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Emma H&N II > Epilepsy > Flashcards

Flashcards in Epilepsy Deck (19)
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1
Q

epilepsy

A

a tendency to spontaneous, recurrent seizures, usually defined by experience of at least 2 UNPROVOKED seizures

2
Q

age w/ highest incidence of seizures

A

first year of life –> highest incidence of epilepsy

then incidence rate decreases until about mid 20s and plateaus

then at age 60 slowly increases

3
Q

seizure: an abnormal, “clinically observable” event associated w/ and caused by an abnormal “____________” discharge in the EEG

A

an abnormal, “clinically observable” event associated w/ and caused by an abnormal “HYPER SYNCHRONOUS” discharge in the EEG

4
Q

seizure first aid

A

roll person on side (to prevent aspiration)

most seizures setup on their own <2 min

5
Q

damaging features of seizures

A
  • external injury
  • motor activity: hypoxemia, acidemia, hypercarbia/hypoventilation
  • local neuronal metabolic exhaustion
  • EAA damage (excitatory amino acid damage)
  • psychological factors
  • poss. reinforcing seizure circuit if let keep firing
6
Q

seizure types (broad)

A
  1. partial (focal) –> localized
    - simple, complex, or partial w/ secondary generalization
  2. generalized –> all over brain
    - absence, myoclonic, tonic-clonic
7
Q

focal seizure vs. generalized seizure

A

refers to ONSET

focal –> starts in just a focal area of cortex, possibly causing a manifestation related to the function of that area of cortex, and then may or may not spread

generalized –> starts all over the surface of the brain at the same time

8
Q

Jacksonian march

A

seizure begins with CLONIC activity in one limb or the face and sequentially SPREADS to the remainder of the involved hemibody, ultimately involving both sides of body w/ a bilaterally synchronous convulsion

EEG discharge: from subset of the motor strip to the whole of one hemisphere, to generalized involvement of BOTH hemispheres

9
Q

features of pt presenting w/ seizures

A
  • focal/asymmetrical features
  • stereotyped, brief episodes
  • randomness (not every time you’re in pool, etc.)
  • activity that starts on ONE SIDE before other
  • preferential eye turning
  • one side stiff, other limp
  • POSITIVE signs vs. negative signs
10
Q

background features of pt possibly presenting w/ seizures

A

-early handedness = hemiparesis
(started using one hand exclusively, early on, bc other hand was abnormal)

  • limb asymmetry (one hand abnormally small bc that side of brain is defective)
  • developmental delay/cognitive disability
11
Q

partial seizures signs

A
  • motor (Jacksonian march)
  • autonomic (vomiting, borborygmi)
  • somatosensory
  • psychic signs
  • autonmatisms
12
Q

how are automatisms unique from other partial seizure signs?

A

they are RELEASE phenomena, NOT driven directly by the seizure discharge.

represent the release of automatic, pre-programmed behaviors that are normally suppressed by the cerebral cortex.

13
Q

processes leading to focal seizures

A
  • old birth injury/stroke
  • old traumatic injury
  • AVM
  • focal dysgenesis/brain malformation
  • sequela of CNS infection
  • tumor
  • genetics
14
Q

causes of generalized epilepsy

A
  • GENETIC

- metabolic derangement

15
Q

simple partial seizure

A

consciousness maintained

16
Q

complex partial seizure

A

loss of consiousness

17
Q

partial seizures w/ secondary generalization

A

initial focal activity, then spreads

still tx as focal seizure

18
Q

types of generalized seizure

A
  1. absence (children, blank stare, brief)
  2. myoclonic (rapid jerking)
  3. tonic-clonic (stiffness THEN jerking)
19
Q

tonic-clonic EEG pattern

A

Sudden, rapid spikes everywhere –> person stiffened (tonic phase)

then activity slows down enough that each spike can cause a separate jerk (clonic phase)

then slows down further