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12 Cards in this Set
- Front
- Back
Epilepsy definition
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Chronic seizure condition
-must have had at least 2 seizures not provoked by acute medical illness |
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Epilepsy prevalence
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.5-1%
10% of population will have 1 seizure during lifetime Susceptible when very young and old |
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Evaluation of spells
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Seizure or other
If Seizure: -Acute cause? If Yes: -Acute symptomatic If No: -Unprovoked -One only: --Single Seizure -More than one: --Epilepsy |
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Seizure diagnosis
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History (most important part)
-patient -witness Physical and Neurological Examination Electroencephalogram (EEG) Imaging- -CT -MRI Video-EEG monitoring |
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EEG
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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.
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International classifications of seizures
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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 |
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Absence vs complex partial seizure diagnosis
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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 |
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Principles of seizure treatment
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Accurate diagnosis of seizure type
Avoid Trigger Factors -Sleep deprivation -Fever -Alcohol -Excessive stress -Heat Specific drug for seizure type |
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Strategies for managing newly diagnosed epilepsy
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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 |
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Criteria for epilepsy surgery
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Medically refractory partial seizures
Single cortical seizure focus Focus resectable with minimal functional impairment Surgery will improve quality of life |
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Epilepsy surgical procedures
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Lesion resection
Temporal lobectomy -most common Extratemporal resection Hemispherectomy Corpus callosotomy Device-vagal nerve stimulator (Cyberonics), responsive neurostimulator (Neuropace) |
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Presurgical evaluation phase I
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Video-EEG monitoring to capture seizures and localize their focus on the brain
Ictal SPECT Neuropsychological testing MRI scanning PET scanning -look for hypometabolism |