Epilepsy and its treatment Flashcards Preview

NMH: Module 2 > Epilepsy and its treatment > Flashcards

Flashcards in Epilepsy and its treatment Deck (37)
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1

Define epilepsy

a disease characterized by a tendency to recurrent unprovoked seizures

2

Define seizure

abnormal, excessive synchronized discharge of cerebral neurons

NB: epileptic seizures are a clinical manifestation of epilepsy

3

Comment on the age of incidence of epilepsy

Huge variety in age of incidence of epilepsy
2 peaks:
- childhood adolescence (20 ish)]- genetic predesposition?
- later in life (75)]- secondary to brain injury e.g. Alzheimer's, stroke etc

4

What is SUDEP?

Sudden Unexpected Death in Epilepsy (SUDEP)

It is a primary brain disorder (“short circuited” brain that fails to reboot)

5

Best way to prevent SUDEP?

Control the seizures

6

How to categorise the causes of epilepsy?

- Idiopathic (70%) i.e. genetic: mendelian-2% risk or non-mendelian-47% risk ("complex")

- Symptomatic (30%) i.e. secondary to brain injury: acquired or inherited

7

Mechanism of innate immunity in environmentally-acquired epilepsy

HMGB1 is released in chronic epilepsy -> binds to Toll-like receptors -> inflammatory cascade (cytokine release) -> cytokines interact w/ NMDA receptors -> hyperexcitability -> chronic seizures -> more HMGB1 released

8

Mechanism of adaptive immunity in environmentally-acquired epilepsy?

Autoantibodies against VGKC, NMDA, AMPA, GABA-a, GAD etc

9

Mechanism of inherited brain injury causing epilepsy?

Malformation of Cortical Development (MCD)

10

How do we classify epilepsy?

According to anatomical location of seizure onset

12

Loci identified by GWAS

- SCN1a (VGSC)
- PCDH7
- FANCL

13

How does a seizure in the latero-temporal cortex manifest?

Auditory hallucination

14

How does a seizure in the medial temporal lobe manifest?

Memory disturbance

15

How does a seizure in the occipital lobe manifest?

Visual hallucination

16

How does a seizure in the occipital pole manifest?

Seeing "lights"

17

Standardise Recording convention on EEG for epilepsy?

10-20 convention:
Distance between electrodes within 10-20% of AP and lateral dimensions of skukk

18

Describe why a deflection appears on an EEG

Synchronised discharge from a set of neurons -> Na+ influx -> sudden depletion of Na+ ions -> EEG -ve deflection

19

What appearance does epilepsy have on EEG?

Spike and slow wave

20

Limitations of using EEG for epilepsy?

- many layers of scalp diminish signal

- Bell’s reflex (blinking causes artefact)

- scalp muscles give artefact

21

How to categorise seizures?

Generalised epilepsy:
- absence, tonic, tonic-clonic, myoclonic, atonic

Focal epilepsy:
simple partial, complex partial, secondary generalised

22

Main causes of death from epilepsy in the UK?

- SUDEP

- status epilepticus -> can't breathe -> hypoxia

- LOC -> drowning

23

What is generalised epilepsy?

- `Extensive, synchronised discharge in both cerebral hemispheres + LOC

- Global ictal discharge

24

What is focal (partial) epilepsy?

Localised, synchronised discharge in one part of the brain

25

Describe tonic seizure

Contraction

26

Describe tonic-clonic seizure

Tense, jerk, repeat

27

Describe myoclonic seizure

Fasciculation

28

Describe atonic seizure

No muscle tone

29

Describe absence seizure

Brief LOC

30

Describe simple-partial seizure

No LOC

31

Describe complex-partial seizure

LOC