epilepsy 2

Question 1

what are the 6 main types of primary generalised seizures?

Answer 1

Absence seizures (‘petit mal’)
Tonic-clonic seizures (‘grand mal’, convulsions)
Myoclonic seizures
Clonic seizures
Tonic seizures
Atonic seizures (‘drop attacks’)

Question 2

what is an absence seizure?

Answer 2

begin & end abruptly –last for ~2-20 seconds
may occur a few times to ~100x daily
sudden blank starring (daydreaming / switched off)
brief impairment of consciousness, awareness &
responsiveness
may be accompanied by physical automatisms –blinking, lip
smacking, fumbling, picking at clothes, twitching of face &
body muscles
no memory / recollection of episode by subject
hyperventilation-induced reproduction
commonly occur in children ~4-14 years

Question 3

what is a tonic-clonic seizure?

Answer 3

most common & typical type of seizure (‘epilepsy’)
usually last for ~30-120 seconds
involve ‘tonic’ & ‘clonic’ phases

Question 4

what is the tonic phase?

Answer 4

generalised muscle contraction stiffening of limbs
loss of consciousness & fall (backwards) to the ground
evoked cry or moan
laboured or shallow breathing cyanosis
tongue, cheek or lip biting bleeding

Question 5

what is the clonic phase?

Answer 5

follows after ‘tonic’ phase
rhythmic contraction & relaxation of muscles jerking of
limbs
occasional bladder or bowel incontinence

Question 6

what is the post-ictal or recovery phase?

Answer 6

slow return to consciousness
muscle relaxation limpness
grogginess, confusion, somnolence
headache & aching limbs
amnesia of event

Question 7

what are myoclonic seizures?

Answer 7

short-lived –lasts for a few seconds
sudden jerks or twitches –irregular, shock-like jerks
may affect whole body
commonly affect arm(s) and/or leg(s), or head / trunk
consciousness is not impaired (single jerks) or impaired
(cluster of jerks clonic-tonic-clonic seizures)
usually occurs in the morning –shortly after waking

Question 8

what are tonic seizures?

Answer 8

generalised tightening of muscles stiffening of body

commonly occur during sleep & short-lived (~20 seconds)

Question 9

what are atonic seizures?

Answer 9

sudden loss of part or all muscle tone limpness
sudden head drop, slump or total collapse
forward fall risk of serious head injury
short-lived
very rapid recovery –no post-ictal confusion

Question 10

what are the three main types of partial or focal seizures?

Answer 10

Simple partial or focal seizures
consciousness is preserved during seizure
subject is alert, can respond to questions/commands &
can remember what occurred during seizure

Complex partial or focal seizures
consciousness is altered or lost
ability to pay attention or respond to questions or
commands is impaired or lost; amnesia of seizure event

Secondarily generalised seizures
partial seizures that spread to become tonic-clonic

Question 11

what are simple partial seizures?

Answer 11

involve only a small part of one side of the brain
subject is fully conscious & aware of surroundings
but have no control over seizure

Question 12

what do symptoms of a simple partial seizure depend on?

Answer 12

symptoms depend on part of brain affected
motor –stiffening, twitching, jerking, etc
sensory –light flashes, hallucinations & illusions, etc
autonomic –sweating, altered HR/BR, gastric discomfort
psychic –fear, anxiety, déjà vu, jamais vu, autoscopy

Question 13

what is complex partial seizures?

Answer 13

nvolve a greater part of one cerebral hemisphere
impaired consciousness & awareness
may occur as
simple partial seizure (Aura) followed by impaired
consciousness
impaired consciousness at seizure onset
most commonly involve one or both temporal lobes
typical duration –few seconds to ~3 minutes

Question 14

what does a complex partial seizure clinical manifestation depend on?

Answer 14

depend on site of origin &
degree of spread:
mainly automatic movements (automatisms)
lip-smacking, chewing, swallowing, etc
fumbling, picking, fiddling, shuffling cards, etc
grunts, repeating a phrase, screaming, running,
disrobing, pelvic thrusting, etc

Question 15

how long does it take to recover from a complex partial seizure?

Answer 15

Variable duration of recovery –minutes to hours

post-ictal confusion & fatigue

Question 16

what is a secondarily generalised seizure?

Answer 16

begin focally (as partial seizures) & spread to
become generalised tonic-clonic
may be preceded by an aura
variable symmetry, intensity & duration of tonic
(stiffening) and clonic (jerking) phases
typical duration ~1-3 minutes
postictal confusion & somnolence, with or without
contralateral Todd’s paralysis

Question 17

what is the basic classification of seizure types?

