Seizures and Epilepsy - Lindsay Schommer (unfinished)

Question 1

what is a seizure

Answer 1

an “electrical storm” in the brain, not all seizures are convulsions

Question 2

what is epilepsy

Answer 2

recurrent unprovoked seizure associated with abnormal electrical activity in the brain

Question 3

what is the criteria for epilepsy

Answer 3

two or more unprovoked seizures separated by at least 24 hours

Question 4

what is the risk of recurrence after first unprovoked seizure

Answer 4

40% - generally not treated

Question 5

what is the risk of recurrent after second unprovoked seizure

Answer 5

70% - start ASM at this time

Question 6

what is provoked or not in regards to seizures

Answer 6

example: metabolic disturbance, infectious, impact, surgery - think alcohol withdrawal or low blood sugar

Question 7

what is isolated or not?

Answer 7

epilepsy should NOT be diagnosed on the basis of a single seizure
exception: if abnormal EEG is present

Question 8

what are the three main categories of seizure types

Answer 8

focal onset
generalized onset
unknown onset

Question 9

what is focal onset seizures

Answer 9

seizures start in, and affect, one part of the brain

aware and impaired awareness

Question 10

what is generalized onset seizures

Answer 10

seizure starts in, affects both sides of the brain at once and happen without warning

motor vs non-motor

Question 11

where do focal seizures originate

Answer 11

from a paroxysmal discharge in a focal area of cerebral cortex (temporal lobe)

Question 12

where do primary generalized seizures originate

Answer 12

the diencephalic activating system and spread simultaneously to all area of brain

Question 13

what are the stages of a seizure

Answer 13

prodrome
aura
ictal phase
post-ictal phase

Question 14

what is it called when there is a feeling something is off preceding the seizure itself

Answer 14

prodrome

Question 15

what is an aura

Answer 15

first clinical change recognizable to patient
“warning sign” - typically a very small seizure, may progress or dissipate, focal epilepsy, may help with localization

Question 16

what is the ictal phase

Answer 16

time from the first symptom (including aura) until the end of the seizure activity - correlated with abnormal electrical discharges in the brain

Question 17

what are clinical manifestations that are correlated with location of seizure activity

Answer 17

may or may not lose consciousness
automatisms, head or eye deviations/version, hyper-motor
may progress as seizure activity spreads to different areas of the brain

Question 18

what location of the brain is associated with visual hallucinations

Answer 18

occipital

Question 19

what location of the brain is associated with somatosensory hallucination

Answer 19

the postcentral gyrus

Question 20

what locationof the brain is associated with focal motor activity

Answer 20

pre-central gyrus

Question 21

what location of the brain is associated with hypermotor activity

Answer 21

frontal lobe

Question 22

what location of the brain is associated with throat tightening and autonomic symptoms

Question 23

what location of the brain is associated with pain

Answer 23

parietal

Question 24

what is the post-ictal phase

Answer 24

time between end of seizure and return to baseline - recovery period

Question 25

what are the different types of focal seizures

Answer 25

focal aware focal with impaired awareness focal to bilateral tonic clonic

Question 26

what is focal aware seizures

Answer 26

starts in one area of the brain - brief < 2 minutes - awake/aware/memory intact - seizure "auras" are small focal aware seizures

Question 27

what is focal with impaired awareness

Answer 27

starts in one area of the brain duration: 1-3 minutes Automatism - picking at clothes, bicycling legs, utilization behavior, smacking lips

Question 28

what is focal to bilateral tonic clonic

Answer 28

used to be Grand Mals may see head or eye deviation/version figure 4 or fencing posture (one stiff arm, one bent arm)

Question 29

what are the types of generalized seizures

Answer 29

absence seizures myoclonic clonic tonic tonic-clonic atonic

Question 30

what is generalized tonic clonic seizures

Answer 30

abrupt onset - symmetric posturing

Question 31

what is an absence seizure

Answer 31

previously Petit mal generalized onset brief loss of consciousness (less than 10 seconds) prompt recovery starting, eyelids may flutter more common in kids - frequently missed

Question 32

what is myoclonic seizures

Answer 32

brief jerks, involving extremities and trunk lasting 1-2 seconds common in juvenile myoclonic epilepsy more common in the morning/upon waking up

Question 33

what is atonic seizure

Answer 33

also called "drop seizures" brief loss of muscle tone (falls if standing, head drops if seated) usually brief <15 seconds

Question 34

what are tonic seizures

Answer 34

brief < 60 seconds sudden increased muscle tone - patient may fall consciousness may or may not be affected (depending on length) may or may not have postictal period

Question 35

what are the imaging/diagnostic tests for seizures/epilepsy

Answer 35

EEG, vEEG, MRI and CT

Question 36

what is Todd's paralysis

Answer 36

inability to move half the body

Question 37

what is vEEG used for

Answer 37

long term inpatient monitoring goal to illicit and characterize seizure in order to classifying the type of seizure/syndrome - rule out mimics, most frequently PNES

Question 38

what is an MRI used for

Answer 38

look for structural lesion/tumor if refractory try to obtain 3 Tesla with epilepsy protocol

Question 39

what is PNES

Answer 39

psychogenic non-eplieptic seizures onset typically before 40yo, typically female highly correlated with history of abuse cross-cultural phenomenon

Question 40

what is the treatment for PNES

Answer 40

limited: SSRIs, CBT, ?EMDR

Question 41

why are frontal lobe seizures often misdiagnosed

Answer 41

exception to every rule and the onset zone is too deep to be appreciated on scalp EEG

Question 42

how do you differentiate between PNES and frontal lobe seizures

Answer 42

out of sleep (Frontal) vs shortly after awakening (PNES) Prolactin may be elevated 3-4 fold after epileptic seizure HISTORY