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Epilepsy and Seizures
Neuro assessment 7
110
Anatomy
Graduate
10/06/2011

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Cards

Term
Seizures
Definition
Episode of abnormally synchronized and high frequency firign of neurons resulting in abnormal behanior or experience
Term
Epilepsy
Definition
Chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures
Term
Epilepsy Syndromes
Definition
Grouping of similar epileptic patients acording to seizure type, EEG age of onset, prognosis and clinical signs
Term
What can predispose
Definition
Term
What can predispose patients of 60 to epileptic seizures?
Definition
Strokes
Term
What are the causes of adult-onset epileptic seizures?
Definition
Carebrovascular disease
Trauma
Tumores
Infections
Cerebral degeneration
Term
What are partial seizures?
Definition
Focal onset seiaures that emanate from a specific cortical head region, may spread to become secondary generalized.
Term
What are Generalized Seizures?
Definition
no focal onset
thought to emanate from the brainstem structures
Spread to both hemispheres at the same time
Term
What is used to distinguish between the different levels of partial seizures?
Definition
level of consciousness
Term
What type of partial seizure is consciousness preserved?
Definition
Simple
Term
What type of Partial seizure is consciousness Impaired only?
Definition
Complex
Term
What type of partial seizure has loss of consciousness and bilateral cerebral involvement?
Definition
Secondarily generalized
Term
What is the Jacksonian march?
Definition
focal seizure starting from (for instance) the hand and "marching" up to involve the arm and face on the same side.
Term
What can simple partial seizure emanating from the motor cortex demonstrate?
Definition
Jacksonian March
Term
Where/What kind would a partial seizure have a focus in if presents with tingling and numbness of an estremity of side of face?
Definition
Sensory Cortex
Somatosensory partial seizure
Term
What signs/symptoms can Autonomic seiqures present with?
Definition
rising epigastric sensations, nausea
Term
What type of seizure presents with fear, Deja vu, or Jamais vu?
Definition
Psychic
Term
What kind of seizures are Auras?
Definition
Simple Partial Seizures, with no overt behavioral manifestations
Term
What does the EEG look like with simple partial seizures?
Definition
Can appear normal
Term
Where do complex partial seizures typically emanate from?
Definition
Temporal or frontal lobes
Term
What type of seizure can have oral or ipsilateral hand automatisms?
Definition
Complex Partial Seizures
Term
What results from spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia?
Definition
Contralateral dystonic posturing
Term
How long do Complex Partial seizures last?
Definition
1 minute
Term
What does the EEG look like in Complex partial seizures?
Definition
Focal EEG abnormality
Term
Is there Post-ictal amnesia and confusion after a complex partial seizure?
Definition
Yes
Term
What are the 6 types of Primary Generalized seizures?
Definition
Absence (petit mal)
Tonic-clonic
Clonic
Tonic
Myoclonic
Atonic
Term
Absence Seizure Features
Definition
Brief loss of consciousness (10-20sec)
Staring Spell
No post-ictal confusion
subtle myoclonic movement, eyelid flutter
No Baselen neurologic deficits
EEG show generalized 3Hz spike-wave discharges
Term
What type of seizure shows a generalized 3Hz spike-wave discharges?
Definition
Absence Seizure
Term
Tonic-Clonic Seizure features
Definition
Cry, loss of consciousness
Muscular rigidiy (tonic)
Patient may fall
Rhythmic jerking (clonic)
Tongue-biting
Bladder/bowel incontinence
Post-ictal confusion/sleep
Term
What seizure type is commonly called a Grand Mal?
Definition
Tonic-Clonic Seizure
Term
What type of seizure has muscular rigidity and rhythmic jerking?
Definition
Tonic-Clonic
Term
Myoclonic seizure Features
Definition
Brief, shock like muscle contractions
Bilaterally symmetrical
Consciousness preserved
Precipitated by awakening of falling asleep
May progress into tonic-clonic
Term
What type of seizure is precipitated by awakening or falling asleep?
Definition
Myoclonic seizure
Term
Atonic Seizure features
Definition
Impaired consciousness
Loss of muscle tone
Head drop
Fall
Brief duration
Injury common
Term
What type of seizure has a loss of muscle tone?
Definition
Atonic seizure
Term
How does the neurological exam usually present in patients with epileptic seizures?
Definition
Normal
Term
What is the Diagnosis routine for Seizures?
Definition
History from patient and witnessess
Physical and Neurological exam
CBC, CMP, AED levels
Inter-ictal EEG
Epilepsy protocol MRI
Video-EEG monitoring
Term
What are examples of epileptiform abnormalities see on EEGs?
Definition
Sharp waves
Spikes
Sharp-and-slow wave discharges
Term
What type of seizure typically has an EEG that demonstrates bilateral burst of epileptiform spike and slow wave discharges simultaneously and symmetrically in both hemispheres?
Definition
Primary Generalized Seizures
(Juvenile Myoclonic epilepsy)
Term
What type type of seizure has bilateral and symmetrical spike and wave activity occurring at a frequency of 3Hz?
Definition
Absence seizure
Term
What does an MRI with gadolinium-DPTA enhanced sequences look for?
Definition
Primary or secondary tumors, infection or inflammation in an adult with recent-onset epilepsy
Term
What is the Epilepsy Protocol MRI?
Definition
-Coronal high resolution T1-weighted volume data set through the whole brain
-Coronal T2-weighted sequence, typically using 3 mm thin section, also to dectect hippocampal signal abnormalities
Term
What causes of focal epilepsy are detectable by MRI?
Definition
Cavernous Malformations
Focal cortical dysplasias
periventricular heterotopias
Term
Can focal epilepsy detectable by MRI be resected?
Definition
Yes, potentially
Term
What does periventricular heterotopia result from?
Definition
abnormal neuronal migration
Term
What is useful in defferentiating epileptic seizures from non-eplileptic seizures?
Definition
Video-EEG monitoring
Term
What suppesses excitability in most neuronal circuits?
Definition
GABAergic inhibition
Term
How does a focal seizure develop?
Definition
GABAergic inhibition is overcome
Term
Why is the hippocampus and thalamus prone to abnormal electrical activity?
Definition
the types of ion channels expressed in these regions and the patterns of inter-neuronal connections
Term
What is Medical Remission?
Definition
Seizure free without side effects on 1 or 2 Antiepileptic Drugs (AEDs)
Term
What is Disease Remission?
Definition
Seizure free off all AEDs
Term
What is Phenobarbital?
Definition
Barbiturate
Enhances activity of GABA receptor, depresses glutamate activity, reduces sodium, potassium conductance

