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70 Cards in this Set
- Front
- Back
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What is the definition of a seizure?
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An episode of altered behavior or sensorium caused by excessive or hypersynchronous discharge of neurons
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How do the neurons fire during a seizure?
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They're hypersynchronized
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What is the definitionof epilepsy?
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An enduring PREDISPOSITION to generate seizures AND an actual occurrence of at least one seizure
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What is the definition of an aura in the context of seizure?
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A subjective abnormality experienced by some patients at the onset of a seizure, not associated with objective clinical signs
It's the first sign of a seizure occurring. |
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What is the definition of automatism in the context of a seizure?
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Coordinated, stereotyped, involuntary motor activity that would be purposeful if the patient were aware of it.
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What are the two broad clssifications of seizures?
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Focal
Broad |
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What are the characteristics of a focal/partial seizure? What types of focal seizures are there?
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The first clinical and EEG changes indicate that the initial activation of the system of neurons limited to one part of he cortex
Two types: simple and complex Simple = no effect on consciousness Complex = alterations in consciousness (either feel different or pass out |
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What are the characteristics of a generalized seizure?
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The first clinical and EEG changes indicate that initial involvement happens with both hemispheres.
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What are some of the ways that partial seizures can spread?
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Locally
Regionally - Jacksonian march (traveling up the homonculus) Bilaterally |
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What are the characteristics of a partial seizure that is bilateral?
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Complex
Generalized tonic-clonic movements |
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What determines the manifestations of a seizure?
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The place that it occurs
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What are some of the different effects that can happen during a seizure?
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Motor
Autonomic Sensory -Somatosensory -Special sensory Emotional/psychic -Fear -Pleasure -Deja vu |
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What are the different types of generalized seizures?
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Absence
Myoclonic Clonic Tonic Tonic-clonic Atonic |
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What is the definition of:
Myoclonic? Clonic? Tonic? Tonic-clonic? Atonic? |
Myoclonic: quick jerks
Clonic:rhythmic jerking Tonic: stiffening Tonic-clonic: stiffening-->jerking Atonic: brief loss of muscle tone |
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What are the characteristics of an absence seizure?
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Staring off into space, completely blankly, for a couple of seconds
Think of the kid doing homework,stares off into space and looks blank, and then is back with it again. |
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What are the two axes of epilepsies?
1. Idiopathic vs. symptomatic 2. Generalized vs. localization related |
1. Idiopathic vs. symptomatic
2. Generalized vs. localization related |
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In the context of epilepsy, what does idiopathic mean?
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It means that the epilepsy has a genetic cause.
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What is the definition of symptomatic epilepsy?
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Epilepsy that has its origins in a known or suspected CNS abnormality
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What are the characteristics of childhood absence epilepsy?
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Onset is between 4 and 8
Sudden beginning of the spells: blank stares, stop activity Provoked by hyperventilation |
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What is the characteristic EEG finding in childhood absence epilepsy?
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3 Hz spike and wave complexes
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What is one way that you can provoke childhood absence epilepsy?
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Have the kid hyperventilate
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What is the treatment for childhood epilepsy? How effective is it?
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1st line: Ethosuximide
2nd line: valproid acid |
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What kind of epilepsy is ethosuximide used to treat for?
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Childhood absence epilepsy
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What class of epilepsy does childhood absence epilepsy fall into?
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Idiopathic generalized epilepsy
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What are the characteristics of juvenile myoclonic epilepsy?
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Onset between 12 and 18
Generalized tonic-clonic |
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What are initial signs of juvenile myoclonic epilepsy?
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Myoclonic jerks a year before the onset of the generalized epilepsy.
In order for it to be worrying it has to happen randomly during the middle of the day |
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What are the characteristic EEG findings for juvenile myoclonic epilepsy?
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4-6 Hz polyspikes and waves
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What is the prognosis for juvenile myoclonic epilepsy?
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It's a lifelong disease
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What is the treatment for juvenile myoclonic epilepsy?
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Valproic acid
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What class does juvenile myoclonic epilepsy belong do?
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Idiopathic generalized epilepsies
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What are the characteristics of benign rolandic epilepsy?
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Onset between 5 and 10
Hemifacial twitching, drooling Happens at night |
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What are the signs on EEG of benign rolandic epilepsy?
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Centrotemporal fpikes
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What is the prognosis for benign rolandic epilepsy?
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Great!
It resolves with the teenage years, right when a whole other host of problems start (puberty, high school, etc.) |
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What is the treatment of benign rolandic epilepsy?
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Any drug that you'd use for partial seizures
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What class does benign rolandic epilepsy belong to?
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Idiopathic localization-related epilepsy
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What are the characteristics of mesial temporal sclerosis?
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Simple or complex partial seizures.
