Seizure Disorder

Describe a typical complex partial seizure.

Complex partial seizures are characterized by impaired alertness and responsiveness, or "staring unresponsiveness," with amnesia for the event. They are often associated with confused purposeless behavior (automatisms), especially lip smacking, vocalizations, swallowing, and fumbling.

What are the common causes of pseudoseizures?

Depression, conversion reaction, hysterical behavior, malingering, and learned behavior

What is the characteristic EEG abnormality present in generalized epilepsies?

Generalized epileptiform discharges (spikes, spike waves, and sharp waves), which are present over all of the brain regions simultaneously and suggest an epileptogenic process involving all of the cortex simultaneously. Some patients with generalized epilepsy may have normal EEGs in between seizures.

What clinical characteristic defines seizures as generalized or partial?

Generalized seizures are associated with a complete loss of consciousness, whereas partial partial seizures preserve wakefulness.

What are some common types of generalized seizures?

Generalized tonic-clonic, myoclonic, absence, atonic

What are Myoclonic seizures?

Muscle jerking, but not the tonic phase, occurs in the morning

What are Psychogenic Non-epileptic Seizures (PNES)?

Psychogenic non-epileptic seizures are not due to epilepsy but may look very similar to an epilepsy seizure

What are Tonic-clonic seizures?

or convulsive seizures (formerly known as grand mal) Bilaterally symmetric and without focal onset Begins with a sudden loss of consciousness—a fall to the ground Tonic phase: very stiff and rigid 10-60 seconds. Clonic phase: generalized convulsions and limb jerking Postictal phase: a confused state

What is the tx for Focal seizures?

phenytoin, and carbamazepine are drugs of choice

What are Absence seizures?

(formerly known as petit mal) Characterized by a brief impairment of consciousness with an abrupt beginning and ending. At times involuntary movements may occur, but they are uncommon and the patient has no recollection and witnesses commonly miss them

What is epilepsy?

A continuing tendency toward spontaneous recurrent seizures as a result of some persistent pathologic process affecting the brain. The latter criterion excludes patients with provoked seizures who have an otherwise normal brain. The International League Against Epilepsy has classified epilepsy syndromes according to the predominant type of seizure, EEG findings, age of onset, interictal abnormalities, and natural history.

What is a pseudoseizure?

A nonepileptic paroxysmal spell that resembles a seizure

What EEG findings suggest pseudoseizure?

A normal EEG during the event suggests pseudoseizure

What is a provoked seizure?

A seizure occurring in an otherwise normal brain as a result of some transient alteration, such as changes in glucose or sodium levels, drug effects, or ETOH withdrawal

What is the treatment for Absence, or petit mal, seizures?

Absence, or petit mal, seizures are best treated with either ethosuximide or valproic acid. Clonazepam is also effective but can be habit forming.

What type of seizure is an aura?

Auras are simple partial seizures that may consist of auditory, visual, gustatory, or olfactory illusions; déjà vu or jamais vu; psychic or emotional phenomena; and epigastric sensations.

Can auras/simple seizures progress?

Auras may progress to complex partial seizures, which may progress to involve the whole brain or "secondarily generalize." Auras may help localize the site of seizure onset.

What is the preferred initial tx of Status epilepticus (SE)?

Benzodiazepines (lorazepam) are the preferred initial treatment after which typically phenytoin is given Untreated generalized seizures lasting > 60 min may result in permanent brain damage; longer-lasting seizures may be fatal This is a medical emergency

What is the treatment for ETOH withdrawal seizures?

Benzodiazepines treat alcohol withdrawal and help prevent seizures. Conventional antiseizure medications are not recommended.

What is the most common generalized epilepsy syndrome arising in childhood?

Childhood absence epilepsy is an idiopathic generalized epilepsy syndrome in which absence seizures begin in early childhood and usually abate by late adolescence.

How are partial seizures classified?

Complex partial seizures are associated with an alteration of consciousness, whereas during simple partial seizures, consciousness is fully preserved. - Simple partial seizures are further classified according to whether they have predominantly motor, sensory, autonomic, or psychic symptoms.

What are Clonic seizures?

During a clonic seizure, a person may lose control of bodily functions and begin jerking in various parts of the body. He/She may temporarily lose consciousness, followed by confusion.

In refractory localization- related epilepsies, what additional treatment can be considered?

