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Flashcards in Seizures Deck (83)
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Paracentral seizures

Originate on mesial surface of parietal lobe, CL genital sensations & postural motor activity, frequently seconarily generative


Risk factors for psychogenic seizures

H/o sexual abuse, epilepsy, psych disorder, head injury/PCS, model for seizure disorder, traumatic life course, family discord/academic stress


Common etiologies of perinatal seizures

Toxemia, infection, congenital defects, difficult birth


Possible distinguishing semiology for pseudoseizures

Acute emotional disturbance may initiate, rare when sleeping or alone, gradual onset, crying during ictus, occasional talking, asynchronous mvmts, react to avoidance testing, personal injury rare, infrequent micturition & defecation, no ictal epileptiform EEG abnormality


Seizures in the frontal opercular region

Epigastric aura, fear, salivation, repetitive chewing mvmts, repetitive swallowing, speech arrest, autonomic symptoms


Todd's paresis

Focal loss of function in whatever region just experience a seizure; loss of motor function is most common, can range from weakness to full paralysis


What is the most common type of seizure?

Complex partial


Factors that increase risk of cognitive deficits in seizure disorders

AED toxicity, symptomatic epilepsy, seizure type & frequency, younger age at onset, poor control, temporal lobe epilepsy surgery


Tonic seizures

Sudden onset of bilateral tonic extension or flexion of the head, trunk, or extremities for several seconds; typically occur during drowsiness or just after falling asleep/waking up


Early signs of mesial temporal lobe seizure

Staring, behavioral arrest, automatisms, motor restlessness, nonforced head deviation


Orbitofrontal lobe seizures

Usu. complex partial seizures that being with motor or gestural automatisms, peri-ictal urination is typical, may see vocalizations, intense fear, complex motor acts


Cognitive effects of Tegretol

May improve processing speed, psychomotor speed, problem-solving & decrease aggression & emotional lability


Neurological & demographic variables that are predictive of post-surgical seizure freedom

Unilateral EEG abnormalities, presence of exclusively IL temporal inter-ictal epileptiform discharges, presence of structural abnormalities, younger age at time of surgery, shorter duration of pre-operative epilepsy


Variables improving quality of life among epilepsy patients

Reducing seizure frequency, reducing AEDs, promote cognitive reserve/activity, decrease psychiatric symptomatology, reduce family/social/cultural stigma/discrimination


Jacksonian motor seizure

Simple partial seizure in which motor symptoms progress or 'march' from fingers to arm to face


Supplementary motor area seizures

Brief, typically include postural symptoms, often refractory to AEDs


Absence seizures (petit mal)

Brief episodes of impairment of consciousness with no warning & short duration no aura or post-ictal fatigue


Late signs of mesial temporal lobe seizure

Arrest reaction, restlessness, staring, dystonic posturing of arms


EEG alpha waves

8-13 CPS/hz Normal dominant/background activity, reflects an anxiety-free state Lost with eye opening, falling asleep, meds that affect mental function, slows in elderly & in nearly ever brain-based neuro illness


Most common underlying pathology of mesial temporal lobe epilepsy

Mesial temporal lobe sclerosis


Cognitive side effects of Dilantin

Psychomotor speed, memory & problem solving; may result in progressive encephalopathy w/ accompanying deterioration in intellectual fx


Which anticonvulsant has the worst cognitive side effects?



Simple partial seizures

Involve at least 1 focal area of the brain, do not impair consciousness


Corpus callostomy is limited to pts with what types of seizures

Unknown seizure focus or multiple seizure foci with debilitating seizures that are frequently atonic/clonic in nature


Childhood absence epilepsy

Onset 4-8 years old, may remit in adulthood Seizures are brief staring spells w/ loss of awareness Increased rates of LDs, ADHD, anxiety d/o, mild deficits in attention/exec, delayed & immediate memory, visuospatial


EEG beta waves

>13 hz; prominent with concentration, anxiety, under effects of minor tranquilizers


The majority of refractory epilepsies have focal seizures that arise from where?

