Wk 32 - Epilepsy 2

Question 1

What are the types of primary generalised seizures?

Answer 1

• Absence seizures (petit mal)
• Tonic-clonic seizures (grand mal)
• Myoclonic seizures
• Clonic seizures
• Tonic seizures
• Atonic seizures (drop attacks)

Question 2

What is absence seizures?

Answer 2

• 2-20 secs
• Occur few times (100x)
• Sudden blank staring (day dream)
• Blinking, lip smacking, fumbling, picking at clothes, twitching of face + body muscle
• No memory of episode
• Hyperventilation induced reproduction
• Common in 4-14yrs old

Question 3

What is tonic-clonic seizures?

Answer 3

• Most common + typical type
• Lasts 30-120 secs
• Involve tonic + clonic phase

Question 4

What is the tonic phase in a tonic-clonic phase?

Answer 4

• Generalised muscle contraction: stiffening
• Loss of consciousness + fall
• Laboured or shallow breathing: cyanosis
• Tongue, cheek or lip biting: bleeding

Question 5

What is the clonic phase?

Answer 5

• Follows tonic
• Rhythmic contraction + relaxation of muscles: limb jerking
• Occasional bladder or bowel incontinence

Question 6

What is the postictal phase in a tonic-clonic seizure?

Answer 6

• Slow return to consciousness
• Muscle relaxation: limpness
• Grogginess + confusion
• Headache + aching limbs
• Amnesia of event

Question 7

What is myoclonic seizures?

Answer 7

• Jerks
• Short lived: few secs
• Affect whole body
• Commonly: arms, legs or head/trunk
• Consciousness not impaired (single jerks) or impaired (cluster of jerks)
• Occurs shortly after waking

Question 8

What is tonic seizures?

Answer 8

• Generalised tightening of muscle: stiffening of body

- Occurs during sleep + 20 secs

Question 9

What is atonic seizures?

Answer 9

• Drop attacks, akinetic seizures
• Sudden loss of part/all muscle tone: limpness
• Sudden head drop, slump or total collapse
• Forward fall: inc risk of serious head injury
• Short lived
• V rapid recovery - no post-ictal confusion

Question 10

what are the 3 main types of partial or focal seizures?

Answer 10

• Simple partial or focal seizure: consciousness preserved + subject alet
• Complex partial or focal seizure: consciousness altered/lost
• Secondarily generalised seizure: partial spread to become tonic-clonic

Question 11

What is simple partial seizure?

Answer 11

• Involve small part of 1 side of brain
• Subject fully conscious + aware of surrounding
• No control over seizure
• Symptom depend on part of brain affected
• Post-ictal weakness

Question 12

What are the symptoms if the motor part of the brain is affected?

Answer 12

• Stiffening
• Twitching
• Jerking

Question 13

What are the symptoms if the sensory part of the brain is affected?

Answer 13

• Light flashes

- Hallucinations + illusions

Question 14

What are the symptoms if the autonomic part of the brain is affected?

Answer 14

• Sweating
• Altered HR/BR
• Gastric discomfort

Question 15

What are the symptoms if the psychic part of the brain is affected?

Answer 15

• Fear
• Anxiety
• Deja vu
• Jamais vu

Question 16

What is complex partial seizures?

Answer 16

• Involve greater part of 1 cerebral hemisphere
• Impaired consciousness + awareness
• Involve 1/both temporal lobes
• Duration: few seconds to 3mins
• Variable duration of recovery - minutes to hrs (confusion + fatigue)

Question 17

What are the symptoms of complex partial seizures?

Answer 17

• Lip smacking, chewing
• Fumbling, picking, fiddling
• Grunts, screaming, pelvic thrusts

Question 18

What is secondarily generalised seizures?

Answer 18

• Begin focally + spread to generalised tonic-clonic
• Preceded by aura
• Variable symmetry, intensity + duration of tonic + clonic
• Duration: 1-3mins
• Postictal confusion + somnolence, w/ or w/o contralateral Todd’s paralysis

Question 19

Outline the basis of classification of seizure types

Answer 19

Where it began:

• Focal
• Generalised
• Unknown

Level of awareness during focal onset:

• Focal aware - retained awareness
• Focal impaired awareness - impaired awareness

Nature of 1st prominent signs + symptoms:

• Motor onset
• Non-motor onset

Question 20

What is the framework for classification of epilepsies?

Answer 20

• Seizure type
• Epilepsy types
• Epilepsy syndromes
• Aetiology
• Comorbidities

Question 21

What is involved when diagnosing epilepsy?

Answer 21

• Patient med history
• Seizure description
• Physical examination
• Lab assessment
• EEG + ECG
• Neuroimaging (CT + MRI)

Question 22

What is needed in a patient’s history?

Answer 22

• Perinatal + developmental history
• History of febrile seizures
• History of CNS infection, trauma
• Fam history of epilepsy

Question 23

What are the seizure description + history needed when diagnosing?

Answer 23

• Past seizure episodes, duration, associated motor, sensory + behavioural fts (pre-ictal, ictal, post-ictal + triggers)
• Observer or eye witness accounts
• Real time eye witness vid recording

Question 24

What are the lab assessments needed when diagnosing?

Answer 24

• Complete blood count
• Electrolyte panel + blood glucose
• Blood urea nitrogen
• Toxicology screen

Question 25

What are the main indications for CT scans + MRI

Answer 25

• Adult-onset seizures
• Seizures w/ focal ft + suspected focal source
• Refractory/worsening seizure

Question 26

When arriving at a diagnosis, what are the 4 main steps?

Answer 26

• Identify type of seizure + precipitating factors
• Correlate seizure type w/ EEG
• Determine aetiology of epilepsy using history + diagnostic measures
• Classify epilepsy syndrome