Term
|
Definition
| recurrent unproviked seizures |
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Term
|
Definition
one or more seizure types
EEG, genetic, and pathological features |
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Term
| general causes of epilepsy (7) |
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Definition
idiopathic
vascular
congenital
trauma
tumor
degeneration
infection |
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Term
|
Definition
complex partial
generalized tonic/clonic
simple partial
abence
myoclonic |
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Term
| epidemology of epilepsy: how many people, disease association, comparison to seizure |
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Definition
1/12 people will have a seizure
2 million people have epilepsy
1/4 of kids with autism will have seizure |
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Term
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Definition
paroxysmal disturbance of brain electrical activity
symptom not disease |
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Term
|
Definition
self limited
continous
non-epileptic
epileptic |
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Term
| types of self limited seizure 2 |
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Definition
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Term
| types of continous seizure 2 |
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Definition
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Term
| types of epileptic seizure 2 |
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Definition
epileptic
status epilepticus |
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Term
| 3 types of self limited generalized seizure |
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Definition
clonic tonic
absence
myoclonic |
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Term
| 3 types of self limited partial seizure |
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Definition
focal sensory
focal motor
gelastic |
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Term
| 3 types of continous generalized seizure |
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Definition
tonic clonic status epilepticus
absence status epilepticus
myoclonic status epilepticus |
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Term
| 3 types of continous focal seizure |
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Definition
epolepsia partialis continous
aura continua
limbic status epolepticus |
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Term
| non-epileptic seizure: percipitating, eyes, duration, post-ictal, ARD effect, prolactin levels, motions |
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Definition
percipitation: stress
eyes: closed
duration: long
post-ictal: none
ARD: refractory
prolactin: normal
motion...
quivering side to side head, pelvic thrust, falling, thrashing, asynchrnous, rhythmic movement of limbs |
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Term
| epipeltpic seizure: percipitating, eyes, duration, post-ictal, ARD effect, prolactin levels, motions |
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Definition
percipitation: none
eyes: open
duration: sec-min
post-ictal: yes
ARD: responsive
prolactin: elevated
movement...
self injrous, incontinence |
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Term
| non-convulsive status epilepticus: electric activity, tx |
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Definition
unequal electrograph seizure activity
periodic epileptiform discharges or rhythmic discharge with either clinical or electrographic response to tx
DO NOT give paralytics |
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Term
| convulsive status epilepticus: duration/definition |
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Definition
no more than 30 min of continous seizure activity OR 2+ sequential seizures without full recovery of consciousness between seizures
modern definition: seizure >10min
practical definition: any patient still seizing |
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Term
| things that percipitate seizure (8) |
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Definition
| stress, emotion, sleep depirvation, sleep, hyperventilation, fever, medications, metabolic disturbance, reflex epilepsy |
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Term
| things that percipitate reflex epilepsy (5) |
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Definition
photic stimuli: TV, flashing lights, visual patterns
startle, music, reading, eating |
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Term
| things that mimic a seizure (8) |
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Definition
syncope
hyperventilation
panic attacks
migraine
paroxysmal movement disorders
sleep disorders
RIAs
transient global amnesia |
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Term
| what is used to evaluate epilepsy (8) |
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Definition
history
EEG: sleep, photic, HV, video monitoring
MRI: unless clearly genetic
PET: surgery prep
SPECT: surgery prep |
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Term
|
Definition
| EEG for use of seizure classification or localization for surgery |
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Term
| pediatric seizre: brain location |
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Definition
| multifocal, never generalized |
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Term
| what do you do if neonate with partial seizure changes post-ictal behavior |
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Definition
| nothing, it changes in a few months for them |
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Term
| causes of partial seizure(4), which is most common |
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Definition
incomplete myelination and inability to produce synchrony
pre and perinatal injury and metabolic causes are most common
