Neurology

Question 1

What is neurodivergency?

Answer 1

Individuals who’s neurology differs substantially from what is considered typical or normal.

Question 2

What is a seizure?

Answer 2

A sudden alteration of neurological function.

Question 3

What is epilepsy?

Answer 3

2 unprovoked seizures at least 24 hours apart.

Question 4

Is epilepsy an investigation based diagnosis or a clinical diagnosis?

Answer 4

Clinical

There is no diagnostic test, it is history based. An EEG is the gold standard SUPPORTIVE test, but only if it is during a seizure.

Question 5

What elements to a history are specific and crucial to form an epilepsy diagnosis?

Answer 5

Eye witness account
Circumstances around the episode
Onset
Evolution of episode
Post ictal period
Aura?
Are the episodes always the same? - if not, not epilepsy

Question 6

What test is over-interperated, causing misdiagnoses of epilepsy?

Answer 6

EEG

Minor EEG abnormalities are common in the general population, often with no symptoms or any issues.

Question 7

Give 3 overarching causes of non-epileptic seizures.

Answer 7

Organic,
- CVS/neuro/etc causes
Psychogenic,
- Psychiatric disorders
Malingering,
- Not real seizures, patients have some or all control

Question 8

Give 2 examples of CVS causes of non-epileptic seizures.

Answer 8

Syncope
Reflex Anoxic Seizures (RAS)

Question 9

What is syncope + seizure-like activity called?

Answer 9

Convulsive syncope. Not the same as syncope-induced seizures, these are anoxic epileptic seizures.

Question 10

What are some differentials for night time episodes?

Answer 10

Parasomnias (Night terrors)
Nocturnal seizures/Epilepsy (usually frontal/temporal lobe)
Psychogenic
Cardiogenic
Benign monoclonus jerk - commonly missed in infants and diagnosed as epilepsy

Question 11

What are parasomnias?

Answer 11

Night terrors or similar events.

They usually occur before 12am and are common in early childhood (~3% of children)

After the episode they return to normal but have no recollection of it occurring.

Parents often got woken by young children crying/screaming at night, go to see whats wrong only to find the child has gone back to sleep.

They can also include sleep walking/talking.

Question 12

What are nocturnal seizures/epilepsy?

Answer 12

Usually frontal lobe epilepsy that can occur at any age. They are normally short episodes and can happen multiple times per night.
They can also occur if sleeping in the day.

Stereotypically, frontal lobe seizures are characterised by initial hyper-motor arm posturing. (I think it kinda looks like drawing a bow) (extending one arm whilst flexing the other).

Question 13

What are benign monoclonus (myoclonus) jerks?

Answer 13

Twitching or random movements of a single muscle or group of muscles that can occur whilst sleeping. Affects many people in their sleep, a lot of which don’t know it happens, and is harmless.

Certain BMJs can also occur as nonREM sleep-wake transition disorders.

Question 14

What are nonREM sleep-wake transition disorders?

Answer 14

Events/episodes that can occur whilst the body transitions from being awake to nonREM sleep. Normally harmless, although they can be distressing if they are severe.

Question 15

Give 4 examples of nonREM sleep-wake transition disorders.

Answer 15

Nocturnal cramps (commonly in the leg - calf)
Rhythmic movement disorders (head bobbing whilst asleep)
‘Sleep starts’
Sleep talking

Question 16

What are ‘sleep starts’?

Answer 16

The sudden jumping awake just as you are about to fall asleep (transition from wake to nonREM sleep). They are often described as ‘feeling like I’ve fallen into my bed whilst sleeping’.

70-80% of people report being able to recall it happening at somepoint in life.

Question 17

What are REM parasomnias?

Answer 17

Parasomnic events that occur in REM sleep.

Question 18

Give 4 examples of REM parasomnias.

Answer 18

REM sleep behaviours
REM-related sinus arrest
Nightmares
Sleep paralysis

Question 19

Why can you sometimes remember a nightmare?

Answer 19

If a nightmare occurs during REM sleep - when the mind processes the day, emotions, fears - and you quickly transition from REM->nonREM->awake then you can remember them. You will normally wake up in the middle of the night remembering them. Something triggers you to quickly wake up from the REM sleep.

Question 20

Why does sleep paralysis occur?

Answer 20

During REM sleep, the brain and eyes are the only bit of the body that remains ‘active’. If you wake up during REM sleep (without transitioning through the sleep cycle) then your brain and eyes are the only things that are ‘active’.

This means you can move your eyes and process vision and be aware, but cannot move. Eventually the body will transition to being awake and the paralysis will go away.