Side Fx: Hepatotoxicity, CT disorder, SJS
Term
What is phenytoin?
Definition
Antiepileptic
Blockade of Na channels and inhibitory action on Ca and Cl conductance

Side Fx: Aplastic Anemia, hepatic failure, SJS, lupus
Term
What is Carbamazepine?
Definition
anticonvulsant
Blockade of neuronal sodium channel conductance
Side Fx: Aplastic anemia, hepatotoxicity, Stevens Johnson syndrome, Lupus
Term
Valproate
Definition
anticonvulsant
Affects GABA glutamatergic activity and reduce threshold of Ca and K conductance

Side Fx: Hepatotoxicity, hyperammonemia, leukopenia, thrombocytopenia, pancreatitis
Term
Ethosuximide
Definition
Inhibits Ca T-channel conductance

Side Fx: Bone marrow depression, hepatotoxicity
Term
Lamotrigine
Definition
Blockage of voltage-dependent Na Channels

Side Fx: SJS, toxic epidermal necrolysis
Term
Oxcarbazepine
Definition
Na channel blockade

Side Fx: Hyponatremia, Rash
Term
Topiramate
Definition
Blockage of Na Channels, enhancement of GABA medicated Cl influx

Side Fx: Renal calculi, hypohidrosis
Term
Zonisamide
Definition
Blockade of Na, K, and Ca channels, Inhibits glutamate excitation

Side Fx: Renal calculi, hypohidrosis
Term
Gabapentin
Definition
Modulation of N-Type Calcium Channel
Term
What older drugs are effective in partial and tonic-clonic seizures?
Definition
Valproate
Phenytoin
Carbamazepine
Phenobarbital
Term
What drugs are effective for absence seizures?
Definition
Ethosuximide
Valproate
Term
What newer drugs are effective for partial seizures?
Definition
Gabapentin
Oxcarbazepine
Term
What Newer drugs are broad spectrum for Partial and generalized seizures?
Definition
Lamotrigine
Topiramate
Levetiracetam
Zonisamide
Term
What Seizure drugs are Hepatic cytochrome P450 inducers?
Definition
Carbamazepine
Phenobarbital
Phenytoin
Oxcarbazepine
Topiramate
Term
What is Intractable Epilepsy?
Definition
Disabling seizures recurring despite optimized therapy
Term
What type of therapy is there for refractory epilepsy?
Definition
AED polytherapy
Vagal nerve stimulator
Ketogenic diet
Atkins diet
Epilepsy surgery
Term
What is Generalized Convulsive status epilepticus?
Definition
Continuous, generalized, convulsive seizure lasting more than 5 minutes or 2 or more sequential seizures occuring without full recovery of consciousness
Term
How is non-convulsive status epilepticus diagnosed?
Definition
EEG
Term
What are some Non-epileptic events?
Definition
Breath Holding spells
Hyperventilation attacks
Motor tics
Movement disorders
Parasomnias
Syncope
Spasmus nutans
Rumination
Sleep myoclonus
Head Banging
Term
What is the major difference between Psychogenic and Epileptic seizures?
Definition
Epileptic seizures have Epileptiform activity on EEG, Psychogenic do not
Term
What are some seizure precautions?
Definition
Showers instead of baths
Swimming
Biking with a helmet
No Driving for 6 months in TN
Term
How should a seizure be treated in the hospital?
Definition
ABCs
Administer a benzodiazepine
Consider antiepileptic
Term
What type of seizures are more likely to have a lesion present, Absence or Complex partial seizure?
Definition
Complex Partial seizures
Term
What is the most common type of childhood seizure?
Definition
Febrile seizures
Term
Definition of Febrile Seizures.
Definition
Seizures that occur in febrile children between the ages of 6 and 60 months who do not have an intracranial infection, metabolic distrubance, or history of afebrile seizures
Term
What is a Simple Fibrile Seizure?
Definition
Isolated, generalized, brief
Term
What is a complex Febrile seizure?
Definition
Multiple, focal, prolonged
Term
What are the risk factors for Febrile Seizure recurrence?
Definition
Young age at onset <18 months
febrile seizure in 1st degree relative
Low grade fever in E.R.
Brief duration between fever and seizure
Term
What diagnostic evaluations should be done on a child with a first simple febrile seizure?
Definition
Lumbar puncunture if they are <12months or on prior antibiotic treatment
Term
Infantile Spasms
Definition
Onset 3-7 months
Seizures: Brief bilateral symmetric contraction of the muscles of the neck, trunk, and extremities
May Flush or turn cyanotic
"Stomach Crunches"
EEG: Hypsarrhythmia - chaotic activity
Term
What is West Syndrome?
Definition
Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression
Term
Lennox-Gastaut
Definition
Onset 1-8 years
Triad:
-At least 2 seizure types
-Slowing of mental development
-EEG: slow spike and wave, 1.5-2.5 Hz
Term
What seizure syndrome is characterized by EEG patterns of 1.5-2.5 Hz?
Definition
Lennox-Gastaut
Term
What are some treatments for Lennox-Gastaut?
Definition
valproic acid, lamotrigine, topiramate, zonisamide, felbamate, benodiazepines, ketogenic dies, corpus callosotomy, vagus nerve stimulator
Term
Childhood Absence Epilepsy
Definition
Onset 4-8 years
Normal Neurologic status
occur multiple times per day
3 Hz spike and wave discharges
Term
What is the age of onset for Juvenile Myoclonic Epilepsy?
Definition
absence seizures - 7-13 years
Myoclonic Jerks - 12-18 years
Tonic-clonic seizures - 13-20 years
Term
When is the highest frequency of myoclonic jerks?
Definition
morning
Term
How is Juvenile Myoclonic Epilepsy characterized?
Definition
brief myoclonic seizures, bilateral not always symmetric, flexor jerks of the arms which may be repetitive
Term
What can precipitate Juvenile Myoclonic Epilepsy?
Definition
sleep deprivation, alcohol ingestion, stress, awakening from sleep, menstruation, photic stimulation
Term
What type of epilepsy is linked to chromosome 6?
Definition
Juvenile Myoclonic Epilepsy
Term
What is the most common form of benign partial epilepsy of childhood?
Definition
Benign Rolandic Epilepsy
Term
What are the characteristics of Benign Rolandic Epilepsy?
Definition
Onset: 4-12 years
Normal neurologic status and imaging
Facial Motor seizures
Nocturnal generalized tonic-clonic seizures
EEG: central-temporal spikes
Term
What form of epilepsy has central temporal spikes?
Definition
Benign Rolandic Epilepsy
Term
What form of epilepsy's most specific type of seizure is a facial motor seizure?
Definition
Benign Rolandic Epilepsy
Term
What Drugs are use for Partial seizures?
Definition
Phenytoin
Carbamazepine
phenobarbital
gabapentin
tiagabine
oxcarbazepine
Term
What is ACTH used to treat?
Definition
infantile spasms
Term
What drugs are Broad-spectrum agents?
Definition
Valproic acid
lamotrigine
topiramate
felbamate
zonisamide
Term
What is Ethosuximide used to treat?
Definition
Absence seizures only
Term
What is the best method to detect epilepsy?
Definition