Epilepsy surgery to remove epileptic focus.

What are Tonic seizures?

Extreme rigidity then immediate LOC, but not followed by a clonic phase

What are Infantile Spasms?

Infantile spasms are a type of epilepsy seizure but they do not fit into the category of focal or generalized seizures

What is the inheritance pattern for juvenile myoclonic epilepsy?

It is inherited as an autosomal dominant trait, but the pathologic abnormality is not known.

What is the etiology of TLE (Temporal lobe seizure)?

It is usually associated with mesial temporal sclerosis, but the etiology is not known.

What does a Todd paralysis indicate?

It usually indicates a seizure is focal in onset.

What is the most common generalized epilepsy syndrome arising in adolescence or early adulthood?

Juvenile myoclonic epilepsy is an idiopathic generalized epilepsy syndrome in which brief generalized myoclonic jerks and convulsions begin in late adolescence and persist throughout life.

What is the most sensitive neuroimaging study in the evaluation of epilepsy?

MRI defines brain anatomy with greater detail and often identifies subtle abnormalities that are not seen on CT.

Why is phenytoin no longer recommended for initial treatment of epilepsy?

Phenytoin may cause cumulative side effects of osteoporosis, peripheral neuropathy, cerebellar ataxia, hirsutism (particularly a problem for women), and has many potential drug interactions.

What is the most sensitive and specific method for determining that a spell is a seizure?

Simultaneous video and EEG monitoring during a spell. However, during simple partial seizures, the EEG is usually normal.

What is the most common epilepsy syndrome of adults?

TLE (Temporal lobe seizure) is a symptomatic partial epilepsy syndrome in which complex partial seizures begin in late adolescence or early adulthood and more or less persist throughout life.

What do the EEG and MRI show in childhood absence epilepsy?

The EEG characteristically shows generalized 3 Hz spike and wave activity in between and during seizures. MRI is normal.

What do the EEG and MRI show in Temporal lobe seizures?

The interictal EEG demonstrates spikes originating from the temporal lobe. MRI may show atrophy and sclerosis of mesial temporal structures.

What do the EEG and MRI show in Juvenile myoclonic epilepsy?

The interictal EEG shows characteristic generalized multiple spike and wave activity in between seizures and occasionally with myoclonic jerks. MRI is normal.

How long must a patient be seizure-free before drug withdrawal is considered?

The risk of seizure occurrence is determined by the natural history of the epilepsy syndrome. For example, patients with juvenile myoclonic epilepsy generally respond well to medication but almost universally will have seizures when medication is withdrawn. However, when either the natural history of the epilepsy suggests that seizures will not recur or when the diagnosis of epilepsy is not definite, then medication withdrawal may be attempted after approximately 2 years.

What is the abnormality leading to childhood absence epilepsy?

The syndrome is caused by an inherited abnormality of neurotransmission involving the thalamus and cortex.

What are Focal seizures with a loss of awareness?

This type of focal seizure may also be called a focal dyscognitive seizure (previously known as complex partial seizures) Altered consciousness, automatisms (ie. Lip smacking) Present with a postictal state (confusion and loss of memory) which differentiate them from absence seizures

What are Focal seizures with retained awareness?

This type of focal seizure was previously known as a simple partial seizure No alteration in consciousness. Abnormal movements or sensations

Why is an EEG indicated in the evaluation of almost all patients with seizures?

To distinguish partial from generalized seizure disorders, to localize the site of seizure onset of partial seizures, and to characterize the epilepsy syndrome

What is Todd paralysis?

Transient hemiparesis after a seizure, reflecting the location of the most involved area of the brain

What is the treatment of a single seizure?

Treatment depends on the cause. If there is a known provoking factor, the provoking factor is relieved. The treatment of a single seizure of unknown etiology is controversial, but generally antiepileptic drugs are not started until after the second seizure, because many patients do not have a second seizure. If the seizure is attributable to an epilepsy syndrome, then therapy may be initiated.

What are Atonic seizures?

also known as drop attacks Looks like syncope, sudden loss of muscle tone

What is Status epilepticus (SE)?

is a single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them Two forms: convulsive and nonconvulsive: - Convulsive status epilepticus presents with a regular pattern of contraction and extension of the arms and legs - Nonconvulsive status epilepticus includes complex partial status epilepticus and absence status epilepticus