Term 1

Seizures

Definition 1

Episode of abnormally synchronized and high frequency firign of neurons resulting in abnormal behanior or experience

Term 2

Epilepsy

Definition 2

Chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures

Term 3

Epilepsy Syndromes

Definition 3

Grouping of similar epileptic patients acording to seizure type, EEG age of onset, prognosis and clinical signs
-

Term 4

What can predispose

Definition 4

Term 5

What can predispose patients of 60 to epileptic seizures?

Definition 5

Strokes

Term 6

What are the causes of adult-onset epileptic seizures?

Definition 6

Carebrovascular disease
Trauma
Tumores
Infections
Cerebral degeneration
-

Term 7

What are partial seizures?

Definition 7

Focal onset seiaures that emanate from a specific cortical head region, may spread to become secondary generalized.

Term 8

What are Generalized Seizures?

Definition 8

no focal onset
thought to emanate from the brainstem structures
Spread to both hemispheres at the same time

Term 9

What is used to distinguish between the different levels of partial seizures?

Definition 9

level of consciousness
-

Term 10

What type of partial seizure is consciousness preserved?

Definition 10

Simple

Term 11

What type of Partial seizure is consciousness Impaired only?

Definition 11

Complex

Term 12

What type of partial seizure has loss of consciousness and bilateral cerebral involvement?

Definition 12

Secondarily generalized
-

Term 13

What is the Jacksonian march?

Definition 13

focal seizure starting from (for instance) the hand and "marching" up to involve the arm and face on the same side.

Term 14

What can simple partial seizure emanating from the motor cortex demonstrate?

Definition 14

Jacksonian March

Term 15

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 15

Sensory Cortex
Somatosensory partial seizure
-

Term 16

What signs/symptoms can Autonomic seiqures present with?

Definition 16

rising epigastric sensations, nausea

Term 17

What type of seizure presents with fear, Deja vu, or Jamais vu?

Definition 17

Psychic

Term 18

What kind of seizures are Auras?

Definition 18

Simple Partial Seizures, with no overt behavioral manifestations
-

Term 19

What does the EEG look like with simple partial seizures?

Definition 19

Can appear normal

Term 20

Where do complex partial seizures typically emanate from?

Definition 20

Temporal or frontal lobes

Term 21

What type of seizure can have oral or ipsilateral hand automatisms?

Definition 21

Complex Partial Seizures
-

Term 22

What results from spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia?

Definition 22

Contralateral dystonic posturing

Term 23

How long do Complex Partial seizures last?

Definition 23

1 minute

Term 24

What does the EEG look like in Complex partial seizures?

Definition 24

Focal EEG abnormality
-

Term 25

Is there Post-ictal amnesia and confusion after a complex partial seizure?

Definition 25

Yes

Term 26

What are the 6 types of Primary Generalized seizures?

Definition 26

Absence (petit mal)
Tonic-clonic
Clonic
Tonic
Myoclonic
Atonic

Term 27

Absence Seizure Features

Definition 27

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 28

What type of seizure shows a generalized 3Hz spike-wave discharges?

Definition 28

Absence Seizure

Term 29

Tonic-Clonic Seizure features

Definition 29

Cry, loss of consciousness
Muscular rigidiy (tonic)
Patient may fall
Rhythmic jerking (clonic)
Tongue-biting
Bladder/bowel incontinence
Post-ictal confusion/sleep

Term 30

What seizure type is commonly called a Grand Mal?

Definition 30

Tonic-Clonic Seizure
-

Term 31

What type of seizure has muscular rigidity and rhythmic jerking?

Definition 31

Tonic-Clonic

Term 32

Myoclonic seizure Features

Definition 32

Brief, shock like muscle contractions
Bilaterally symmetrical
Consciousness preserved
Precipitated by awakening of falling asleep
May progress into tonic-clonic

Term 33

What type of seizure is precipitated by awakening or falling asleep?

Definition 33

Myoclonic seizure
-

Term 34

Atonic Seizure features

Definition 34

Impaired consciousness
Loss of muscle tone
Head drop
Fall
Brief duration
Injury common

Term 35

What type of seizure has a loss of muscle tone?

Definition 35

Atonic seizure

Term 36

How does the neurological exam usually present in patients with epileptic seizures?

Definition 36

Normal
-

Term 37

What is the Diagnosis routine for Seizures?

Definition 37

History from patient and witnessess
Physical and Neurological exam
CBC, CMP, AED levels
Inter-ictal EEG
Epilepsy protocol MRI
Video-EEG monitoring

Term 38

What are examples of epileptiform abnormalities see on EEGs?

Definition 38

Sharp waves
Spikes
Sharp-and-slow wave discharges

Term 39

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 39

Primary Generalized Seizures
(Juvenile Myoclonic epilepsy)
-

Term 40

What type type of seizure has bilateral and symmetrical spike and wave activity occurring at a frequency of 3Hz?