Inter-ictal EEG


(increased detection with sleep deprevation and extended recording times)

Term
What catagory of drugs are the old AEDs and the new AEDs?
Definition

Old - Catagory D

New - Catagory C

(Increase in birth defects with higher doses and polytherapy)

Term
How effective is switching AEDs if the patient doesn't respond to the first?
Definition
Changing or adding another drug is NOT very effective. Most patients who respond to AEDs do so with the first AED used
Term
What is optimized therapy?
Definition
At least 2 AEDs at maximal tolerated dose with good compliance
Term
How should Intractable (Refractory) Epilepsy be diagnosed?
Definition

Confirmed by re-examination

 

Make sure seizures aren't due to something else that is treatable

Term
What drug can be used to treat Status Epilepticus and Seizure Clusters in children?
Definition

Diastat

(rectal diazepam)

Term
Should epilepsy patients be evaluated after their first non-febrile seizure?
Definition
Hells no
Term
What should be tested if a child with epilepsy develeps Status Epilepticus?
Definition

AED level toxicology

also consider an EEG and MRI if etiology is unknown

Term
What are 3 risk factors for febrile seizures developing into epilepsy in children?
Definition

Complex Febrile Seizures

Family history of epilepsy

Neurologic impairment prior to febrile seizure

 

Term
How are Febrile Seizures managed long-term?
Definition

 Oral Diazepam at onset of fever

 

Rectal Diazepam (Diastat) for seizure clusters or seizures more than 3 minutes long (not in addition to oral diazepam)

 

Is NOT prevented with antipyretics or anticonvulsants

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