Chapter 15: epilepsy

Question 1

Epileptic seizure

Answer 1

When there is abnormal and excessive electrical activity in the brain that leads to changes in the functioning or behavior of the patient. Depending on the focus of the epileptic activity a temporary disturbance occurs in, for instance, consciousness, motor skills, cognitive functioning or sensory functions.

Question 2

Clinical criteria for epilepsy

Answer 2

• At least 2 unprovoked seizures with an interval between seizures of more than 24 hours.
• One unprovoked seizure and probability of at least 60% one will have other seizures within 10 years.
• The diagnosis of an epilepsy syndrome.

Question 3

Classification steps

Answer 3

Classification of epilepsy happens in 3 steps:
1. The seizure types: focal, generalized or unknown.
2. Type of epilepsy: focal, generalized, combination or unknown.
3. Epilepsy syndrome.

Question 4

Focal onset

Answer 4

A seizure that lasts seconds or minutes.

Question 5

Motor onset

Answer 5

Small shocks, fidgeting with clothes (open-mouthed chewing for example).

Question 6

Non-motor onset

Answer 6

A rising sensation from the stomach area or smelling a strange smell for example.

Question 7

Tonic-clonic seizure

Answer 7

A generalized seizure with muscle twitching and jerking.

Question 8

Generalized onset

Answer 8

There are epileptic discharges in both hempispheres at the same time, which always leads to a loss of consciousness.

Question 9

Tonic

Answer 9

Stiffening of the body and muscles.

Question 10

Clonic

Answer 10

Muscle twitching

Question 11

Atonic seizure

Answer 11

Loss of muscle tention.

Question 12

Status epilepticus

Answer 12

When a seizure lasts too long or does not stop on its own.

Question 13

Conclusive status of a seizure

Answer 13

When there are continuous muscle cramps ant twitching and breathing is interrupted. This is life threatening.

Question 14

Non-conclusive status of a seizure

Answer 14

When someone shows confused or strange bahavior, but no muscle cramps and no trouble breathing.

Question 15

Etiology

Answer 15

First a MRI scan is done to determine structural brain abnomality and then there are blood tests and cerebronspinal fluid analysis to determine the cause of the epilepsy.

Question 16

Structural epilepsy

Answer 16

As a result of malformation of cortical development or an abnormal development of the cerebral cortex during pregnancy.

Question 17

Genetic epilepsy

Answer 17

Some people have non-functioning or reduced functioning sodium channels in their neurons that result in more epileptic charges.

Question 18

Treatment

Answer 18

• Anti-epileptic drugs help about 70% of people to get rid of seizures.
• Polytherapy: multiple medications.
• In people with focal epilepsy a surgery can help them. In surgery the site of where the seizures start is removed.
• Deep brain stimulation: electrodes in the brian to modulate activity.
• Keto diet.

Question 19

Network theory

Answer 19

Epilepsy should be regarded as a network disease. It is characterized by hypersynchrony of brain networks. The disruptions in their functional connectivity cause epileptic seizures. This theory states that cognitive impairment is not a consequnce of epilepsy, but a comorbidity.

Question 20

Cognitive functions

Answer 20

Only specific types of epilepsy are associated with a lower IQ. Temporal lobe epilepsy had been associated with impairments in episodic memory, which difficulties in encoding and retrieving new information (due to hippocampal atrophy).
People with epilepsy show a slowed information processing speed on tasks and first-generation epilepsy medication ca worsen this.
A lot of patients also show language problems, but limited impairment in verbal function. Naming and word-finding problems mostly occur.
They can be less able to recognize basis facial emotions and have impaired theory of mind. They can report mood symptoms, feeling more agitated, anxious and depressed.
They have a 3 times higher risk of developing dementia etc.