Seizures start in the temporal lobe, can spread to the bilateral limbic structures History of febrile seizures, then they go for a long time being seizure free. |
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What happens if a seizure spreads to the bilateral limbic structures?
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Alterations in consciousness
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What does an EEG of mesial temporal sclerosis look like?
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Mesial temporal abnormalities
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What does an MRI of mesial temporal sclerosis look like?
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Mesial temporal sclerosis
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What is the prognosis for mesial temporal sclerosis?
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Variable
Some respond to meds, some don't. Some people have the condition resolve entirely. If nothing helps, surgery is great. |
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What is the surgical treatment for mesial temporal sclerosis?
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Anterior temporal resection
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What are two requirements for the generation of seizrues?
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1. Excessive neuronal excitability
2. Pattern of synaptic connections between neurons that permit the hypersynchrony (think the circuits that cause arrhythmias in the heart) |
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What class does mesial temporal sclerosis epilepsy belong to?
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Symptomatic localization-related epilepsy
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What processes contribute to the development of seizures?
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1. Activity of voltage-gated ion channels
2. Distribution and the activity of inhibitory synapses 3. Distribution and activity of excitatory synapses (glutaminergic) |
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What is part of the brain contributes to the deveopment of mesial temporal sclerosis?
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The mossy fibers of the hippocampus
They sprout collateral fibers that then go and make abberrant connections inside the brain that go CRAAAZZZAAAAYYYY |
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When you treat seizrues, what is the goal as far as occurrence? Why?
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You don't want someone to seize at all.
Why? 1. It's unpleasant and scary for the patient 2. Seizures induce collateral sprouting that can then generate more seizures |
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What kinds of circuits are in generalized epilepsy?
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Pre-existing thalamocortical circuits
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What part of the brain shows morphologic changesin mesial temporal sclerosis? What part?
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The hippocampus
CA1 |
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What are the different types of cortical malformations that can cause seizures?
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Poymicrogyria/pachygyria
Schizencephaly |
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What happens to the brain during polymicrogyria? What are symptoms?
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The surface of the brain is covered up with all kinds of little gyri.
Seizures Motor delay Developmental delay |
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What changes happen to the brain during schizencephaly?
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A malformation in the brain that results in gray matter being continuous from the ventricles to the pial surface.
It looks like someone took a chunk out of the brain |
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What's on the differential diagnosis for seizures?
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Syncope
Movement disorders Sleep disorders TIAs migranes |
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How do you differentiate between seizures and syncope?
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In syncope there's a warning of light-headedness and is usually precipitated by a change in position or sudden motion
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How do you differentiate between seizures and movement disorders?
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Movement disorders are usually ongoing, or if they're episodic, there's a variable duration
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How do you differentiate between seizures and sleep disorders?
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They occur in a specific phase of sleep
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How do you differentiate between seizures and TIAs?
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In TIAs there are usually negative symptoms
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How do you differentiate between seizures and migranes?
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Migranes are longer and also have a headache
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What are the differences between seizures and non-epileptic spells/pseudo-seizures?
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Pseudoseizures: less stereotyped
Characteristics: -Bilateral limb movemnets -Preserved consciousness -ASYNCHRONOUS LIMB MOVMENTS -Side-side head turning -Pelvic thrusting -Crying shortly after the spell -Prolonged motionless unresponseiveness, with forced eye closure |
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Are seizures and non-epileptic spells mutually exclusive in the same person?
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No.
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What's the algorithm for treating a single unprovoked seizure?
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1. Look for a cause
2. If there's a cause, treat it. 3. If not, don't treat it DON'T START AN AED AFTER THE FIRST!! |
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Should a person who has had a seizure be able to drive?
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NO
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What are some components of a workup for an unprovoked seuzre?
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Head CT
-Labs (electrolytes, blood levels, urinalysis, toxicology) -LP |
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What is the recurrence rate after a single unprovoked seizure?
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50%
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What are the requirements to perform surgery on someone who has epilepsy?
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1. Spells must be epileptic
2. Seizures must be focal/partial 3. All seizures must have the same focue 4. You've got to be able to remove the tumor safely |
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What's cure rate after surgery for epilepsy?
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70%
SURGERY FTW!!!! |
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What are some alternative treatment options to medication?
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Vagus nerve stimulation (30-50% patients have a reduction in seizures)
Ketogenic diet |
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What's the definition of status epilepticus?
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it's a pattern of recurrent seizures that lasts for more than 5 minutes
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What's the mortality rate for status eplepticus?
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20%
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If someone was in status epilepticus and they're still, should you relax?
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NOOOOO!!!!
The motor activity could have died out but the seizure is still going on. |
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What is the treatment algorithm for status epilepticus?
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1.ABCs
2. IV lorazepam 3.Fosphenytoin If still seizing, more fosphenytoin If STILL seizing, add another agent IF STILL SEIZING, induce a coma |