Temporal lobe


Lennox-Gastaut syndrome

Onset ages 2-8 yrs Triad: atonic, atypical absence, tonic seizures MR, autistic features, bx problems common, developmental delay can predate onset of seizures or become apparent later Common to have multiple seizures daily, status epilepticus is common


Risk factors for complex febrile seizures evolving into later seizures

Family hx of afebrile seizures, some kind of neuro involvement prior to febrile seizures, abnormal EEG


Occipital lobe epilepsy

Elementary visual hallucinations usually in periphery of CL visual field Amaurosis, scotomas, hemianopsias, quadrantanopsias Tonic/clonic eye deviation, head deviation, blinking, sensation of eye mvmt, nystagmoid eye mvmts Typically spread to temporal, frontal, supplementary motor, or parietal areas


Complex partial seizure

Involve at least 1 focal area of the brain, impair awareness/responses to environmental stimuli Typically starts as simple partial (aura), lasts 30 sec-2 mins


Cryptogenic seizure disorder

Related to a structural abnormality that is not identifiable with current available methods


Common etiologies of seizures in young adults

Trauma, ETOH, neoplasm, drug-related, AVM, AIDS


Common etiologies of seizures in middle aged adults

Neoplasm, ETOH, vascular disorder, trauma


Atonic seizures

Brief loss of muscle tone of the postural muscles


Autosomal dominant nocturnal frontal lobe epilepsy

-Begins in childhood/adolescence -Spells occur in clusters during sleep -Typically begin w/ aura, evolve into prominent motor phenomena


Juvenile myoclonic epilepsy

-Cardinal feature: myoclonus w/ preserved awareness -Triad of seizure types: myoclonus, generalized tonic-clonic, absence -NP deficits: generally mild, processing speed, attention/wm, lang, mem, visuospatial, & exec fx reported -Most consistent deficit is exec fx, typically not present in adulthood


Post-ictally, EEGs show

Low voltage activity (postictal depression) followed by diffuse high voltage slowing


Vagus nerve stimulator

Chronic stimulation of the L vagal nerve by electrode implantation & programmable signal generator placed subdermally under the clavicle


Most important predictors of quality of life among epilepsy patients

perceived seizure frequency, perceived adverse effects of AEDs, perceived cognitive problems due to epilepsy and/or AEDs, limitations in independence


Which anticonvulsant drug has been linked to hyperactivity, irritability, & sleep deprivation?



Up to what percentage of individuals with known epileptic disorders will not show abnormalities on the typical in-office brief EEG?



Multiple subpial transaction

Horizontal axonal fiber tracts in the brain are transected while preserving the vertical oriented axonal fiber tracts; offered to pts w/ seizure focus in eloquent cortex


Risk factors for epilepsy surgery failure

Presence of B EEG abnormalities, presence of secondarily generalized tonic-clonic seizures with TLE, no structural pathology w/ high resolution MRI, CL memory function intact on Wada (TLE only)


Juvenile absence epilepsy

Typically begin around puberty, frequency less than childhood variety, consciousness less affected, tonic-clonic seizures more frequent (these tend to persist, while absence decrease/disappear with age)


Common etiologies of seizures in late life

Vascular disorder, neoplasm, degenerative, cysticercosis, CVA most common after age 65


Idiopathic seizure disorder

Presumed genetic; thought to reflect molecular dysfx


Precentral frontal lobe seizures

Begin in primary motor cortex, may consist of simple partial or myoclonic jerks w/ or w/o secondary generalized tonic-clonic convulsions; postictal paralysis of affected body part is common


Ictal EEGs show

Paroxysmal activity consisting of spikes, slow waves, or complexes of spikes & waves or poly-spikes & waves



Simple & repetitive actions that are not mediated by conscious intention; common ones seen in complex partial seizures include lip smacking or repetitive hand movements


What percent of the population has nonspecific EEG changes?



Symptomatic seizure disorder

Related to a known structural abnormality


Postcentral gyrus seizures

Almost always assoc. w/ aura of positive (or negative) sensations, many objective signs depend on where seizure spreads outside of parietal lobe


Premotor frontal lobe seizures

Originate in lateral/medial premotor frontal regions, characterized by tonic & postural motor phenomena most common in UEs


Most common neurocognitive effects of AEDs

Sustained attention, secondary learning & memory effects


Familial seizure disorder

Demonstrated to be genetic; typically autosomal dominant


Benign rolandic epilepsy

-Age limited (often remit by 16 yrs old) -Onset 3-13 -Seizures arise from centrotemporal region -Tonic-clonic in nature (most frequently facial twitching); can have UL parathesias & speech arrest