Definition 40

Absence seizure

Term 41

What does an MRI with gadolinium-DPTA enhanced sequences look for?

Definition 41

Primary or secondary tumors, infection or inflammation in an adult with recent-onset epilepsy

Term 42

What is the Epilepsy Protocol MRI?

Definition 42

-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 43

What causes of focal epilepsy are detectable by MRI?

Definition 43

Cavernous Malformations
Focal cortical dysplasias
periventricular heterotopias

Term 44

Can focal epilepsy detectable by MRI be resected?

Definition 44

Yes, potentially

Term 45

What does periventricular heterotopia result from?

Definition 45

abnormal neuronal migration
-

Term 46

What is useful in defferentiating epileptic seizures from non-eplileptic seizures?

Definition 46

Video-EEG monitoring

Term 47

What suppesses excitability in most neuronal circuits?

Definition 47

GABAergic inhibition

Term 48

How does a focal seizure develop?

Definition 48

GABAergic inhibition is overcome
-

Term 49

Why is the hippocampus and thalamus prone to abnormal electrical activity?

Definition 49

the types of ion channels expressed in these regions and the patterns of inter-neuronal connections

Term 50

What is Medical Remission?

Definition 50

Seizure free without side effects on 1 or 2 Antiepileptic Drugs (AEDs)

Term 51

What is Disease Remission?

Definition 51

Seizure free off all AEDs
-

Term 52

What is Phenobarbital?

Definition 52

Barbiturate
Enhances activity of GABA receptor, depresses glutamate activity, reduces sodium, potassium conductance

Side Fx: Hepatotoxicity, CT disorder, SJS

Term 53

What is phenytoin?

Definition 53

Antiepileptic
Blockade of Na channels and inhibitory action on Ca and Cl conductance

Side Fx: Aplastic Anemia, hepatic failure, SJS, lupus

Term 54

What is Carbamazepine?

Definition 54

anticonvulsant
Blockade of neuronal sodium channel conductance
Side Fx: Aplastic anemia, hepatotoxicity, Stevens Johnson syndrome, Lupus
-

Term 55

Valproate

Definition 55

anticonvulsant
Affects GABA glutamatergic activity and reduce threshold of Ca and K conductance

Side Fx: Hepatotoxicity, hyperammonemia, leukopenia, thrombocytopenia, pancreatitis

Term 56

Ethosuximide

Definition 56

Inhibits Ca T-channel conductance

Side Fx: Bone marrow depression, hepatotoxicity

Term 57

Lamotrigine

Definition 57

Blockage of voltage-dependent Na Channels

Side Fx: SJS, toxic epidermal necrolysis
-

Term 58

Oxcarbazepine

Definition 58

Na channel blockade

Side Fx: Hyponatremia, Rash

Term 59

Topiramate

Definition 59

Blockage of Na Channels, enhancement of GABA medicated Cl influx

Side Fx: Renal calculi, hypohidrosis

Term 60

Zonisamide

Definition 60

Blockade of Na, K, and Ca channels, Inhibits glutamate excitation

Side Fx: Renal calculi, hypohidrosis
-

Term 61

Gabapentin

Definition 61

Modulation of N-Type Calcium Channel

Term 62

What older drugs are effective in partial and tonic-clonic seizures?

Definition 62

Valproate
Phenytoin
Carbamazepine
Phenobarbital

Term 63

What drugs are effective for absence seizures?

Definition 63

Ethosuximide
Valproate
-

Term 64

What newer drugs are effective for partial seizures?

Definition 64

Gabapentin
Oxcarbazepine

Term 65

What Newer drugs are broad spectrum for Partial and generalized seizures?

Definition 65

Lamotrigine
Topiramate
Levetiracetam
Zonisamide

Term 66

What Seizure drugs are Hepatic cytochrome P450 inducers?

Definition 66

Carbamazepine
Phenobarbital
Phenytoin
Oxcarbazepine
Topiramate
-

Term 67

What is Intractable Epilepsy?

Definition 67

Disabling seizures recurring despite optimized therapy

Term 68

What type of therapy is there for refractory epilepsy?

Definition 68

AED polytherapy
Vagal nerve stimulator
Ketogenic diet
Atkins diet
Epilepsy surgery

Term 69

What is Generalized Convulsive status epilepticus?

Definition 69

Continuous, generalized, convulsive seizure lasting more than 5 minutes or 2 or more sequential seizures occuring without full recovery of consciousness
-

Term 70

How is non-convulsive status epilepticus diagnosed?

Definition 70

EEG

Term 71

What are some Non-epileptic events?

Definition 71

Breath Holding spells
Hyperventilation attacks
Motor tics
Movement disorders
Parasomnias
Syncope
Spasmus nutans
Rumination
Sleep myoclonus
Head Banging

Term 72

What is the major difference between Psychogenic and Epileptic seizures?

Definition 72

Epileptic seizures have Epileptiform activity on EEG, Psychogenic do not
-

Term 73

What are some seizure precautions?

Definition 73

Showers instead of baths
Swimming
Biking with a helmet
No Driving for 6 months in TN

Term 74

How should a seizure be treated in the hospital?

Definition 74

ABCs
Administer a benzodiazepine
Consider antiepileptic

Term 75

What type of seizures are more likely to have a lesion present, Absence or Complex partial seizure?

Definition 75

Complex Partial seizures
-

Term 76

What is the most common type of childhood seizure?

Definition 76

Febrile seizures

Term 77

Definition of Febrile Seizures.

Definition 77

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 78

What is a Simple Fibrile Seizure?

Definition 78

Isolated, generalized, brief
-

Term 79

What is a complex Febrile seizure?

Definition 79

Multiple, focal, prolonged

Term 80

What are the risk factors for Febrile Seizure recurrence?

Definition 80

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 81

What diagnostic evaluations should be done on a child with a first simple febrile seizure?

Definition 81

Lumbar puncunture if they are <12months or on prior antibiotic treatment
-

Term 82

Infantile Spasms

Definition 82

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 83

What is West Syndrome?

Definition 83

Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression

Term 84

Lennox-Gastaut

Definition 84

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 85

What seizure syndrome is characterized by EEG patterns of 1.5-2.5 Hz?

Definition 85

Lennox-Gastaut

Term 86

What are some treatments for Lennox-Gastaut?

Definition 86

valproic acid, lamotrigine, topiramate, zonisamide, felbamate, benodiazepines, ketogenic dies, corpus callosotomy, vagus nerve stimulator

Term 87

Childhood Absence Epilepsy

Definition 87

Onset 4-8 years
Normal Neurologic status
occur multiple times per day
3 Hz spike and wave discharges
-

Term 88

What is the age of onset for Juvenile Myoclonic Epilepsy?

Definition 88

absence seizures - 7-13 years
Myoclonic Jerks - 12-18 years
Tonic-clonic seizures - 13-20 years

Term 89

When is the highest frequency of myoclonic jerks?

Definition 89

morning

Term 90

How is Juvenile Myoclonic Epilepsy characterized?

Definition 90

brief myoclonic seizures, bilateral not always symmetric, flexor jerks of the arms which may be repetitive
-

Term 91

What can precipitate Juvenile Myoclonic Epilepsy?

Definition 91

sleep deprivation, alcohol ingestion, stress, awakening from sleep, menstruation, photic stimulation

Term 92

What type of epilepsy is linked to chromosome 6?

Definition 92

Juvenile Myoclonic Epilepsy

Term 93

What is the most common form of benign partial epilepsy of childhood?

Definition 93

Benign Rolandic Epilepsy
-

Term 94

What are the characteristics of Benign Rolandic Epilepsy?

Definition 94

Onset: 4-12 years
Normal neurologic status and imaging
Facial Motor seizures
Nocturnal generalized tonic-clonic seizures
EEG: central-temporal spikes

Term 95

What form of epilepsy has central temporal spikes?

Definition 95

Benign Rolandic Epilepsy

Term 96

What form of epilepsy's most specific type of seizure is a facial motor seizure?

Definition 96

Benign Rolandic Epilepsy
-

Term 97

What Drugs are use for Partial seizures?

Definition 97

Phenytoin
Carbamazepine
phenobarbital
gabapentin
tiagabine
oxcarbazepine

Term 98

What is ACTH used to treat?

Definition 98

infantile spasms

Term 99

What drugs are Broad-spectrum agents?

Definition 99

Valproic acid
lamotrigine
topiramate
felbamate
zonisamide
-

Term 100

What is Ethosuximide used to treat?

Definition 100

Absence seizures only

Term 101

What is the best method to detect epilepsy?

Definition 101

Inter-ictal EEG


(increased detection with sleep deprevation and extended recording times)

Term 102

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

Definition 102

Old - Catagory D

New - Catagory C

(Increase in birth defects with higher doses and polytherapy)
-

Term 103

How effective is switching AEDs if the patient doesn't respond to the first?

Definition 103

Changing or adding another drug is NOT very effective. Most patients who respond to AEDs do so with the first AED used

Term 104

What is optimized therapy?

Definition 104

At least 2 AEDs at maximal tolerated dose with good compliance

Term 105

How should Intractable (Refractory) Epilepsy be diagnosed?

Definition 105

Confirmed by re-examination

 

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

Term 106

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

Definition 106

Diastat

(rectal diazepam)

Term 107

Should epilepsy patients be evaluated after their first non-febrile seizure?

Definition 107

Hells no

Term 108

What should be tested if a child with epilepsy develeps Status Epilepticus?

Definition 108

AED level toxicology

also consider an EEG and MRI if etiology is unknown
-

Term 109

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

Definition 109

Complex Febrile Seizures

Family history of epilepsy

Neurologic impairment prior to febrile seizure

 

Term 110

How are Febrile Seizures managed long-term?

Definition 110

 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