Lecture 45: Epilepsy

Question 1

Seizure

Answer 1

Uncontrolled release of electrical activity

Question 2

Epilepsy

Answer 2

Seizure disorder: two or more unprovoked seizures

Question 3

How often does a seizure have a found cause?

Answer 3

25%

Question 4

Kindling

Answer 4

Epilepsy isn’t good for you, the more you have the more you get

Question 5

Main categories of epilepsy (2)

Answer 5

Primary Generalized; Focal/Partial

Question 6

Most generalized epilepsy has what cause?

Answer 6

Genetic

Question 7

Types of generalized epilepsy (6)

Answer 7

Absence, myoclonic, primary generalized tonic-clonic, tonic, clonic, atonic

Question 8

Focal epilepsy in two categories. Also categorized by…

Answer 8

Simple and complex; brain region (i.e. temporal)

Question 9

Reflex epilepsy

Answer 9

Triggered by stimuli (i.e. photosensitive by particular Hz)

Question 10

Epilepsy differential (7)

Answer 10

Syncope, cardiac arrhythmias, migraine, hypoglycemia, narcolepsy, panic attacks, psychogenic non-epileptic seizures

Question 11

What do you look for when testing epilepsy?

Answer 11

Lesion!

Question 12

Epileptic regions

Answer 12

Hippocampus, enterorhinal cortex and amygdala (medial temporal lobe)

Question 13

Why do you record EEG near the ear?

Answer 13

Amplifies EEG

Question 14

Delta

Question 15

Theta

Answer 15

4-8Hz

Question 16

Alpha

Answer 16

8-13Hz: awake, alert but relaxed, eye closed

Question 17

Beta

Answer 17

> 13Hz: awake/alert in anterior head regions, large numbers associated w/ benzo use

Question 18

Epilepsy auras differ from migraine in that they…Can include (4)

Answer 18

Are part of (don’t precede) seizure; sudden intense fear, deja/jamais vu, olfactory/gustatory hallucinations, visual/motor

Question 19

Frontal lobe seizures are common/rare. Only seizure that can be…Symptoms?

Answer 19

Fairly rare; bilateral w/out LOC; vocalizations, shaking, head turn

Question 20

Generalized tonic-clonic seizure: aura, length, consciousness, post-ictal state

Answer 20

Must be generalized from onset, no aura (no focal areas involved), LOC, 2-3 minutes, amnesia/confused after

Question 21

Tonic

Answer 21

Freeze

Question 22

Clonic

Answer 22

Moving

Question 23

Absence seizures. Another name?

Answer 23

Sudden behavioral arrest, staring/unresponsive, sudden return to normal w/out pre-event amnesia but doesn’t recognize seizure; also called petit-mal seizures

Question 24

Absence/petit mal common trigger…describe. Common wave pattern?

Answer 24

Triggered by hyperventialation, regular generalized, 3/second spike and slow wave

Question 25

Absence seizures are common in?

Answer 25

Children

Question 26

Myoclonic seizure. Common trigger? Always epilepsy?

Answer 26

Brief, quick movements in body; light/startle; no

Question 27

Todd's post-ictal paralysis

Answer 27

Post-seizure paralysis due to seizure in motor region of the brain

Question 28

What is the most common abnormality underlying temporal lobe epilepsy?

Answer 28

Medial temporal sclerosis

Question 29

Describe temporal seizure symptoms

Answer 29

Epigastric rising feeling, intense fear, deja vu, olfactory hallucinations, automatisms (lip smacking)

Question 30

Frontal lobe seizures are common/rare. Only seizure that can be...Symptoms?

Answer 30

Fairly rare; bilateral w/out LOC; vocalizations, shaking, head turn

Question 31

Occipital lobe seizures are common/rare. Symptoms

Answer 31

Rare; poorly formed colored lights across visual field

Question 32

Juvenile myoclonic epilepsy; associated with? Prognosis?

Answer 32

Myoclonus early in day; positive family history; benign but may last for life

Question 33

Benign epilepsy with centrotemporal spikes (Rolandic seizure) symptoms. Prognosis?

Answer 33

Parethesiae involving mouth --> unilateral clonic activity of face; often occurs shortly after falling asleep; benign, resolve by adolescence

Question 34

Infantile spasms (West syndrome) age of onset, symptoms, prognosis. Treatment?

Answer 34

3-12 months of age; jerk followed by stiffening; NOT benign, associated w/ retardation; give high doses ACTH

Question 35

Lennox-Gaustat Syndrome triad. Prognosis?

Answer 35

Mental retardation, slow spike and wave, multiple seizure types; difficult to treat

Question 36

Atonic seizures are dangerous because?

Answer 36

Sudden loss of tone can lead to falling --> injury

Question 37

Febrile seizures definition and prognosis

Answer 37

Occurs w/ high fever in young child, less than 15 min; generally benign and don't require treatment

Question 38

Seizures are the _______ most common presentation of brain tumor

Answer 38

Second

Question 39

Drug treatment response rate and rules

Answer 39

70%; first try monotherapy: "start slow, increase slowly"

Question 40

How long seizure-free when medication will be often be stopped?

Answer 40

Three years

Question 41

Surgical treatment is primarily for...

Answer 41

Focal seizures

Question 42

Status Epilepticus definition

Answer 42

Condition w/ seizures lasting for more than 30 minutes or multiple seizures lasting 30 minutes w/out recovery

Question 43

Why is Status Eplipeticus serious

Answer 43

Death in 5-10% due to circulatory collapse

Question 44

Psychogenic Non-Epileptic seizures are associated with (3). What do they look like?

Answer 44

True seizure disorder, sexual abuse, bereavement; non-stereotyped thrusting, eyes closed, face not involved, feels normal afterward