Adult Seizure Disorder Flashcards Preview

Neurology > Adult Seizure Disorder > Flashcards

Flashcards in Adult Seizure Disorder Deck (38):
1

Seizure

Episode of abnormally synchronized and high frequency firing of neurons resulting in abnormal behavior or experience.

2

Epilepsy

Chronic brain disorder of various etiologies characterized by RECURRENT, UNPROVOKED seizures

3

WHat are some conditions that may provoke seizures

fever, acute head trauma, metabolic disorders such as hypo or hyperglycemia, electrolyte disturbances such as hyponatremia

4

Increase in rate of epileptic seizures in pts over 60. WHy?

High rate of strokes in that age group and strokes predispose to epileptic seizures

5

Epilepsy incidence peaks?

Children and the elderly

6

causes of adult onset epileptic seizures

- cerebrovascular disease
- Trauma
- Tumors
- Infection
- Cerebral degeneration

7

What are partial seizures

- Focal onset seizures that emanate from a specific cortical region. They affect 1 area of the brain and most commonly originate in the median temporal lobe. May spread to become generalized

8

Generalized seizures

no focal onset, thought to originate from brainstem structures; with spread to both hemispheres at the same time.

9

Simple partial seizure

consciousness intact

10

Complex Partial

Impaired consciousness

11

So what are the two types of partial seizures

simple and complex

12

Partial seizure with secondary generalization

consciousness lost + bilateral cerebral involvement

13

Simple partial seizures emanating from the motor cortex may demonstrate what

Jacksonian March. That is, they start at the hand and march up to involve the arm and face on the same side.

14

Simple partial seizures involving the sensory cortex involve what

tingling or numbness of an extremity or side of face

15

Simple partial seizures involving autonomic

Rising epigastric sensations, nausea,

16

Simple partial seizures that are psychic involve

Fear, deja vu, jamais vu

17

Complex partial seizures

impaired consciousness

- Remmeber that partial is interchangeable with focal in seizure talk

18

Complex partial seizures typically emanate from the temporal or frontal lobe

ok

19

Complex partial seizures last how long

about 1 minute

20

Features of complex partial seizures

- Blank stare
- Oral automatisms: chewing and lip smacking movements
- Typical hand automatisms are hand rubbing or picking movements

- contralateral dystonic posturing- sustained muscle contractions on one side of the body cause twitching. A result of a spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia.

- Post-ictal amnesia and confusion

- Focal abnormality of EEG

21

What are the 6 types of Primary Generalized seizures

- Absence
- Tonic-clonic
- Clonic
- Tonic
- Myoclonic
- Atonic

22

Absence Seizure

- Brief Loss of consciousness
- Staring spell
- No post-ictal confusion
- Subtle myoclonic

23

Tonic-Conic Seizure

- loss of consciousness
- muscular rigidity (tonic)
- jerking movements (clonic)
- tongue-biting/ injury common
- bladder/ bowel incontinence
- post-ictal confusion/ sleep

24

Myoclonic seizure

- Brief muscle contractions (clonic) of the head and upper extremities
- Usually symmetrical and bilateral
- consciousness preserved
- precipitated by awakening or falling asleep
- may progress into tonic-clonic seizures

25

Atonic

- Impaired consciousness
- loss of muscle tone
- head drop
- fall
- brief duration
- injury common

26

Seizure diagnosis

- history from patient and witness (very important)
- Physical and neurological exam
- CBC, metabbolic panel (CMP), AED (anti-epileptic drug levels...helps determine whether pt has not been taking meds or screwed up the dose)
- inter-ictal EEG
- Epilepsy protocol MRI
- Video-EEG monitoring

27

Serial EEGs reveal epileptiform discharges in what percent of patients

80-90....way better than inital EEG

28

Outside of Serial EEGs, what are some good ways to detect epileptiform changes

studies with sleep deprivation and extended recording times

29

Sharp waves, spikes, sharp and slow wave discharges?

All examples of epileptiform abnormalities

30

Bilateral and symmetrical spke and wave activity occuring at a frequency of 3 per second (3 hz) is classic EEG for

Absence seizure

31

Receont onset epilepsy in adults requires

MRI

32

Causes of tumors in adults

tumors, trauma, stroke, infection

33

Epilepsy MRI protocol

- You want high res T1 weighted volume set, coronal slices, through the whole brain

- ALso a coronal T2 weighted sequence, using 3mm thin sections, should also be done to detec hippocampal sclerosis

34

Video- EEG monitoring

simultaneously records EEG and seizure.
- Useful in differentiating epleptic seizures from non
- Essential for pre-surgical localization of seizure focus

35

In most neuronal circuits, GABA inhibition exerts a powerful suppression of excitability

This inhibition is overcome during the development of a focal seizure.

- A seizure results when excitation significantly exceeds inhibition. Know that most antiepileptic medications work by attempting to restore the excitation inhibition balance by reducing glutamate-mediated excitation or by increasing GABA mediated inhibition

36

Two types of remission when fighting epilepsy

Medical remission: seizure free with no side-effects on 1 or 2 AEDs

Disease Remission: Seizure free off all AEDs...generally a result of surgery

37

Intractable epilepsy

Disabling seizures- seizures causing impaired quality of ife, limited educational or occupational apportunities, physical injuries, or social compromise.

38

Status epilepticus

continuous, generalized, convulsive seizure lasting more than 5 minutes or two or more sequetial seizures occurring without full recovery of consciousness