Epilepsy

Question 1

epilepsy

Answer 1

a tendency to spontaneous, recurrent seizures, usually defined by experience of at least 2 UNPROVOKED seizures

Question 2

age w/ highest incidence of seizures

Answer 2

first year of life –> highest incidence of epilepsy

then incidence rate decreases until about mid 20s and plateaus

then at age 60 slowly increases

Question 3

seizure: an abnormal, “clinically observable” event associated w/ and caused by an abnormal “____________” discharge in the EEG

Answer 3

an abnormal, “clinically observable” event associated w/ and caused by an abnormal “HYPER SYNCHRONOUS” discharge in the EEG

Question 4

seizure first aid

Answer 4

roll person on side (to prevent aspiration)

most seizures setup on their own <2 min

Question 5

damaging features of seizures

Answer 5

• external injury
• motor activity: hypoxemia, acidemia, hypercarbia/hypoventilation
• local neuronal metabolic exhaustion
• EAA damage (excitatory amino acid damage)
• psychological factors
• poss. reinforcing seizure circuit if let keep firing

Question 6

seizure types (broad)

Answer 6

1. partial (focal) –> localized
   - simple, complex, or partial w/ secondary generalization
2. generalized –> all over brain
   - absence, myoclonic, tonic-clonic

Question 7

focal seizure vs. generalized seizure

Answer 7

refers to ONSET

focal –> starts in just a focal area of cortex, possibly causing a manifestation related to the function of that area of cortex, and then may or may not spread

generalized –> starts all over the surface of the brain at the same time

Question 8

Jacksonian march

Answer 8

seizure begins with CLONIC activity in one limb or the face and sequentially SPREADS to the remainder of the involved hemibody, ultimately involving both sides of body w/ a bilaterally synchronous convulsion

EEG discharge: from subset of the motor strip to the whole of one hemisphere, to generalized involvement of BOTH hemispheres

Question 9

features of pt presenting w/ seizures

Answer 9

• focal/asymmetrical features
• stereotyped, brief episodes
• randomness (not every time you’re in pool, etc.)
• activity that starts on ONE SIDE before other
• preferential eye turning
• one side stiff, other limp
• POSITIVE signs vs. negative signs

Question 10

background features of pt possibly presenting w/ seizures

Answer 10

-early handedness = hemiparesis
(started using one hand exclusively, early on, bc other hand was abnormal)

• limb asymmetry (one hand abnormally small bc that side of brain is defective)
• developmental delay/cognitive disability

Question 11

partial seizures signs

Answer 11

• motor (Jacksonian march)
• autonomic (vomiting, borborygmi)
• somatosensory
• psychic signs
• autonmatisms

Question 12

how are automatisms unique from other partial seizure signs?

Answer 12

they are RELEASE phenomena, NOT driven directly by the seizure discharge.

represent the release of automatic, pre-programmed behaviors that are normally suppressed by the cerebral cortex.

Question 13

processes leading to focal seizures

Answer 13

• old birth injury/stroke
• old traumatic injury
• AVM
• focal dysgenesis/brain malformation
• sequela of CNS infection
• tumor
• genetics

Question 14

causes of generalized epilepsy

Answer 14

• GENETIC

- metabolic derangement

Question 15

simple partial seizure

Answer 15

consciousness maintained

Question 16

complex partial seizure

Answer 16

loss of consiousness

Question 17

partial seizures w/ secondary generalization

Answer 17

initial focal activity, then spreads

still tx as focal seizure

Question 18

types of generalized seizure

Answer 18

1. absence (children, blank stare, brief)
2. myoclonic (rapid jerking)
3. tonic-clonic (stiffness THEN jerking)

Question 19

tonic-clonic EEG pattern

Answer 19

Sudden, rapid spikes everywhere –> person stiffened (tonic phase)

then activity slows down enough that each spike can cause a separate jerk (clonic phase)

then slows down further