolism