Term
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Definition
| Episode of abnormally synchronized and high frequency firign of neurons resulting in abnormal behanior or experience |
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Term
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Definition
| Chronic brain disorder of various etiologies characterized by recurrent, unprovoked seizures |
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Term
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Definition
| Grouping of similar epileptic patients acording to seizure type, EEG age of onset, prognosis and clinical signs |
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Term
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Definition
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Term
| What can predispose patients of 60 to epileptic seizures? |
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Definition
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Term
| What are the causes of adult-onset epileptic seizures? |
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Definition
Carebrovascular disease
Trauma
Tumores
Infections
Cerebral degeneration |
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Term
| What are partial seizures? |
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Definition
| Focal onset seiaures that emanate from a specific cortical head region, may spread to become secondary generalized. |
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Term
| What are Generalized Seizures? |
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Definition
no focal onset
thought to emanate from the brainstem structures
Spread to both hemispheres at the same time |
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Term
| What is used to distinguish between the different levels of partial seizures? |
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Definition
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Term
| What type of partial seizure is consciousness preserved? |
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Definition
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Term
| What type of Partial seizure is consciousness Impaired only? |
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Definition
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Term
| What type of partial seizure has loss of consciousness and bilateral cerebral involvement? |
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Definition
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Term
| What is the Jacksonian march? |
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Definition
| focal seizure starting from (for instance) the hand and "marching" up to involve the arm and face on the same side. |
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Term
| What can simple partial seizure emanating from the motor cortex demonstrate? |
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Definition
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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? |
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Definition
Sensory Cortex
Somatosensory partial seizure |
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Term
| What signs/symptoms can Autonomic seiqures present with? |
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Definition
| rising epigastric sensations, nausea |
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Term
| What type of seizure presents with fear, Deja vu, or Jamais vu? |
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Definition
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Term
| What kind of seizures are Auras? |
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Definition
| Simple Partial Seizures, with no overt behavioral manifestations |
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Term
| What does the EEG look like with simple partial seizures? |
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Definition
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Term
| Where do complex partial seizures typically emanate from? |
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Definition
| Temporal or frontal lobes |
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Term
| What type of seizure can have oral or ipsilateral hand automatisms? |
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Definition
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Term
| What results from spread of seizure activity from the temporal lobe to the ipsilateral basal ganglia? |
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Definition
| Contralateral dystonic posturing |
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Term
| How long do Complex Partial seizures last? |
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Definition
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Term
| What does the EEG look like in Complex partial seizures? |
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Definition
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Term
| Is there Post-ictal amnesia and confusion after a complex partial seizure? |
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Definition
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Term
| What are the 6 types of Primary Generalized seizures? |
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Definition
Absence (petit mal)
Tonic-clonic
Clonic
Tonic
Myoclonic
Atonic |
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Term
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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 |
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Term
| What type of seizure shows a generalized 3Hz spike-wave discharges? |
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Definition
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Term
| Tonic-Clonic Seizure features |
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Definition
Cry, loss of consciousness
Muscular rigidiy (tonic)
Patient may fall
Rhythmic jerking (clonic)
Tongue-biting
Bladder/bowel incontinence
Post-ictal confusion/sleep |
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Term
| What seizure type is commonly called a Grand Mal? |
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Definition
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Term
| What type of seizure has muscular rigidity and rhythmic jerking? |
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Definition
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Term
| Myoclonic seizure Features |
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Definition
Brief, shock like muscle contractions
Bilaterally symmetrical
Consciousness preserved
Precipitated by awakening of falling asleep
May progress into tonic-clonic |
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Term
| What type of seizure is precipitated by awakening or falling asleep? |
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Definition
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Term
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Definition
Impaired consciousness
Loss of muscle tone
Head drop
Fall
Brief duration
Injury common |
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Term
| What type of seizure has a loss of muscle tone? |
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Definition
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Term
| How does the neurological exam usually present in patients with epileptic seizures? |
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Definition
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Term
| What is the Diagnosis routine for Seizures? |
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Definition
History from patient and witnessess
Physical and Neurological exam
CBC, CMP, AED levels
Inter-ictal EEG
Epilepsy protocol MRI
Video-EEG monitoring |
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Term
| What are examples of epileptiform abnormalities see on EEGs? |
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Definition
Sharp waves
Spikes
Sharp-and-slow wave discharges |
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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? |