brainstem activity with severe injury (synchrnous motor events) |
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Term
| types of pediatric seizure (4) |
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Definition
simple febrile
complex febrile
childhood absence epilepsy
juvenile myoclonic epilepsy |
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Term
| simple febrile seizure: duration, location in brain, outcome, tx |
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Definition
brief, do not reoccur in 24h, not focal
do not increase risk of epilepsy or developmental issues
not tx unless frequently reoccurrant |
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Term
| complex febrile seizure: outcome, tx |
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Definition
increase risk of epilepsy by 3-10%
not tx unless problematic (preventitive: daily phenobarbital, intermittent valium with fever) |
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Term
| childhood absence epilepsy: epidemology, onset, tx, outcome |
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Definition
20% genetic predisposition
75% female
onset 3012yo (peak6-7)
TX: VPA, ESM
5% remitting |
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Term
| childhood absence epilepsy EEG signs (5) |
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Definition
bilateral
synchronous
symmetrical
3sec spike wave
normal background |
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Term
| childhood absence epilepsy seizure: frequency, type, presentation |
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Definition
frequent
simple seizure
absence: ADD like, staring spells |
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Term
| juvenile myoclonic epilepsy: epidemology, onset, TX, outcome |
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Definition
25% genetic predisposition
male = female
onset 8-26yo (peak 17-18)
TX: VPA, TPX, LEV, ZON, LTG
10% remitting |
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Term
| juvenile myoclonic epilepsy EEG signs |
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Definition
| rapid 4-5 sec spike OR polyspike wave ictally and intraictally |
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Term
| juvenile myoclonic epilepsy seizure: percipitation, type, timing, symptoms |
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Definition
often photosensitive
myoclonus
GTCS on waking or sleep depirvation
occasional absence |
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Term
| focal/partial seizure: location in brain, progression |
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Definition
originate in focus in brain
can spread to other parts
can become secondary generalized |
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Term
| clinical signs of focal/partial seizure that became secondary generalized (3) |
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Definition
tonic/clonic
incontinence
autonomic disturbance |
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Term
| symptoms of a frontal lobe focal seizure (jacksonian) (2) |
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Definition
tingling of arm
adverse seizure: eyes or head turn to one side |
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Term
| symptoms of a temporal lobe focal seizure (5) |
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Definition
strange smell or taste
altered behavior
deja vu
lip smacking/chewing |
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Term
| symptoms of a parietal lobe focal seizure (3) |
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Definition
flashing lights
spots
post seizure migraines (migralepsy) |
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Term
| define simple partial seizure, one symptom |
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Definition
focal seizure that does not spread
often have aura |
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Term
| define complex partial seizure |
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Definition
| focal seizure with bilateral spread |
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Term
| define generalized seizures |
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Definition
whole brain is firing at the same time
no aura |
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Term
| 7 symptoms/types of generalized seizures |
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Definition
tonic
clonic
absences
myoclonic
atomic
astatic
GTCS |
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Term
|
Definition
| pure bilateral stiffening |
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Term
|
Definition
| pure rhythmic bilateral flexion and extension |
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Term
|
Definition
| brief behavorial arrest with unresponsiveness and automatisms (staring for 2-10sec) |
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Term
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Definition
| lightning fast single bilateral jerk |
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Term
| who usually gets myoclonic seizures |
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Definition
| 13-18yo girls with family hx |
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Term
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Definition
| sudden generalized loss of tone |
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Term
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Definition
| drop attacks due to tonic, myoclonic, or atonic seizure |
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Term
|
Definition
generalized tonic/clonic seizure
non-focal primary generalized tonic stiffening altering with rhythmic slonus |
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Term
| when do you treat seizures |
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Definition
risk of reoccurance is 30-35% after first unprovoked seizure: only tx if they have tumor or something
risk of reoccurrence is 70% after second unprovoked seizure: tx |
