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NEURO CLERKSHIP > Epilepsy and EEG > Flashcards

Epilepsy and EEG Flashcards

1
Q

Criteria for epilepsy

A
  1. Two unprovoked seizures > 24hrs apart
  2. 1 unprovoked seizure with the probability of further seizures
  3. Two seizures in a setting of reflex epilepsy
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2
Q

Which cells are involved in the origin of seizure activity

A

Pyramidal Cells

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3
Q

Definition of seizure

A

Paroxysmal transient occurrence of signs and symptoms due to abnormal excessive or synchronous neuronal activity in the brain

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4
Q

What is the definition of epilepsy?

A

A disorder of the brain where there is a predisposition to generate epileptic seizures leading to neurobiological, cognitive and psychological/social consequences of the disorder

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5
Q

What is a generalized seizure?

A

A seizure originating within and rapidly involving bilaterally distributed networks (cortical/subcortical) that can be asymmetrical

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6
Q

What is a focal seizure?

A

Originating from a discrete location within one hemisphere; may spread to contralateral hemisphere

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7
Q

Best test for evaluating and diagnosing epilepsy

A

EEG

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8
Q

Benefits of EEG

A
  1. Distinguish generalized and focal epilepsy
  2. Distinguish epilepsy and non-epileptiform events
  3. Can r/o subclinical seizures causing AMS in ill patients
  4. Diagnosing hypoxic/anoxic brain injuries, herpes encephalitis
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9
Q

Minimum criterion for a useful EEG

A

45mins and asleep

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10
Q

Factors which increase the yield of the EEG

A
  1. Within 24-48hrs of seizure
  2. Done w/ sleep deprivation
  3. Recorded sleep state
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11
Q

When to consider Tx after a single seizure

A

If epileptiform activity is seen on the EEG

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12
Q

What are landmarks used to place the EEG leads?

A
  1. Nasion
  2. Inion (occipital protuberance)
  3. Zygoma
  4. Tragus
  5. Preauricular Point
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13
Q

What are the types of EEG waves and their respective frequencies?

A

Alpha 8-13Hz
Beta 13-30Hz
Theta 4-8Hz
Delta 1-4Hz

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14
Q

What is the T6 Spike?

A

An intra-ictal event which shows up as a sharp peak between episodes

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15
Q

What is a focal seizure without loss of consciousness?

A

Simple Partial

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16
Q

What is a focal seizure with a loss of consciousness/dyscognitive?

A

Complex Partial

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17
Q

What is a focal seizure that evolves to result in bilateral convulsions?

A

Partial Seizure with secondary generalization

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18
Q

What term denotes a focal seizure?

A

Partial

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19
Q

Which term denotes no loss of consciousness?

A

Simple

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20
Q

Which term denotes loss of consciousness?

A

Complex

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21
Q

What are different types of generalized-onset seizures?

A
  1. Absence
  2. Myoclonic
  3. Tonic-Clonic
  4. Atonic
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22
Q

What is the typical EEG finding of an Absence Seizure?

A

3Hz Spike and Wave

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23
Q

What are the possible etiologies of epilepsy?

A
  1. Genetic
  2. Structural/Metabolic
  3. Idiopathic
  4. Immune Mediated Inflammatory Process
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24
Q

What are some examples of genetic causes of epilepsy?

A

Channelopathies (Dravet Syndrome, AD Nocturnal Frontal Lobe Epilepsy)