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Definition
Primary Generalized Seizures
(Juvenile Myoclonic epilepsy) |
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Term
| What type type of seizure has bilateral and symmetrical spike and wave activity occurring at a frequency of 3Hz? |
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Definition
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Term
| What does an MRI with gadolinium-DPTA enhanced sequences look for? |
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Definition
| Primary or secondary tumors, infection or inflammation in an adult with recent-onset epilepsy |
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Term
| What is the Epilepsy Protocol MRI? |
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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 |
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Term
| What causes of focal epilepsy are detectable by MRI? |
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Definition
Cavernous Malformations
Focal cortical dysplasias
periventricular heterotopias |
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Term
| Can focal epilepsy detectable by MRI be resected? |
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Definition
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Term
| What does periventricular heterotopia result from? |
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Definition
| abnormal neuronal migration |
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Term
| What is useful in defferentiating epileptic seizures from non-eplileptic seizures? |
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Definition
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Term
| What suppesses excitability in most neuronal circuits? |
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Definition
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Term
| How does a focal seizure develop? |
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Definition
| GABAergic inhibition is overcome |
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Term
| Why is the hippocampus and thalamus prone to abnormal electrical activity? |
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Definition
| the types of ion channels expressed in these regions and the patterns of inter-neuronal connections |
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Term
| What is Medical Remission? |
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Definition
| Seizure free without side effects on 1 or 2 Antiepileptic Drugs (AEDs) |
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Term
| What is Disease Remission? |
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Definition
| Seizure free off all AEDs |
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Term
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Definition
Barbiturate
Enhances activity of GABA receptor, depresses glutamate activity, reduces sodium, potassium conductance
Side Fx: Hepatotoxicity, CT disorder, SJS |
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Term
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Definition
Antiepileptic
Blockade of Na channels and inhibitory action on Ca and Cl conductance
Side Fx: Aplastic Anemia, hepatic failure, SJS, lupus |
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Term
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Definition
anticonvulsant
Blockade of neuronal sodium channel conductance
Side Fx: Aplastic anemia, hepatotoxicity, Stevens Johnson syndrome, Lupus |
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Term
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Definition
anticonvulsant
Affects GABA glutamatergic activity and reduce threshold of Ca and K conductance
Side Fx: Hepatotoxicity, hyperammonemia, leukopenia, thrombocytopenia, pancreatitis |
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Term
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Definition
Inhibits Ca T-channel conductance
Side Fx: Bone marrow depression, hepatotoxicity |
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Term
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Definition
Blockage of voltage-dependent Na Channels
Side Fx: SJS, toxic epidermal necrolysis |
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Term
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Definition
Na channel blockade
Side Fx: Hyponatremia, Rash |
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Term
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Definition
Blockage of Na Channels, enhancement of GABA medicated Cl influx
Side Fx: Renal calculi, hypohidrosis |
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Term
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Definition
Blockade of Na, K, and Ca channels, Inhibits glutamate excitation
Side Fx: Renal calculi, hypohidrosis |
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Term
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Definition
| Modulation of N-Type Calcium Channel |
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Term
| What older drugs are effective in partial and tonic-clonic seizures? |
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Definition
Valproate
Phenytoin
Carbamazepine
Phenobarbital |
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Term
| What drugs are effective for absence seizures? |
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Definition
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Term
| What newer drugs are effective for partial seizures? |
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Definition
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Term
| What Newer drugs are broad spectrum for Partial and generalized seizures? |
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Definition
Lamotrigine
Topiramate
Levetiracetam
Zonisamide |
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Term
| What Seizure drugs are Hepatic cytochrome P450 inducers? |
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Definition
Carbamazepine
Phenobarbital
Phenytoin
Oxcarbazepine
Topiramate |
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Term
| What is Intractable Epilepsy? |
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Definition
| Disabling seizures recurring despite optimized therapy |
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Term
| What type of therapy is there for refractory epilepsy? |
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Definition
AED polytherapy
Vagal nerve stimulator
Ketogenic diet
Atkins diet
Epilepsy surgery |
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Term
| What is Generalized Convulsive status epilepticus? |
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Definition
| Continuous, generalized, convulsive seizure lasting more than 5 minutes or 2 or more sequential seizures occuring without full recovery of consciousness |
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Term
| How is non-convulsive status epilepticus diagnosed? |
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Definition
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Term
| What are some Non-epileptic events? |
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Definition
Breath Holding spells
Hyperventilation attacks
Motor tics
Movement disorders
Parasomnias
Syncope
Spasmus nutans
Rumination
Sleep myoclonus
Head Banging |
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Term
| What is the major difference between Psychogenic and Epileptic seizures? |
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Definition
| Epileptic seizures have Epileptiform activity on EEG, Psychogenic do not |
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Term
| What are some seizure precautions? |
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Definition
Showers instead of baths
Swimming
Biking with a helmet
No Driving for 6 months in TN |
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Term
| How should a seizure be treated in the hospital? |
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Definition
ABCs
Administer a benzodiazepine
Consider antiepileptic |
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Term
