CHAPTER 16 EPILEPSY Flashcards
are a group of somewhat diverse,
age-dependent phenotypes that are characterized by generalized 2.5- to 4-Hz bifrontally predominant spikes or polyspike-and-slow-wave discharges that arise without underlying structural abnormalities.
genetic component underlies many
of these disorders
primary generalized epilepsies
This is the tonic phase of the seizure and lasts for
_______
10 to 20 s .
clonic jerking of the extended limbs (usually less
severe than those of a grand mal seizure) that occurs with _________
vasodepressor syncope or a Stokes-Adams hypotensive
attack.
Absence seizures are said to be________ if they have a
rapid onset and offset, typical three per second spike andwave, and complete loss of awareness
“typical”
In many such patients, ________ for 2 to 3 min is an effective way of inducing absence attacks.
voluntary
hyperventilation
Cases of absence status have also been
described in adults with ________
frontal lobe epilepsy
and about _______of absence pts will at some time
have major generalized (tonic-clonic) convulsions
half
_________ is a
term that was introduced to describe long runs of slow
spike-and-wave activity, usually with no apparent loss
of consciousness.
Atypical absence
onset between 2 and 6 years of age and
is characterized by atonic, or astatic, seizures (i.e., falling attacks), often succeeded by various combinations of minor motor, tonic-clonic, and partial seizures and by progressive intellectual impairment in association with a distinctive, slow (1- to 2-Hz) spike-and-wave EEG pattern.
Lennox-Gastaut syndrome
infantile spasms, a characteristic
high-amplitude chaotic EEG picture (“hypsarrhythmia”),
and an arrest in mental development
West syndrome
Conditions associted with West
Prematurity, perinatal injury and metabolic
diseases of infancy are the most common underlying
conditions.
_____________,
when occurring in isolation, is relatively benign
and usually responds well to medication
seizure-associated myoclonus
___________characterizes the group of juvenile
lipidosis, Lafora-type familial myoclonic epilepsy,
certain mitochondrial disorders, and other chronic familial degenerative diseases of undefined type
Chronic progressive polymyoclonus
with dementia
the most common form of idiopathic generalized
epilepsy in older children and young adults. It begins in
adolescence, typically around age 15 years, with a range that essentially spans all of the teenage years.
JME
myoclonic jerks of the arm and upper trunk that is brought out with __________
fatigue, early stages of sleep, or alcohol ingestion.
EEG of JME
A linkage has been established to ______
4- to 6-Hz irregular polyspike activity.
chromosome 6
AEDS for JME
VA, Lev, LTG
MC origin of Frontal Lobe Seizures
SMA
Tonic elevation and extension of the
contralateral arm (“fencing posture”) and choreoathetotic
and dystonic postures have been associated with _____________
high medial frontal lesions
___________been recorded in proven
cases of temporal lobe disease and less often with lesions of the insula and parietal operculum;
Gustatory hallucinations
It has been noted that lesions on the
___________ (Brodmann areas 18
and 19) are likely to cause a sensation of twinkling or
pulsating light
lateral surface of the occipital lobe
_________usually located in the superoposterior
temporal region or the junction between parietal
and temporal lobes
Vertiginous sx
_____ sensations come from temporal lobe, upper bank of the sylvian fissure, in the upper or
middle frontal gyrus, or in the medial frontal area near
the cingulate gyrus
visceral sensations
gelastic seizures and precocious puberty has been traced __________
to a hamartoma of the hypothalamus.
43 percent displayed some of the motor
changes;
32 percent, automatic behavior;
and 25 percent, alterations in psychic function
what is this triad
psycho-motor triad
______which is reported on video recording to
occur in half of patients with temporal lobe seizures, is
carried out by the hand ipsilateral to the seizure focus
Postictal
nose wiping,
Psych comorbids of MTS
Depression
Anxiety
Psychotic: 10%
The EEG during this period may show no seizure discharge,
although this does not exclude repeated seizures in temporal
lobe structures that are remote from the recording
electrodes. This disorder, virtually indistinguishable from
psychosis, may also present in the interictal period.
paranoid-delusional or amnesic psychosis
anger, paranoia, and cosmologic or religious
conceptualizing are more characteristic of_______ temporal
lesions.
left
SUDEP has _______lifetime incidence
9%
pathophysiology of SUDEP
A postictal “shutdown”
of brainstem activity resulting in hypercapnia or hypoxemia
has been suggested.
The risk of sudden death is as high as ______ times greater for untreated patients
20
common focal motor epilepsy is unique among the
focal epilepsies of childhood in that it is self-limiting
despite a very abnormal EEG pattern
autosomal dominant trait
and begins between 5 and 9 years of age.
BECTS
benign in the sense
that there is no intellectual deterioration and the seizures
often cease in adolescence, has been associated with
spike activity over the occipital lobes
Epilepsy with Occipital Spikes
spikes are greatly accentuated by sleep
Epilepsy with Occipital Spikes
Benign Epilepsy of Childhood with
Centrotemporal Spikes
Both the seizures and the EEG abnormalities
may respond dramatically to treatment with
adrenocorticotropic hormone (ACTH), corticosteroids, or
the benzodiazepine drugs, of which clonazepam is probably
the most widely used.
Infantile spasms
Infantile spasms may later progress to the _______a seizure disorder of early childhood of graver
prognosis
Lennox-Gastaut st;ndrome,