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25
What are some structural causes of epilepsy?
1. CVA 2. Tumor 3. Trauma 4. AV Malformation 5. Infection/Abscess
26
What are some metabolic causes of epilepsy?
1. Hypernatremia | 2. DKA
27
What is a possible cause of seizures in the neonate?
Benign Familial Neonatal Epilepsy
28
What are possible causes of epilepsy in infancy?
1. West Syndrome | 2. Dravet Syndrome
29
What are possible causes of epilepsy in children > 1?
1. Benign Epilepsy with Centrotemporal Spikes | 2. Childhood Absence Epilepsy
30
What is the Triad for Infantile Spasm?
1. Hipsarrythmia 2. Spasms 3. Psychomotor
31
What is the treatment for Infantile Spasm?
1. ACTH 2. Pyridoxine 3. Ketogenic Diet 4. Vigabatrin 5. DPK 6. Zonisamide 7. TPX
32
What are the possible etiologies of Infantile Spasm?
1. Malformations 2. Tuberous Sclerosis 3. Down Syndrome 4. Phenylkentonuria 5. HIE 6. Genetic Mutations (forehead protein G1 14q12 duplications)
33
What is the EEG appearance of hipsarrythmia of Infantile Spasm?
Disorganized Background
34
What are the common seizure disorders of Adolescence to Adult?
1. Juvenile Myoclonic Epilepsy | 2. Juvenile Absence Epilepsy
35
Which syndrome may present as excessive clumsiness in the morning due to myoclonic jerks?
Juvenile Myoclonic Epilepsy
36
What are structural syndromes causing epilepsy?
1. Mesial Temporal Lobe Epilepsy w/ Hippocampal Sclerosis 2. Gelastic Seizures w/ Hypothalamic Hamartoma 3. Neurocutaneuous Syndromes (Sturge Weber, TS) 4. Cortical Malformation
37
What is the purpose of +/- contrast MRIs in the evaluation of epilepsy?
To r/o heterotopia or mesial temporal sclerosis
38
What is the special consideration in doing an MRI of a child under age 2 for epilepsy?
Repeat MRI after a year incase cortical lesions did not show up
39
What imaging studies can be used in patients with Epilepsy?
1. MRI 2. SPECT 3. PET 4. MEG
40
What is the chance of having a second seizure within 5 years of an unprovoked seizure?
30-50%
41
What is the Goal of Therapy for Epilepsy>
1. Complete Seizure Control 2. No adverse events 3. Best quality of life
42
What is Treatment-Resistant?
Failure of adequate trial of two well tolerated, appropriately chosen medications to achieve seizure freedom
43
Which anti-epileptics induce CYP enzymes?
1. Phenobarbital 2. Phenytoin 3. Carbamazepine 4. Oxcarbamazepine 5. Valproate 6. Ethosuximide
44
What are common side effects of all anti-epileptics?
1. Drowsiness 2. Dizziness 3. Fatigue 4. Teratogenicity
45
What are the broad spectrum AEDs?
1. Valproate 2. Lamotrigine 3. Levetiracetam 4. Topiramate 5. Phenobarbital
46
What is meant by "broad spectrum" AED?
Effective against focal and generalized seizures
47
How can Valproate (Depakote) be administered?
IV or PO
48
What are the side effects of Valproate (Depakote)?
1. Teratogenicity | 2. Weight Gain
49
Which AED is good for pregnancy?
Lamotrigine (Lamictal)
50
Which AED causes rash/SJS?
Lamotrigine (Lamictal)
51
How can Levetiracetam (Keppra) be administered?
IV or PO
52
What is the benefit of Levetiracetam (Keppra)?
Few side effects/drug interactions
53
What is a side effect of Levetiracetam (Keppra)?
Irritable mood
54
How can Topiramate (Topamax) be administered?
PO
55
Which AED works well for migraine prophylaxis?
Topiramate (Topamax)
56
What are the side effects of Topiramate (Topamax)?
1. Weight Loss 2. Impaired fluency/Cognition/naming objects 3. Renal Stones 4. Numbness and tingling
57
How can Phenobarbital be administered?
IV or PO
58
What is the main side effect to watch out for with Phenobarbital?
Respiratory Depression
59
Which AED may be abused?
Phenobarbital
60
What are non-pharmacologic treatments for seizures?
1. Vagal Nerve Stimulation 2. Epilepsy Surgery 3. Ketogenic Diet 4. Psych Tx
61
What is meant by Catamenial Epilepsy?
The increase in seizure frequency some women experience during certain times of their menstrual cycle
62
What is the effect of estrogen on seizures?
It lowers seizure threshold
63
Epilepsy in women is associated with
1. Infertility 2. Decreased libido 3. Increased Polycystic Ovarian Syndrome
64
What is the effect of AEDs on bone health?
1. Increased fractures | 2. Decreased bone mineral density
65
How are AEDs teratogenic?
They cause NTDs (even exposure 28 days prior to conception can cause NTDs)
66
Which nutritional supplement may be beneficial to mitigate the teratogenic effects of AEDs?
Folic Acid
67
Which AED has the highest risk of major congenital defects?
Valproate
68
Why should changing AEDs during pregnancy be avoided?
Because the risk of a seizure puts the fetus at risk of hypoxic injury and the mother could be injured
69
What is status epilepticus?
At least 5 mins of octal activity OR 2+ seizures between which there is incomplete recovery of consciousness
70
What is the risk of status epilepticus?
The prolonged convulsive state can lead to cardiorespiratory collapse, multi organ failure or neonatal injury
71
What is the treatment order for Status Epilepticus?
1. Benzodiazepines 2. IV Fosphenytoin - can use Valproate/Levetiracetam/lacosamide 3. Intubate w/ IV Midazolam or Thiopental
72
What is the criteria for being free of epilepsy
10yrs seizure free w/o medication

NEURO CLERKSHIP (10 decks)

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