| What type of seizures are more likely to have a lesion present, Absence or Complex partial seizure? |
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Definition
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Term
| What is the most common type of childhood seizure? |
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Definition
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Term
| Definition of Febrile Seizures. |
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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 |
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Term
| What is a Simple Fibrile Seizure? |
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Definition
| Isolated, generalized, brief |
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Term
| What is a complex Febrile seizure? |
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Definition
| Multiple, focal, prolonged |
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Term
| What are the risk factors for Febrile Seizure recurrence? |
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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 |
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Term
| What diagnostic evaluations should be done on a child with a first simple febrile seizure? |
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Definition
| Lumbar puncunture if they are <12months or on prior antibiotic treatment |
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Term
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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 |
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Term
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Definition
| Triad of infantile spasms, hypsarrhythmia, and developmental arrest/regression |
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Term
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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 |
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Term
| What seizure syndrome is characterized by EEG patterns of 1.5-2.5 Hz? |
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Definition
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Term
| What are some treatments for Lennox-Gastaut? |
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Definition
| valproic acid, lamotrigine, topiramate, zonisamide, felbamate, benodiazepines, ketogenic dies, corpus callosotomy, vagus nerve stimulator |
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Term
| Childhood Absence Epilepsy |
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Definition
Onset 4-8 years
Normal Neurologic status
occur multiple times per day
3 Hz spike and wave discharges |
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Term
| What is the age of onset for Juvenile Myoclonic Epilepsy? |
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Definition
absence seizures - 7-13 years
Myoclonic Jerks - 12-18 years
Tonic-clonic seizures - 13-20 years |
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Term
| When is the highest frequency of myoclonic jerks? |
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Definition
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Term
| How is Juvenile Myoclonic Epilepsy characterized? |
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Definition
| brief myoclonic seizures, bilateral not always symmetric, flexor jerks of the arms which may be repetitive |
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Term
| What can precipitate Juvenile Myoclonic Epilepsy? |
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Definition
| sleep deprivation, alcohol ingestion, stress, awakening from sleep, menstruation, photic stimulation |
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Term
| What type of epilepsy is linked to chromosome 6? |
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Definition
| Juvenile Myoclonic Epilepsy |
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Term
| What is the most common form of benign partial epilepsy of childhood? |
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Definition
|
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Term
| What are the characteristics of Benign Rolandic Epilepsy? |
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Definition
Onset: 4-12 years
Normal neurologic status and imaging
Facial Motor seizures
Nocturnal generalized tonic-clonic seizures
EEG: central-temporal spikes |
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Term
| What form of epilepsy has central temporal spikes? |
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Definition
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Term
| What form of epilepsy's most specific type of seizure is a facial motor seizure? |
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Definition
|
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Term
| What Drugs are use for Partial seizures? |
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Definition
Phenytoin
Carbamazepine
phenobarbital
gabapentin
tiagabine
oxcarbazepine |
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Term
| What is ACTH used to treat? |
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Definition
|
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Term
| What drugs are Broad-spectrum agents? |
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Definition
Valproic acid
lamotrigine
topiramate
felbamate
zonisamide |
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Term
| What is Ethosuximide used to treat? |
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Definition
|
|
Term
| What is the best method to detect epilepsy? |
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Definition
Inter-ictal EEG
(increased detection with sleep deprevation and extended recording times)
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|
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Term
| What catagory of drugs are the old AEDs and the new AEDs? |
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Definition
Old - Catagory D
New - Catagory C
(Increase in birth defects with higher doses and polytherapy) |
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Term
| How effective is switching AEDs if the patient doesn't respond to the first? |
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Definition
| Changing or adding another drug is NOT very effective. Most patients who respond to AEDs do so with the first AED used |
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Term
| What is optimized therapy? |
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Definition
| At least 2 AEDs at maximal tolerated dose with good compliance |
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Term
| How should Intractable (Refractory) Epilepsy be diagnosed? |
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Definition
Confirmed by re-examination
Make sure seizures aren't due to something else that is treatable |
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Term
| What drug can be used to treat Status Epilepticus and Seizure Clusters in children? |
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Definition
Diastat
(rectal diazepam)
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|
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Term
| Should epilepsy patients be evaluated after their first non-febrile seizure? |
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Definition
|
|
Term
| What should be tested if a child with epilepsy develeps Status Epilepticus? |
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Definition
AED level toxicology
also consider an EEG and MRI if etiology is unknown |
|
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Term
| What are 3 risk factors for febrile seizures developing into epilepsy in children? |
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Definition
Complex Febrile Seizures
Family history of epilepsy
Neurologic impairment prior to febrile seizure
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|
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Term
| How are Febrile Seizures managed long-term? |
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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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