Lec 42 Epilepsy

Question 1

What is a seizure?

Answer 1

release of excessive and uncontrolled electrical activity in the brain

Question 2

What is epilepsy?

Answer 2

seizure disorder –> neurologic condition cahracterized by 2 or more unprovoked seizures

Question 3

When does epilepsy usually present?

Answer 3

childhood or elderly

Question 4

What is intractable epilepsy?

Answer 4

epilepsy that is at least partially resistant to drug treatment
found in ~30% of those with epilepsy

Question 5

What is differential diagnosis for epilepsy [other things that look like epilepsy but aren’t]?

Answer 5

• syncope attack due to loss of cerebral blood flow
• cardiac arrhythmias
• migraines
• hypoglycemia
• narcolepsy
• panic attacks
• pseudoseizures [psychosomatic disorder]

Question 6

What are the 2 main categories of epileptic siezures?

Answer 6

• partial/focal/localization related

- primary generalized

Question 7

What are possible causes of primary generalized epilepsy?

Answer 7

• genetic causes, starts in childhood, adolescence

Question 8

What are possible causes of focal epilepsy?

Answer 8

• trauma, tumor, stroke, encephalitis [infection]

Question 9

What is onset/symptoms of primary generalized seizures?

Answer 9

• onset in both hemispheres, no aura, lasts 2-3 minutes, see EEG changes in al leads
• symptoms: generalized, post-ictal confusion, incontinence, amnesia

Question 10

What is the difference simple vs complex seizures?

Answer 10

• both are types of partial seizures

simple = have full consciousness, onset in 1 site or lobe

complex = impaired consciousness, onset in 1 site then spreads, most common site is MTL [medial temporal lobe]

Question 11

What is secondary generalized tonic-clonic seizure? common causes?

Answer 11

• a partial complex seizure that starts at a focus and then spreads to the rest of brain
• becomes secondarily generalized
• associated with trauma, stroke, drugs, old brain trauma, drug withdrawal

Question 12

What is absence seizure [petit mal]? characteristic EEG?

Answer 12

• type of generalized seizure
• common in kids
• sudden behavior arrest without falling
• EEG = 3Hz/s spikes
• no post-ictal confusion

Question 13

What are myoclonic jerks?

Answer 13

type of generalized seizure

• brief, rapid movement
• may or may not lose consciousness, no aura, may precede tonic-clonics

Question 14

What is juvenile myoclonic epilepsy? etiology?

Answer 14

• myoclonic jerk generalized epilepsy
• need life-long treatment
• due to familial/genetic
• associated with channelopathy

Question 15

What are tonic-clonic seizures [grand mal]?

Answer 15

• loss of consciousness
• alternating stiffening/jerking
• not preceded by aura
• amnestic for the event

Question 16

What are atonic seizures?

Answer 16

• drop seizure

- fall to the floor, mistaken for fainting

Question 17

What is reflexive epilespy?

Answer 17

• epilepsy brought on by particular triggers for seizure to occur
  ex. triggered by flashing light or by reading

Question 18

What is delta wave?

Answer 18

< 4Hz
seen in slow wave stage 3+4 sleep
also seen in encephalopathy, delirium, diffuse lesions

Question 19

What is theta wave?

Answer 19

4-8 Hx

drowsiness and stage 1+2 sleep

Question 20

What is alpha wave?

Answer 20

8-13 Hz

when awake, relaxed, eyes closed

Question 21

what is beta wave?

Answer 21

> 13 Hz
seen in anterior head regions
increasingly common in pts on benzos/barbs
normally sen when pt eyes open, alert, active thinking

Question 22

What type of EEG waveforms suppressed or promoted by caffeine/stimulants?

Answer 22

• suppress theta and alpha

- promote beta

Question 23

What are epilepsy auras?

Answer 23

• perceptual disturbance considered a simple seizure but often followed by secondary generalized seizure = considered “warning” sign

manifests as: intense fear, deja vu, olfactory or gustatory hallucinations, rising abdominal sensation, moving sensory symptoms or visual/motor symptoms

Question 24

What is status epilepticus?

Answer 24

continuous seizure for > 30 min OR recurrent seizures without regaining consciousness between seizures for > 30 min
= medical emergency

Question 25

What regions are most prone to being epiletogenic?

Answer 25

medial temporal = hippocampus, enterorhinal cortex, amygdala

Question 26

what are signs of temporal lobe seizure?

Answer 26

• epigastric rise at beginning
• intense fear
• deja vu
• olfactory hallucinations
• automatisms [lip smacking, chewing, button picking]

Question 27

What are signs of frontal lobe seizure?

Answer 27

• can be bilateral without loss of awareness
• often nocturnal
• contralateral muscle jerks [due to motor cortex involvement] = jacksonian march

Question 28

What are signs of occipital lobe seizure?

Answer 28

• complex figures or colors in part of visual field

Question 29

What is mesial temporal sclerosis?

Answer 29

• hippocampal sclerosis causing temporal lobe epilepsy [TLE]
• important cause of refractory epilepsy [ie epilepsy poorly controlled by meds]
• characterized by neuronal loss in CA1, CA3, and CA4 regions of hippocampus + atrophy and gliosis

Question 30

What is clinical presenation of mesial temporal sclerosis?

Answer 30

• aura of rising epigastric fullness
• intense fear
• impaired consciousness
• automatisms –> lip smacking, chewing, button picking

EEG –> anterior temporal spikes
MRI –> hyperintensity + atrophy of hippocampus

Question 31

What are signs of frontal lobe epilepsy?

Answer 31

• often nocturnal
• brief vocalizations, shaking, forced head turn to opposite side from epiletpic foci
• jacksonian march = myoclonus begins in one pat of body and migrates along the pattern of the motor homunculus

Question 32

What is todd’s paralysis?

Answer 32

• post-ictal condition of focal weakness in one part of body
• helps you discriminate between primary and secondary generalized seizure b/c region of weakness = region of focus
• can be confused with stroke

Question 33

How do you distinguish frontal lobe epilepsy vs frontal stroke?

Answer 33

epilepsy: pt looks away from epileptic foci, promotes contralateral eye movement
stroke: pt looks toward lesion due to unopposed ipsilateral eye movement from preserved hemisphere

Question 34

What is rolandic seizure?

Answer 34

• benign epilepsy with centrotemporal spikes
• resolves by adolescence
• usually occurs shortly after falling asleep

signs: unilateral parasthesia and clonus of tongue, lip, pharynx, dysarthria, drooling

Question 35

What is lennox-gaustat syndrome?

Answer 35

• triad: mental retardation, slow spike and wave, multiple seizure types
• diagnosed before age 8
• tonic seizures out of sleep

Question 36

What is west syndrome?

Answer 36

• infantile spasms age 3-12 mo
• sudden jerk followed by stiffening
• treat with ACTH if AEDs fail
• may be due to tuberous sclerosis

Question 37

What are febrile seizures?

Answer 37

• benign simple seizure, less than 15 min with shaking
• occurs in 3mos - 5yos with fever
• treatment not required

Question 38

Tumors in which locations of brain are more or less likely to cause seizures?

Answer 38

more common: near rolandic fissure, temporal lobes, insular cortex

cerebellum/brainstem tumors do not causes seizures

Question 39

When is it safe to withdraw treatment from pt with epilepsy?

Answer 39

• if seizure free for 3 years –> perform slowly + carefully

Question 40

Are epileptic drugs safe for pegnant?

Answer 40

• risk of teratogenicity especially with valproate

- withdrawing drug therapy in pregnancy more risky than continuation