NEURO - Epilepsy Flashcards
(32 cards)
Define:
- ictus
- seizure
- epilepsy
- Ictus: Sudden neurological event
- Seizure: Abnormal, hypersynchronous neural activity
- Epilepsy: Tendency to repeated, spontaneous seizures
Common seizure types
- (3) generalised
- (2) focal
Generalised
•Generalised Tonic-Clonic (GTCS)
•Absence
•Myoclonus
Focal
•Dyscognitive
•Evolving to a bilateral, convulsive seizure (Secondarily generalised)
Discuss generalised tonic clonic seizure
- 2 phases
- duration
- injury
- post event
- Tonic phase: Arms down, Eyes open, Cry
- Clonic phase
- Apnoea: Cyanosis or plethora
- Last 1-5 minutes
- Minor injury common: Tongue biting
- Aftergoing confusion: Wake up in the ambulance or ED
Describe absence (generalised) seizure
- Px
- duration
- epidemiology
- Alteration of consciousness: Stay upright, No warning, Difficult to detect
- Facial twitch: 3Hz Blink, Oral myoclonias, Eyes often drift open
- Last 2-10 seconds
- Present in children or teenagers
Describe myoclonus (generalised) seizure - Px
- Sudden, involuntary muscle twitch
- Not specific to seizure: Sleep myoclonus, Common in metabolic encephalopathy
- Myoclonic seizures: Action related, Appear as prodrome to GTCS
Describe focal seizures
- area of brain
- consciousness involvement
- Px depending on location
- duration
•Single area of brain •Without alteration of consciousness •Features depend on location - Temporal – Smell, deja-vu - Motor strip – Localised clonus - Occipital – Visual hallucinations etc...
•Usually brief
Describe focal dyscognitive seizures
- area of brain
- consciousness involvement
- comparison to absence seizure
- Localised region
- Affects consciousness: Bilateral temporal lobes involved
•Similar to absence but…
- Longer
- Less distinct offset
- Automatisms
- Less frequent
- Preceding simple seizure
Describe childhood absence epilepsy (Petit Mal)
- onset
- seizure types
•Onset 4-8 years, up to 12
Seizure types
–Absence seizures: Frequent - many / day
–Generalized Tonic-Clonic Seizures: 40%, Adolescence
Describe juvenile absence epilepsy
- onset
- seizure types
•Onset: adolescence
•Seizure types
–Generalized Tonic-Clonic Seizures
–Absence seizures: infrequent, Absence Status
Describe juvenile myoclonic epilepsy (Janz)
- onset
- seizure types
- other associated features
- prognosis
•Onset 12 - 18 years •Seizure types –Myoclonus –GTCS (general tonic clonic seizure) –Absences in 30% •Photosensitive •Sleep-wake cycle •May evolve from CAE •Prognosis –Not often refractory –Spontaneous remission rare
Difference between seizure type & epilepsy syndrome
Seizure type:
- clinical characteristics (Seizure, pts)
- EEG features
Epilepsy syndrome:
- seizure types
- age
- clinical course
- interictal EEG
- MRI
(3) DDx of a seizure
- Syncope
- TIA
- Psychogenic pseudoseizure
Discuss syncope
- causes
- Px
•Cause: Insufficient cerebral blood flow
- Neurocardiogenic
- Orthostatic
- Cardiac
•Collapse and LOC
- Convulsion
- Urinary incontinence
Hx of a syncope
- before
- during
- after
Before:
- predisposition
- trigger
- pre-syncope (prodrome)
During:
- Px
- convulsion?
- other associated features to DDx causes of syncope/seizure
After:
- recovery
- confusion?
(5) Typical predispositions of syncope
- Dehydration
- Anti-hypertensives
- Prolonged standing
- Stressful situation
- Recent awakening
(4) Triggers of syncope
- Emotional
- Valsalva
- Pain
- Postural change
(3) pre-syncope Px (prodromes)
•“Dizziness” •Feeling of distance •Visual disturbance –Silver flickers –Greying of vision
(3) Predisposition & triggers of seizure
–Sleep deprivation
–Hang-over or abrupt abstinence
–Flicker
What (2) medications can induce seizures?
–Clozapine
–Tramadol
What should you ask in a syncope pt?
•Previous syncope and presyncope
•Recent medication changes
•Drugs
–Amphetamines
Features of psychogenic pseudoseizure
- Fluctuating intensity
- Very long
- Eyes closed: Pseudo-sleep
- Non-anatomical tremor
- Reactive
- Consciousness retained: Usually denied
Difference between epilepsy & seizure
Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”)
A seizure is a brief, temporary
disturbance in the electrical activity of the brain
Comment on ictal & interictal EEG
Ictal EEG:
•Almost always abnormal in seizure
•Perfect for pseudoseizure
Interictal EEG:
•Diagnostic test for epilepsy, not seizure
–Prognosis
–Epilepsy syndrome diagnosis
•Most abnormal patterns also seen in normals
–Normal patterns often interpreted as abnormal
Prognosis of single seizure presentation
- % recurrence at one year
- % recurrence long term
- Most recurrence early
- 40% recur at one year
- Just over 50% long term
