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Anat 1082 Multiple Choice Revision > Seizure And Epilepsy > Flashcards

Seizure And Epilepsy Flashcards

1
Q

5 points of relevance for seizure and epilepsy…GO

A

1- Epilepsy is a common neurological condition affecting approx 1 in 200 people.
2- Epilepsy is the most common serious brain disorder worldwide with no age, racial, social class, national or geographic boundaries
3- Some of the most common maternal neurological disorders are seizures during pregnancy.
4- The frequency of seizures in pregnancy with pre existing epilepsy is known to increase by 30-50%
5- At least 50% of cases begin in childhood or adolescence.

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2
Q

What is tuberous sclerosis?

A
  • A rare condition that causes growths in organs including the brain 🧠
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3
Q

What is Neurofibromatosis?

A
  • A genetic condition that can cause growth on the nerves
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4
Q

What are 10 of the triggers and provoking factors of seizures?

A

1- Brain damage from prenatal or perinatal causes eg loss of O2 or trauma during birth
2- Severe head injury, haemorrhage, cerebral oedema
3- Malnutrition
4- Hyperglycaemia
5- Hyperthermia
6- Infections of the brain such as meningitis
7- Alcohol
8- Pregnancy
9- Pyrexia (temperature)
10- Parasitic disease

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5
Q

Explain the concept of the seizure threshold.

A
  • This is one part of the genetic makeup
  • The chance of having a seizure may depend partly on whether either or both of the parents have epilepsy
  • If you have a low seizure threshold your brain is resistant to seizures, these people rate more likely to start having seizures for no obvious reason.
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6
Q

What are the causes and triggers for epilepsy?

A
  • Triggers for a seizure are not the same as causes for epilepsy
  • A trigger for someone to have their first seizure may be a stressful situation, but the underlying cause for that person to start having seizures may be different
  • Causes can be genetic or as a result of structural damage to the brain 🧠.

Examples include:

  • Not taking medication
  • Sleep and epilepsy
  • Photo sensitive epilepsy
  • Musicogenic epilepsy
  • Alcohol and drugs epilepsy
  • Febrile convulsions
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7
Q

What are Febrile convulsions?

A
  • This is the most common childhood neurological disease with an incidence of 1-10% in children
  • However the pathophysiology of febrile convulsions remains unclear
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8
Q

What are some of the explanations for febrile convulsions?

A
  • High temps may decrease the neurological threshold
  • Inflammatory mediators have a role to play
  • Electrolyte imbalance
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9
Q

What does pyrexia (high temps) do to cells?

A

Extremely high temps cause cellular damage by:

  • Disrupting the Golgi apparatus
  • Swelling of the mitochondria (this is where the conversion of glucose to ATP takes place)
  • Changes cellular permeability
  • Disrupts the nucleus and aggregation of chromatin which is the combination of DNA and protein in the nucleus
  • Elevating protein synthesis
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10
Q

MEGA PRINCIPLE

What can a disruption to the sodium potassium pump cause?

A
  • Anything that’s interferes with the sodium potassium pump can result in seizure.
  • Anything that interferes with the sodium potassium pump in the heart can result in cardiac arrest.
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11
Q

What 5 things interfere with the sodium potassium pump?

A 
1- O2
2- Acid 
3- Cardiac output
4- Glucose 
5- Change in temp
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12
Q

The epilepsy society divides seizures into three groups.

What are they?

A
  • Where they start in the brain (onset)
  • Whether or not a persons awareness os affected
  • Whether or not seizures involve other symptoms such as memory loss
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13
Q

There are three classifications of seizures what are they?

A

1- Focal onset
2- Generalised onset
3 Unknown onset

These classifications are based on where the seizures start

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14
Q

What are focal onset seizures?

A
  • these seizures start in and effect one area of the brain it might affect a large part of one hemisphere or just a small area in one of the lobes
  • Sometimes they can spread to both sides of the brain ( Focal bilateral tonic- clonic seizure) this is then a warning that another seizure will happen.
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15
Q

What are focal aware seizures?

A
  • In these seizures the person is conscious (aware and alert) will usually know that something is happening and will remember the seizure afterwards
  • During the seizure that may feel ‘strange’ but not be able to describe the feelin afterwards.
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16
Q

What are focal impaired awareness seizures?

A
  • These affect a bigger part of one hemisphere of the brain then focal onset seizures
  • The persons consciousness is affected and they may be confused and difficult to communicate with
  • These seizures often happen in the temporal lobes but can happen in other parts of the brain.
  • After the seizure the person may be confused for a while,tired and may not remember the event at all
17
Q

What are the six motor symptoms of a Focal seizure?

A
  • Making lip smacking or shewing movements
  • Repeatedly picking up objects or pulling at clothes
  • Suddenly loosing muscle tone and limbs going floppy or becoming stiff
  • Repetitive jerking movements that affect one or both sides of the body
  • Making loud cries or screams
  • Making strange postures pr repetitive movements such as cycling or kicking
18
Q

What are the 5 non- motor symptoms of focal seizures?

A
  • Deja vu
  • Unusual smell or taste
  • Intense feeling, fear, or joy
  • Twitching, numbness, tingling
  • Visual disturbances flashing lights hallucinations
19
Q

What are focal to bilateral Tonic - clonic seizures?

