Epilepsy - Krupp/spitz

Question 1

What are the signs and symptoms of an epileptic seizure?

Answer 1

Generally positive signs. Altered consciousness, along with a paroxysmal change in behavior or movement.

The area affected will cause different symptoms (eg visual cortex seizure might generate visual hallucinations/lights/flashes etc.)

Question 2

Describe the difference between a primary generalized tonic-clonic seizure and a secondarily generalized tonic-clonic seizure

Answer 2

Secondary generalized–> starts as a partial seizure

Primary generalized–> starts generalized

Question 3

3 Hz, no postictal confusion, blank stare

Seizure type, category?

Answer 3

Absence (Generalized)

Question 4

Quick, repetitive muscle jerks.

Seizure type, category?

Answer 4

Myoclonic seizure (Generalized)

Question 5

Alternating stiffening and movement

Seizure type, category?

Answer 5

Tonic Clonic (Grand mal) (Generalized)

Question 6

Muscle stiffening.

Seizure type, category?

Answer 6

Tonic (Generalized)

Question 7

Person suddenly drops to the floor, often mistaken for fainting.

Seizure type, category?

Answer 7

Atonic seizure, aka Drop seizure (Generalized)

Question 8

What is status epilepticus?

Answer 8

continuous seizure for > 30 min or recurrent seizures without regaining consciousness between seizures for > 30 min.

Question 9

What is epilepsy?

Answer 9

a disorder of recurrent seizures
(febrile seizures are not epilepsy)

[The term epilepsy implies chronicity and is generally used to indicate a tendency for recurrent seizures because of an underlying brain abnormality. The incidence of epilepsy is 0.7%.]

Question 10

What are the 5 types of generalized seizures?

Answer 10

Tonic Clonic
Absence
Myoclonic
Tonic
Atonic

Question 11

What are partial seizures (definition)?

What are the 2 types of partial seizures?

What differentiates these two types?

Answer 11

Affect 1 area of the brain. Most commonly originate in medial temporal lobe. Often preceded by seizure aura; can secondarily generalize.

Simple partial
Complex partial

Simple–> retain consciousness
Complex–> impaired consciousness

Question 12

Between 15-30% of people with diagnoses of intractable epilepsy who are referred to seizure centers actually do not have epilepsy. What two diagnostic tools are most useful in making/eliminating this diagnosis?

Answer 12

1) Clinical history (what preceeded, what symptoms, what happened afterward). Question witnesses also.

Question 13

What differentiates partial and generalized seizures?

Answer 13

Generalized involve a wide swath of cortex from the outset.

Partial may involve the entire cortex, but originate in a focal area.

Question 14

How can one differentiate between partial complex seizures and an absence?

Answer 14

Both of these consist of a period of altered mental status unaccompanied by major motor manifestations.

Absence are generally not associated with negative symptoms in the postictal period, while partial complex seizures are.

Question 15

What is the clinical criteria for diagnosing epilepsy?

Answer 15

2 or more unprovoked seizures separated by greater than 24 hours or 1 seizure with studies suggesting further risk for seizures

Question 16

___% of seizure disorders are due to a structural abnormality.

Answer 16

30%

Question 17

Define febrile Seizure

Answer 17

An event in infancy or childhood, usually occurring between 3 months and 5 years of age, associated with fever but without evidence of intracranial infection or defined cause. Seizure with fever in children who have suffered a previous non-febrile seizure are excluded

Question 18

What causes the most common childhood seizure? In what population is it generally seen?

Answer 18

Febrile seizure, generally seen before age 3.

2-4% of kids have one

Question 19

What qualifies as intractable epilepsy?

What percent of new seizure patients will develop intractable epilepsy?

Answer 19

Seizures which do not respond to a trial of at least 3 anticonvulsants.

Approximately 30% of new onset seizure patients may develop intractable epilepsy.

Question 20

Differentiate between simple febrile seizures and complex ones.

Answer 20

Simple
– Generalized
– Less than 10 – 15 minutes
– Do not recur with in 24 hours

Complex
– Focal in nature at onset or during
– Longer than 10 – 15 minutes
– Recur in less than 24 hours

**If any criteria from complex are met, cannot be simple. 20-30% of seizures are complex.

Question 21

Febrile seizures usually occur within the first ____ hours of the illness.

True/false: febrile seizures occur at the highest temperature during a course of illness.

Answer 21

24

False. No correlation between the temperature and the onset of seizure.

Question 22

True/False: preventing a fever (eg temperature management) will prevent a seizure

Answer 22

False.

Question 23

What are the old-school classifications for epilepsy?

Low yield.

Answer 23

Symptomatic–> known etiology
Idiopathic–> unknown
Cryptogenic–> etiology not yet proven

Also Benign/Catastrophic, which are mostly self-explanatory.