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Term
| cause of hippocampal sclerosis and tx |
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Definition
| untreated seizure for long period of time allows pathways to develop too well and meds dont work so you need to remove part of the brain with epilepsy surgery |
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Term
| general pathway of medication of epilepsy |
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Definition
always use single drug first, start low go slow
increase dose until controlled or toxicity (above theraputic range dosen't always mean toxicity)
if it dosent work switch
if monotherapy dosent work then try using two drugs (careful, sometimes it causes more seizure) |
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Term
| how is status epilepticus tx |
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Definition
oxygen, vitals, IV access, IV fluids, check glycemia
protect pt and others from injury
position pt on side to prevent aspiration
treat seizure
Labs and testing
transfer to neuro ICU, consider heat CT, EEG, LP |
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Term
| what labs and tests do you get for someone in status epilepticus (8) |
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Definition
| SMA6, SMA12, CBC with diff and platelets, hold urine, CXR, EKG myoglobulin, if on AED check levels |
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Term
| what should a pregnant women with seizures be on, what testing schedule |
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Definition
folate 1-4mg/d
vit K 20mg/d mo 8 OR
vit K 10mg IV 4h before birth + 1mg IV to newborn
check a-fetoprotein 15wk
check ARD lvl at week 0, 18, 34, post partum 12wk
ultrasound wek 18, 22 |
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Term
|
Definition
seizure free for 2-5 years
single type partial or generalized
normal neuro exam and IQ
EEG normal with tx |
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Term
| what is the ratep of relapse when ppl get off AED |
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Definition
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Term
| what is a non-drug way to help with seizures, why, who can use it |
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Definition
ketogenesis improves seizure control
4 protein : 1 carb on caloric basia
uses med chain TG and allows for more carbs
beneficial in pt <10yo because the diet is hard to force on them |
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Term
| what do you do if ARD meds dont work |
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Definition
experimental AED new med trial
surgery |
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Term
| define mirror foci/kindling |
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Definition
| many zeisures all day an new focu developing |
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Term
| when do use vagal nerve stimulator (4) |
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Definition
vagus nerve stimulator is used on extratemporal non-lesion forms
in ppl who are at high risks for getting or have failed surgery
primary/secondary generalized epilepsy (surgically cannot remove) |
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Term
|
Definition
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Term
| percent of epilepsy pt who need surgery, reasons to do it |
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Definition
30% dont respond to drugs
seizures must be worse than probability of causing functional impairment in surgery
have tried med for 6mo-2y (unless paritalis continous or in kid where seizure is causing developmental delay) |
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Term
|
Definition
EEG-CCTV
MRI
PET/ictal SPECT
neuropsychological testing
wada test |
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Term
| wxplain how to do wada test |
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Definition
language test to make sure you dont cut out dominant language center or hemiparesis.
inject with Na barbital and localize the part of the brain needing to be removed |
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Term
| explain the three types of focal resection |
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Definition
temporal lobe seizure: temporal lobectomy, anterior medial resection, amygdalohyppocampectomy
structural lesions: remove abnormality, resect epileptogenic tissue
extratemporal cortical resection: less common, difficult to localize, resection can cause functional deficit |
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Term
| when do you use disconnect procedures, aka, process |
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Definition
palliative for generalized seizures (esp atonic)
corpus allosotomy: disconnect hemispheres |
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Term
| hemispherectomy: symptoms, outcomes |
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Definition
unilateral cogenital injuries
sturge weber syndrome
hemimeganecephaly
rasummens encephalitis
cortex is already dysfunctional, hemispherectomy does not cause motor, sensory, or cognition effects |
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Term
| what is the outcome of seizure free and responding to medications |
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Definition
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Term
| what is the outcome of seizure free and resoponding to VNS |
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Definition
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Term
| what is the outcome of seizure free and resoponding in temporal resection |
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Definition
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Term
| what is the outcome of seizure free and resoponding in extratemporal and non-lesional surgery |
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Definition
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