A
  • When this happens the person becomes unconscious and will usually have tonic clonic convulsions or shaking.
  • If this happens very quickly they may not be aware that it has started as a focal seizure
20
Q

What is a generalised onset seizure?

A
  • These affect both sides of the brain at once and happen without warning
  • The person will be unconscious (except in myoclonic seizure), even is just for a few seconds and afterwards will not remember what has happened during the seizure
21
Q

What happens at the start of a tonic clonic seizure?

A
  • The person becomes unconscious
  • Their body goes stiff and if they are standing up they will usually fall backwards
  • They may cry out
  • They may bite Their tongue or cheek
22
Q

What happens to a person during a tonic clonic seizure?

A
  • They jerk and shake as their muscles relax and tighten rhythmically
  • Breathing difficulties
  • Incontinence
  • After the seizure they may feel tired, confused or want to sleep
23
Q

What are Clonic seizures?

A

These involve repeated rhythmical jerking movements of one side or part of the body or both sides (whole body) depending on where the seizure starts.
- Seizures can start in one side of the brain (focal) or affect both sides of the brain (generalised)

24
Q

What are tonic and atonic seizures?

A
  • In a TONIC seizure the persons muscles suddenly become stiff if stood up they often fall backwards and may injure their head. They tend to be very brief and happen without warning.
  • In and ATONIC seizures the persons muscles suddenly relax and they become floppy
  • With both tonic and atonic seizures people usually recover quickly apart form possible injury
25
Q

What are myoclonic seizures?

A

Myoclonic = muscle jerk

  • Muscle jerks are not always due to epilepsy (some people have them as they fall asleep)
  • Myoclonic seizures are brief but can happen shortly after waking up
  • In myoclonic seizures the person is conscious but they care classified as generalised seizures. This is because the person is likely to have another problem seizure such as a tonic, clonic seizure as well as a myoclonic seizure
26
Q

Absence seizures

What are typical absences?

A
  • During a typical absence the person becomes briefly blank and unresponsive for a few seconds they may appear to be daydreaming
  • The person may stop what they are doing, look blank and stare. Their eyelids might blink or flutter.
  • They will not respond to what is happening around them
  • If they are walking they may carry on walking but not be aware of what they are doing.
27
Q

Absence seizures

What are Atypical absences?

A
  • These are similar to typical absences but they start and end slowly and last a bit longer they a typical absence.
  • They also include a change in muscle tone where the limbs go limp or floppy some people may even fall.
28
Q

What is the pathophysiology of seizures?

A
  • The brains cells have to work in harmony
  • The entire nervous system functions by sending nerve impulses to one another rand muscles and glands
  • The electrical activity of the brain can be measured using an EEG
  • In individuals with epilepsy the EEG is abnormal, characteristic wave forms are altered by the appearance of spikes in electrical activity
  • The brain requires 20% of the resting cardiac output
  • Most epileptic seizures are thought to be the result from abnormal hyperactive neurones that form and epileptogenic focus
  • During and epileptic seizure there is abnormal and excessive discharging of impulses from brain cells.
  • This reaches the Skeletal muscle fibres to stimulate contractions and later subsides due to a lack of neurotransmitters in the synapse
29
Q

Why can seizures be so serious?

A
  • During a seizure the cerebral O2 consumption increases by as much as 60%
  • In status epilepticus O2 and glucose consumption by skeletal muscle contraction coupled with periods of apnoea, rapidly depletes the O2 delivery + nutritive stores leading to hypoxemia, hypercapnia and hyperglycaemia
  • Seizures cause metabolic requirements to increase which results in elevation of cerebral blood flow and volume
  • The increase in cellular lactate further complicate the pathophysiological state
  • The end result us and energy debt that rapidly leads to cellular exhaustion
  • If blood flow cannot match the demand, ischaemia develops, cerebral energy stores are depleted and irreversible neuronal destruction occurs
30
Q

How can taking a history help with the diagnosis of seizures and epilepsy?

A

-This will help describe the seizure type, cause, duration, previous treatment and current state.

31
Q

What diagnostic tests along with baseline bloods can be done to help diagnose epilepsy?

A
  • EEG - is a measure of the cerebral function, tracing the brains electrical activity and can identify disruption
  • MRI scan - uses magnetic fields and radio waves to scan the brain in a non-invasive way to identify very small lesions and scars
  • CT or CAT scan- is an enhanced x-ray technique for studying the cerebral structure.
  • Ambulatory EEG- the Persian wears the EEG for several days and nights recording the brains electrical activity
  • Video telemetry - This consists of simultaneous EEG recording of the brains electrical activity and and a video recording of the seizures
32
Q

There are 5 types of brain wave… name them…GO

A

1- Delta waves- deeper levels of relaxation and restorative sleep
2- Theta waves - prevalent in a trance or hypnotic state (day dreaming)
3- Alpha waves - Bridges between conscious thinking and subconscious thinking
4- Beta waves- Channelled during conscious stage such as cognitive reasoning, thinking, calculations and speaking
5- Gamma waves- involved in processing more complex tasks

Anat 1082 Multiple Choice Revision (20 decks)

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