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PBD Exam 3
PBD Exam 3 Dr. Frazier Material
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11/19/2010

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Term
Define Epilepsy.
Definition
A brain disorder characterized by transient but recurrent seizures.  Can impair consciousness or lead to abnormal movements/ behavior.
Term
Define a seizure.
Definition
A sudden, excessive and highly SYNCHRONOUS discharge of neurons in the CNS.
Term
T/F:  Status Epilepticus is an Epilepsy Syndrome.
Definition
False; it is a prolonged seizure (>30 mins) or a series of repeated seizures.  It is not epilepsy but a continous state of seizure activity. 
Term
T/F:  Epilepsy originates in the spinal cord.
Definition
False; it can only originate in the CNS.  it is a BRAIN disorder.
Term
Who was the first to assert that epilepsy was a brain disorder and not an attack of the Gods.
Definition
Hippocrates. He htought it was due to a buildup of cold phlegm form the brain flowing down into the warm blood of the body.
Term
Fill in the Blank: Galen noted _______ which only the patient is aware of.
Definition

Aura's

A specific sensation before the attack

Term
The highest incidence of epilepsy is in what age groups?
Definition

young children

elderly

Term
The 2 broad categories for classifying the type of seizure that occured in Epilepsy is which 2.
Definition

Partial-- impaired or no loss of consciousness

Generalized-- complete loss of consciousness

Term
Partial Seizures orginiate at a ____________ whereas generalized seizures have no _________ but occur all over the brain.
Definition

Seizure focus (small group of neurons at a certain part of the brain)

Foci

Term
Partial seizures generally last about ________
Definition

less than 2 minutes

 

Term
True/False: In simple Partial seizures it is generally preceeded by an aura.
Definition
True
Term
Partial seizures can be broken down into _____________ and ____________.
Definition

Simple

Complex

Term
What are the subtypes of Simple Partial Seizures?
Definition

1. Motor = changes its activity

2. Sensory = Causes perceptual changes

3. Autonomic = Changes in autonomic control organs

4. Psychic = changes how they think, feel or experience things (emotional state)

Term
Complex Partial Seizures differ from simple Partial seizures because they impair _________________ and ___________
Definition

Consciousness

Short-term memory

Term
Complex Partial Seizures generally last about ____________ seconds but may leave the patient confused or tired for several minutes after an event.
Definition
30-120 seconds
Term
The seizure focus of Complex Partial seizures is often in the _______ or __________ lobe.
Definition

Temporal

Frontal

Term
Complex Partial Seizures can be further broken down into ___________ or __________ which means that they can progress to generalized seizures.
Definition

Nonevolving

Evolving

Term
Evolving Complex Partial Seizures as the name implies progresses to generalized seizures. These are aka
Definition

Secondarily Generalized Seizures

or

Jacksonian March for the guy who discovered it

Term
Generalized Seizures have no discrete foci in the brain, so they recruit _______________ in the ___________.
Definition

Synchronousy

whole brain-- in both hemispheres

Term
Generalized seizures can be broken down into ____________ or ____________
Definition

Convulsive

Nonconvulsive

 

 

Term
T/F: Convulsive seizures are those that involve tonic and clonic movements. Whereas nonconvulsive seizures dont change muscle movements or tone.
Definition
True
Term
Tonic movements involve the ____________ in the ____________.
Definition

Increase

Muscle tone

Term
Clonic movements are those that involve _______ alternation between ____________________
Definition

Repetitive

Muscle contraction and Relaxation

Term
What are some different types of Generalized seizures that can occur?
Definition

1. Simple/Typical Absense Seizure

2. Tonic Seizure

3. Clonic Seizure

4. Tonic-Clonic Seizure

5. Complex Absense Seizure

6. Myoclonic Seizure

7. Atypical Absense Seizure

8. Atonic Seizure

Term
Describe Simple/Typical Absense Seizures.
Definition

They are aka petit mal

Have brief staring spells

Last <10 secs, but can be as long as 20 secs

Begin and end abruptly

Awareness and responsiveness during the seizure is impaired

Patients are not aware that they had one

Term
Describe Complex Absense Seizure
Definition

Share the same features as simple absense but involve muscle activity.

 

People tend to Blink the eyes, move the mouth as if tasting something, rub hands and minor contractions of muscles.

They generally last longer than 10 secs.

Term
What is the difference between Atypical Absense seizure and the other types of absense seizures?
Definition

They last longer, could be as long as 30 secs.

Begin and end gradually; not abruptly

It leaves the patient more aware of events during the seizure.

More likely to be associated with low IQ and can persist throughtout life.

Term
Since Absense seizures and its subtypes dont involve changes in muscle tone or contraction they are said to be _____________.
Definition
Nonconvulsive
Term
Myoclonic seizures are convulsive because they are brieft shock like ____________ of ____________.
Definition

Jerks

muscle or muscle groups

Term
In Epilepsy Myoclonic Seizures it lasts about ______________ and involve muscle groups on ______________________.
Definition

1-2 seconds

both sides of the body simultaneously

Term
Atonic Seizures is when all the muscle suddenly ____________ leaving the muslce without tone.
Definition
Relax
Term
What are some general features of Atonic Seizures?
Definition

Aka Akinectic, falling or drop seizures

Last <15 secs

Patient remains conscious

Body can get bruised or head injury due to falling

Often last into adulthood

Term
Durring a Tonic Seizure ____________ greatly increases which leads to sudden ____________.
Definition

Muscle tone

stiffening movements of the body

Term
What are some features of Tonic Seizures.
Definition

last <20 secs

Conscious

Occurs most often during sleep

Involves most or all of the brain

 

Term
Clonic Seizures consist of __________________________ of the arms and legs; sometimes on both sides.
Definition
rhythmic jerking movements
Term
Which is the most common forms of Seizures?
Definition

Tonic-Clonic

or aka

Grand Mal

Term
What are some features of Grand Mal (tonic-clonic) Seizures?
Definition

Last about 2-3 mins

Consciousness is lost and slow to return

After seizure patient may be very sleepy, agitated, confused or depressed.

Term
If someone is having a seizure, how long must they be having it to call for medical help?
Definition
longer than 5 minutes
Term
Signs are considered ____________ findings such as weakness whereas symptoms are ____________ findings like a feeling of fear or tingling in fingers.
Definition

Objectiven (a 3rd party can observe it)

Subjective (only the patient can feel/see it)

Term
An Epilepsy Syndrome is defined by a cluster of which features?
Definition

Type of seizures observed

age of onset

Cause of seizure

area of brain involved

factors that promote the seizure

severity, frequency and time of seizures

EEG patterns

Term
What are some features for Febrile Seizures?
Definition

They are tonic- clonic seizures that occur in kids between 3 months - 5 yrs

Have a high fever with a seizure

occurs in 2-5 % of all children

Tends to run in family

Fever reduction does not prevent seizures

Term
What are some features of Childhood Absense Epilepsy (CAE)?
Definition

This syndrome is simple absense seizures ocuring in kids 4-8 yrs old that is often started due to exercise.

It accounts for 2-8% of all patients with epilepsy.

Primary cause is due to genetics

Usually grow out of it in adulthood

Term
What are some features of Juvenile Myoclonic Epilepsy (JME)?
Definition

Occurs in juveniles

Usually observed in the early morning or shortly after waking up.

Is the most common forms of epilepsy makes up 7% of all cases. 

More common in peeps who have family with some form of generalized epilepsy.

Seizures are started due to strobe lights, TVs, video games, etc.

Term
If you have CAE as a child what % is it that it will develop into JME?
Definition
15%
Term
JME is aka __________________ that can be caused be lights, TVs, etc.
Definition
Photosensitive Seizure
Term
T/F: CAE is the most form of epilepsy.
Definition
False: JME is the most common, it accounts for 7% of all cases.
Term
Temporal Lobe Epilepsy (TLE) is a partial epilepsy arising from the temporal lobe in the brain. Which kinds of seizures are common in TLE syndrome?
Definition

Simple and Complex partial seizures

Secondarily generalized seizures

Term
T/F: TLE can develop at any age, but is sometimes observed after a head injury or cerebral infection.  It also includes auras of many types.
Definition
True
Term
T/F: After TLE, Frontal Lobe Epilepsy (FLE) is the most common form of epilepsy featuring Partial seizures.
Definition
True
Term
Which type of partial seizure is mostly likely to produce automatisms?
Definition
Complex seizures originating in the frontal lobe.
Term
What are automatisms?
Definition
Inappropriate expression of coordinated muscle activity
Term
How can you definetly diagnose someone with FLE ?
Definition
an EEG during the seizure
Term
What are some causes for Epilepsy?
Definition

Can be symptomatic or Idiopathic.

 

Some causes for Symptomatic Epilepsies are:

head trauma, drugs, infection, stroke, tumors

 

Idiopathic is unknown causes. It is probably due to genetics

Term
When is surgery need to treat for Epilepsy?
Definition
When it is intractable and does not respond to the medicine.
Term
What are some common areas of removal of the brain for Surgical Epilepsy treatment.
Definition

The amygdala

Anterior hippocampus

entorhinal cortex

Term
Who invented the Electroencephalogram (EEG)?
Definition
Hans Berger
Term
The EEG measures the frequency and amplitude. So during active thought process you have a ______ freq and a ________ amp
Definition

High freq

Low amp

Term
As the synchronousy of neurons increase then the amplitude ____________ and the frequency ___________.
Definition

Increases

decreases

 

(amp and freq are inverse of each other)

Term
What are the EEG values for a normal human?
Definition

4-30 Hz

20-100 microVolts

Term
What are some important things to remeber about an EEG?
Definition

The time scale is very slow and amplitudes are very low.

Data represent a population of neuorns, not 1.

Spikes in the EEG should not be confused for an A.P in a neuron.

Excitatory or Inhibitory events cannot be determined soley by this.

Term
In partial seizures only _______ lead is involved whereas in generalized seizures _____________ leads are affected.
Definition

1

all

Term
What is characteristic of generalized seizures?
Definition
3 Hz spikes
Term
In evolving complex partial seizure you can use a ___________ and  a _______ to determine an exact foci for surgical removal.
Definition
EEG and a MRI
Term
In Partial Seizures, since there is a seizure focus, each neuron in that focus will experience a synchornized response called a
Definition

Paroxysmal Depolarizing Shift (PDS).

 

PDS is D.P followed by H.P

Term
The Depolarizing phase of PDS in partial seizures is mediated by
Definition

Activation of Glu receptros

and Voltage gated Ca2+ channels.

Term
The Hyperpolarizing phase of the PDS in partial seizures is mediated by
Definition

Activation of GABA receptors

and

Ca2+ activated K+ channels

Term
What are some of the main components of PDS in partial seizures?
Definition

1. A large (20-40 mV), and long lasting (50-200 msec) suprathreshold D.P.

2. Afterhyperpolarization

Term
T/F:  PDS generation is supported by simple circuits because all phases of a PDS can be driven by single excitatory afferent.
Definition
True
Term
Simply put how does surround inhibition work?
Definition

If cells a and b have a recurrent excitatory connection to each other and if input of an excitatory to either of a or b will excite both and thus inhibit cells c and d because they are inbited when a or b are activated.

(feedback inhibition)

Term
What is the purpose of surround inhibition?
Definition
To contain a seizure focus so it prevents the spread of partial seizures.
Term
If you had a breakdown of sound inhibition what will occur?
Definition
An increase in synchronization of neuronal activity and thus contributes more to the spread of the partial seizure.
Term
What is one key factor that may lead to the breakdown of surround inhibition?
Definition
Loss of afterhyperpolarization due to modulation of GABAergic systems.
Term
How do anticonvulsants work?
Definition
By increasing surround inhibition or by decreasing excitation.
Term
Absense seizures are the best understood of generalized seizures.  What do we know about them?
Definition

They have large amplitude spike waves that occur at 3 Hz.

This is similar to sleep spindles but have a way higher amplitude.

This observation lead to the centrencepalic hypothesis.

Term
What does the centrencepalic hypothesis suggest in generalized seizures?
Definition
That rapid generalization is due to rapid pacing by groups of nuerons in thalamus or brainstem that project diffusely to the cortex.
Term
In the Thalmocortical circuitry, ______________ have reciprocal excitatory connections with ________________.
Definition

Cortical pyramidal neurons

Thalamic Relay neurons

Term
T/F: GABAergic nuerons only inhibit the thalamic relay neurons in the thalmocortical circuitry.
Definition
True; although both thalamic relay neurons and cortical pyramidal neurons excite them.
Term
What is needed for generating bursting behavior of the thalamic relay neurons in the thalmocortical circuity?
Definition
Special hyperpolarization activated Ca2+ channels (T-type)
Term
T/F: Partial seizures probably spread due to the loss of surround inhibition.
Definition
True
Term
Secondarily generalized seizures likely recruit ________________________ once surround inhibition is lost.
Definition
diffuse thalmocortical afferents
Term
Generalized seizures originate in the ____________.
Definition
Thalamus
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