Answer 17

where the seizure began
the lebel of awarness during focal onset seizure
the nature of the first prominent signs and symptoms

Question 18

where are the different places a seizure could begin in the brain?

Answer 18

Focal onset –limited to one hemisphere of the brain
Generalised onset –originates simultaneously in both
hemispheres of the brain (based clinical or EEG findings)
Unknown onset –nature of onset not know with certainty

Question 19

what are the levels of awarness that can occur in a seizure?

Answer 19

Focal Aware –retained awareness

Focal Impaired Awareness –impaired awareness

Question 20

what are the different types of first prominent signs and symptoms of a seizure?

Answer 20

Motor onset –motor signs/symptoms at the onset

Non-motor onset –non-motor signs/symptoms at onset

Question 21

what is the ILAE classification of eplipsies and epliepsy syndromes?

Answer 21

based on whether seizures arise in a circumscribed
part of brain or in the whole brain
based on whether (or not) the disorder is associated
with an identifiable neurological abnormality (or cause)

Question 22

where could a seizure arise in a circumscribed part of the brain/ whole brian?

Answer 22

Localisation-related, Partial or Focal Epilepsies
seizures arise in a circumscribed part of brain
Generalised Epilepsies
seizures arise diffusely in entire brain –both cerebral
hemispheres

Question 23

what are the classes of an identifiable neurological abnormality?

Answer 23

Idiopathic
no apparent or obvious identifiable cause
presumed genetic basis
Symptomatic
known or obvious identifiable cause
Cryptogenic
no currently known cause, but presumed likely cause

Question 24

what are the two types of partial epilepsy?

Answer 24

Idiopathic (with age-related onset)
benign childhood epilepsy (‘Rolandic’ epilepsy)
childhood epilepsy with occipital paroxysms
primary reading epilepsy

Symptomatic or Cryptogenic
chronic epilepsia partialis continua of childhood
(e.g. ‘Rasmussen’s encephalitis’ )
temporal, frontal, occipital & parietal lobe epilepsies, etc

Question 25

what are the two types of generalised eplipsies?

Answer 25

``` Idiopathic (with age-related onset) benign neonatal familial convulsions benign myoclonic epilepsy in childhood, juvenile myoclonic epilepsy childhood absence epilepsy, juvenile absence epilepsy Symptomatic or Cryptogenic West Syndrome Lennox-Gastaut Syndrome ```

Question 26

how do you diagnose epilepsy?

Answer 26

``` based on probability –after exhaustive patient evaluation & assessment involves combined series of investigations Patient medical history Seizure description Physical examination Laboratory assessment EEG (and ECG) Neuroimaging (CT scan & MRI) ```

Question 27

what would be involved in a patient history for diagnosing epilepsy?

Answer 27

perinatal & developmental history history of febrile seizures history of CNS infection, trauma, etc family history of epilepsy

Question 28

what would be involved in a seizure description and history for a diagnosis?

Answer 28

past seizure episodes, duration, patterns, associated motor, sensory & behavioural features, etc pre-ictal phenomenon –aura ictal manifestations post-ictal state precipitating or trigger factors observer or eye witness accounts real-time eye witness video recordings of episodes

Question 29

what would be involved in a lab assessment for the diagnosis of epilepsy?

Answer 29

``` to rule out other possible causes of seizure complete blood count electrolyte panel & blood glucose blood urea nitrogen toxicology screen ```

Question 30

what would be involved in an EEG for the diagnosis of epilepsy?

Answer 30

the most useful diagnostic procedure for epilepsy involves recording of ictal or inter-ictal spikes, sharp waves & spike-wave discharges provides answers to 2 main questions does the patient have epilepsy? where is the ectopic focus or epileptogenic zone? various forms standard / sleep / ambulatory / video-telemetry

Question 31

what would be involved in neuroimaging for a diagnosis of epilepsy?

Answer 31

useful for detection or exclusion of structural or organic cause of epilepsy helps detect or define underlying brain lesions or neurological abnormality main indications adult-onset seizures seizures with focal features & suspected focal source refractory or worsening seizures

Question 32

overall, what are the 4 main steps of an epilepsy diagnosis?

Answer 32

Identify the type of seizure & precipitating factors consider differential diagnosis for non-epileptic event Correlate seizure type with EEG, if possible Determine the aetiology of epilepsy using history & diagnostic measures Classify the epilepsy syndrome