Inferior parietal seizures

May give rise to sexual sensations, severe vertigo, abdominal sensations, gustatory hallucinations, apraxias, disturbances of body image, spatial disorientation


Frontal lobe epilepsy

Rapid secondary generalization, focal clonic motor activity, prominent asymmetric tonic posturing, explosive onset & sudden ending, minimal post-ictal confusion, frequent & brief seizures that occur in clusters


Good prognostic features of neuropsychological outcome following epilepsy surgery

Presence of lesion IL to seizure focus, unilateral EEG abnormalities, presurgical lateralizing NP data in which memory impaired for IL temporal lobe, longer duration of epilepsy, higher presurgical cognitive ability, asymmetric fx neuroimaging findings, memory good on Wada IL injection


Dorsolateral frontal lobe seizures

Forced thinking, loss of contact w/ & awareness of surroundings, CL adverse deviation of head & eyes, tonic movements, speech arrest


Focal (partial) seizures

Begin in a focal area of the cortex & are usually associated with underlying structural abnormality


Primary generalized tonic-clonic seizures (grand mal)

Tonic extension of extremities for about 20 secs followed by clonic synchronous rhythmic muscle mvmts generally lasting about 45 secs


Secondary generalized seizures

From simple or complex, spreads across CC to entire cortex


Clonic seizures

Brief rhythmic jerking mvmts of the muscles frequently affecting both UEs & LEs during which consciousness is impaired


Predicting confrontation naming outcomes following epilepsy surgery

Reliable decline in naming more likely for patients w/ resection of language dominant temporal lobe & intact naming score and/or shorter duration of epilepsy Reliable decline less likely w/ presurgical naming deficits & longer duration of epilepsy


Which types of seizures carry an increased risk of cognitive deficits?

Tonic/clonic, atypical absence, mixed


Seizures in the anterior cingulate gyrus

Usu. complex partial seizures with complex motor & gestural automatisms; autonomic hyperarousal signs & changes in mood/affect common


Common etiologies of seizures in young children

Congenital abnormality, neonatal meningitis, neurocutaneous disorders


West's syndrome (infantile spasms)

Onset b/t 6-18 mos of age, usu. cease by 2-4, 25-60% give rise to other types of seizures Clinical triad: infantile spasms, developmental arrest, hypsarhthmia EEG pattern MR, autistic features, behavioral problems common


The most consistent neuropsychological deficit seen in childhood absence epilepsy is

Visual memory deficits


Myoclonic seizures

Sudden, shock-like muscle contractions lasting only a fraction of a second


Generalized seizures

No aura, no focal semiology, no lateralized findings, no focal EEG abnormalities; immediate LOC


Anterior temporal lobectomy

Surgical resection in which the anterior temporal lobe is resected en bloc


Risk factors for post-op decline in verbal memory following anterior temporal lobectomy

Dominant hemisphere resection, intact pre-op NP memory testing, intact pre-op Wada memory testing, absence of mesial temporal sclerosis on imaging


What percentage of patients experience seizure freedom with surgical resection?



Landau-Kleffner syndrome

Gradual or sudden onset of auditory agnosia that may involve total unresponsiveness to language or progressive deterioration of expressive speech Language decline may precede presentation of seizures, recovery of lang fx strongly related to age of onset (


Common etiologies of seizures in adolescents

Idiopathic, trauma, drug-related


EEG theta & delta waves

Theta = 4-7 hz Delta = 1-3 hz Detected in children & everyone entering deep sleep; generally absent in healthy, alert adults May indicate a degenerative illness or metabolic derangement, focal presence may suggest lesion in that region


Which anticonvulsants have the least side effects?

Keppra, neurontin, Lamictal


Other conditions that mimic seizures

Episodic dyscontrol syndrome, cerebrovascular disturbance, panic disorder, breath-holding spells in infants, sleep disorders, migraine, metabolic disturbances


Multiple subpial transaction

Horizontal axonal fiber tracts in the brain are transected while preserving the vertical oriented axonal fiber tracts; offered to patients the seizure focus in eloquent cortex


Posterior parietal seizures

Primarily involve BA 5&7 Prominent staring & relative immobility, visual phenomena may occur