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M2 Neuron Brain Behavior > 9/29 Seizures/Epilepsy - Bhise > Flashcards

9/29 Seizures/Epilepsy - Bhise Flashcards

1
Q

terminology:

ictal

post-ictal

interictal

A

ictal: during a seizure

post-ictal: immediately following seizure

interictal: time between seizures

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2
Q

Todd’s paresis

A

post-ictal contralateral hemiparesis

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3
Q

epileptiform

A

on EEG, discharge with appearance of being potentially epileptogenic (spike or sharp wave)

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4
Q

seizure

A
  • transiet episode with signs/sx of abnormal excessive synchronous neuronal activity in brain
  • physical manifestations vary based on pattern of network involvement in brain
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5
Q

mapping old terminology to current terminology

grand mal

petit mal

A

grand mal → generalized

petit mal → focal/partial onset/absent

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6
Q

seizure classification

two general types

multiple subtypes

A

1. general

  • tonic-clonic
  • tonic: only stiffening
  • clonic: only rhythmic jerking
  • myoclonic: rapid brief jerks
  • atonic/astatic: loss of postural tone
  • absence: brief staring spells

2. focal/partial

  • simple partial: no altered consciousness
  • complex partial: alteration of consciousness
  • secondary generalized
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7
Q

generalized tonic-clonic convulsion

A

bilateral tonic stiffening of extremeties alternating with clonic jerking

  • impaired consciousness
  • sympathetic sx: tachycardia, mydriasis
  • mild cyanosis at mouth, distal extremities
  • foaming at mouth
  • urinary incontinence
  • lateral tongue biting
  • post-ictal fatigue, weakness, amnesia
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8
Q

simple partial seizure

A

type of focal/partial seizure

  • manifestation related to brain region involved
  • may be an aura
  • no alteration of awareness
  • may progress into a CPS or GTC seizure
  • post-ictal deficit maybe seen
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9
Q

complex partial seizure

A

typical presentaiton: staring and alteration of awareness

  • possible gaze deviation, forced head deviation, or unilateral/asymmetric limb involvement
  • possible automatisms
  • might progress into GTC seizure
  • might see post-ictal deficit

often no recal of most of event

EARLIEST manifestation helps localize the source brain region

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10
Q

secondary generalized seizure

A

seizure activity beginning in one part of brain that spreads to involve the rest

transition may be slow over minutes OR fast and appear “generalized” at onset

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11
Q

symptomatic causes of seizure: categories

A
  1. metabolic-toxic
  2. structural
  3. benign
  4. genetic
  5. abnormal substrate
  6. rare causes
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12
Q

symptomatic causes

metabolic toxic seizure

A
  • electrolyte imbalance
  • ingestion
  • medication-induced
  • rapid withdrawal
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13
Q

symptomatic causes

structural

A
  • head trauma
  • stroke
  • anoxia
  • meningitis/encephalitis
  • tumor
  • brain malformation (AVM, cortical dysplasia)
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14
Q

symptomatic causes

benign

A
  • fever(children)
  • post syncopal
  • contact
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15
Q

symptomatic causes

abnormal substrate

A
  • autism
  • other genetic disorder
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16
Q

symptomatic causes

rare causes

A
  • inflammatory
  • degenerative
  • inborn error of metabolism
17
Q

mechanism of seizure

forces involved

concept of seizure threshold - how?

A

excitation

  • ionic currents: Na, Ca INWARDS
  • nt: glu, asp

inhibition

  • ionic currents: Cl INWARD, K OUTWARD
  • nt: GABA

in seizure, excitation >> inhibition

  • excitability to the extent that a seizure is produced occurs due to reduced seizure threshold

how?

  1. hypersynchronization (synaptic connectivity leading to propagation)
  2. inability to self-terminate (failure of negative feedback or feed-forward loop)
  3. changes in extracellular environment
  4. synapse chanel remodeling → permanency!
18
Q

mechanism of genetic epilepsies

A

genetic epilepsies code for proteins in ion channels

→ ion flow is affected (overexcitable or low inhibition)

19
Q

parts of the brain that are particularly prone to seizing activity

A

cerebral cortex and hippocampus particularly prone to synchronized bursts of activity

  • strong recurrent excitatory connections
  • intrinsically burst-generating neurons
  • ephaptic interactions among closely spaced neurons
  • synaptic plasticity
20
Q

epilepsy

A

disorder of the brain that results in seizures that are:

  1. recurrent
  2. unprovoked
  3. stereotyped
21
Q

seizure etiology

(classification)

A
  1. idiopathic → genetic
  2. symptomatic → structural/metabolic
  3. cryptogenic → unknown
22
Q

idiopathic seizures

A
  • genetic in nature without brain insult
  • probably polygenic inheritance

ex. benign epilepsy with centrotemporal spikes, childhood absence epilepsy

23
Q

symptomatic seizures

A

clear/known brain insult causes seizures

ex. metabolic-toxic, fever, head injury, tumor, meningo-enceph, pre/perinatal ischemic/anoxic injury, neuronal migration defect

24
Q

cryptogenic seizures

A

no evidence of a known brain insult or documented testing abnormality

  • test for: metabolic, radiologic, genetic evals
  • usually see degeneration, progression, regression
  • ex. infantile spasms
25
Q

genetics of seizures

A

most often polygenic and multifactorial

  • single gene can cause epilepsy syndrome
  • single gene can cause multiple syndromes or non-seizure disorders (ex. movement disorders)
  • diff genes (monogenic), may cause a single epilepsy syndrome

typically involve ion channels: Na, Ca, GABA, K

26
Q

localization of seizures and effects seen

  • temporal: medial vs lateral
  • frontal: dorsofrontal, SMA, orbitofrontal
  • parietal
  • occipital
A

temporal

  • medial: staring, automatism, posturing, fear
  • lateral: staring, vertigo, hearing

frontal: brief, bizarre, nocturnal

  • dorsolateral: contralateral vision
  • SMA: fencing posture
  • orbitofrontal: elaborate, sounds, smells

parietal: sensory

occipital: formed visual phenomena

27
Q

EEG

A

measures electrical activity over scalp generated by the cortex

  • captures wakefulness, drowsiness, stage2 sleep
    • epileptiform activity commonly activated in stage2 sleep
28
Q

when would you get an MRI of brain?

A

patients with evidence of focality in seizures

  • looking for underlying structural lesion (encephalomalacia, cortical dysplasia, stroke, tumor, AVM, etc)
29
Q

absence seizures

A
  • multiple events daily (could be > 100 daily)
  • usually 10s or less, triggered by hyperventilation, return to full awareness
    • often unnoticed
    • might have subtle automatisms during seizure
  • can contribute to poor academic performance

EEG: 3 Hz spike and wave

30
Q

Lennox Gastaut

A

starts between infancy-14yo

  • most common in 2-3yr old
  • more in boys

multiple seizure types seen

  • axial tonic
  • atonic
  • atypical absence

cognitive impairment or regression

EEG: slow spike and wave, GPFA seizures

tx: tough to control

31
Q

infantile spasms

when/who?

symptoms?

EEG

tx?

A

onset: 3-18months
* children with trisomy 21 or tuberous sclerosis more susceptible

characteristics

flexor, extensor, or combo events in clusters around sleep-wake transition

West syndrome: combo of spasms, hyparrhythmia, devpt regression

EEG shows hypsarrythmia: chaotic, high ampl, multifocal apikes, electrodecrement

idiopathic, symptomatic, or cryptogenic

tx: ACTH, vigabatrin, steroids, ketogenic diet

32
Q

benign rolandic epilepsy

A

most common type of childhood epilepsy

ages 4-15, most commonly 7yo

symptoms

  • nightime focal onset or rapid secondary generalized seizure
  • speech arrest, drooling, gurgling, facial tonic-clonic activity, facial hemisensory
  • infrequent seizures
  • cognitive problems (often with language)

EEG: bilateral independent centrotemporal spikes

good outcomes! likely to outgrow, so practitioners might choose not to treat

  • if do treat, treat following second seizure
33
Q

Wada test

A
  • injection of anesthetic into R or L internal carotid artery
  • test each hemisphere for memory and language
34
Q

status epilepticus

A

one continuous seizure > 30 min

OR

recurrent seizures without regaining consciousness between seizures for over 30 min

35
Q

acute management of status epilepticus

A
  1. ABCs
  2. IV lorazepam or diazepam
  3. fosphenytoin
  4. phenobarbital or valproic acid
  5. versed drip or pentobarbital coma

M2 Neuron Brain Behavior (53 decks)

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