T/F You cannot have epilepsy without a seizure but you can have seizures without epilepsy
True
Define epilepsy
Disorder of the brain characterized by an ENDURING PREDISPOSITION to generate epileptic seizures
- TRANSIENT occurrence of signs and/or symptoms of abnormal excessive or synchronous neuronal activity in the brain
How is Epilepsy diagnosed (3)
- At least 2 unprovoked seizures occurring >24hrs apart from
- 1 unprovoked seizure with over 60%+ recurrence (stroke, brain lesion, trauma, CNS infection, cognitive developmental disability etc.)
- Diagnosis of epilepsy syndrome
Define Status Epilepticus
A seizure that persists for a long time or is repeated frequently enough to produce a fixed and enduring epileptic condition
- over 5 minutes
At what time does neuronal damage start after Status epilepticus with GTC
30 minutes
What clinical presentation does a partial onset seizure have in:
Temporal lobe (7)
- Deja-va
- Butterflies in stomach
- Nausea
- Fear
- Panic
- Bland staring
- alimentary automatisms (lip smacking, chewing)
What clinical presentation does a partial onset seizure have in:
Frontal lobe (4)
- Contralateral tonic-clonic
- turning of eyes, head, body away from side of seizure
- aphasia (cannot produce speech)
- Olfactory hallucinations
What clinical presentation does a partial onset seizure have in:
Parietal lobe (6)
- Vertigo
- Contralateral numbness
- Tingling
- Burning
- Sensation of movements
- aphasia (cannot produce speech)
What clinical presentation does a partial onset seizure have in:
Occipital lobe (7)
- Sparkles
- Flashes
- Pulsating coloured lights
- Scotoma (partial loss of vision)
- Heminopsia (50%+ blindness )
- Formed visual hallucinations
- Eye-blinking
What are the classification (2) and subclasifications (3) (5) of seizures
Focal (partial)
- Aware (simple)
- Unaware (complex)
- Focal to bilateral tonic-clonic (Secondary GTC)
Generalized
- Primary tonic clonic
- Absence (Non-motor), Atypical Absence
- Tonic
- Atonic
- Myoclonic
Differentiate between focal awareness maintained and focal awareness impaired (simple partial vs complex partial)
Duration
Post-ictal symptoms (5)
Seizure control (%)
EEG
Duration
- Simple: 30 secs or less
- Complex: 1-3 minutes
Post-ictal symptoms
- Simple: None
- Complex: Confusion, lethargy, altered behaviour, amnesia
Seizure control (%)
- Simple: 30-50%
- Complex: 40-60%
EEG
- Simple: Focal spikes over area corresponding to symptoms
- Complex: unilateral or bilateral discharge in temporal/frontotemporal regions
Focal to bilateral tonic-clonic seizures (secondary GTC)
Symptoms
Duration
Post-ictal symptoms (2)
Symptoms
- Progressed seizures have a tonic (stiffening) phase, followed by clonic (jerking) phase.
- Presents just like generalized seizures, but would appear different on EEG.
- This seizure type is has the most serious manifestation (salivation, falling, urinary incontinence)
Duration
- 1-3 minutes
Post-ictal symptoms
- confusion, somnolence
Generalized tonic-clonic seizures (grand Mal)
Symptoms
Autonomic changes
Common Age
Duration
Post-ictal symptoms (2)
Seizure control (%)
Symptoms
- Loss of consciousness, falling
- Tonic phase, rapide replaced by synchronous clonic movements of head, face, arms legs
Autonomic changes
- Inc BP, HR, bladder pressure
- Dilated pupils, hypersecretion of skin
Common age
- 20s
Duration
- 1-5 minutes
Post-ictal symptoms
- Lethary, sleepiness
Seizure control (%)
- 70-85%
What is the trend between seizure control and type of seizure?
As seizure type worsen, seizure control is better
Generalized non-motor seizures (absence seizures) (petit-mal)
Typical & Atypical
Symptoms
Trigger
Age
Duration
EEG
Seizure control
Symptoms
- Impaired awareness
- abrupt recovery
- 20-50% develop GTC (check atypical)
Trigger
- Hyperventilation
Age
- 4-12 years
Duration
- 2-15 seconds
EEG
- 3 spikes and wave per second
Seizure control
- 75-85% good prognosis
Atypical:
- Change in tone, onset, and cessation is not abrupt
What does the cluster of symptoms include (6)
- Seizure type
- Etiology
- Neurologic status
- Age at onset
- Family history
- Prognosis
Which age groups have the highest incidence of seizures?
Which gender?
Which income class?
Age groups
- 0-14
- 60+
Which gender?
- Equal risk
Which income class?
- Low/middle
What is the pathogenesis of a seizure in action potentials
- Group of abnormal neurons undergo prolonged depolarization with rapid firing of action potentials
- Then they recruit adjacent normals cells
- Synchronized firing (clinical seizure)
- Spread to other areas of brain (propagation)
*No resting potential
What is the pathophysiology of seizures in terms of neurotransmitters?
Excitatory inc/dec? (3)
Inhibitory inc/dec? (3)
Increased EXCITATORY synaptic neurotransmission
- inc Glutamate
- Na+ influx
- Paroxysmal depolarizations
Decreased inhibitory synaptic neurotransmission
- dec GABA
- K+ efflux
- Cl- influx
What are frequent sites for seizure onset? (3)
Neocortex
Mesial temporal lobes
- Hippocampus
Which areas of the brain play key roles in spread of seizure activity (3)
- Thalamus
- Substantia nigra
- Corpus striatum
When seizure frequency is severe, the corpus striatum is severed.
- The corpus striatum is responsible for communication between the hemispheres
- the brain will become unaware of what is happening on the other side of your body
What are possible patient factors that causes of seizures (6)
- Structural (stroke, trauma)
- Genetic
- Metabolic
- Infectious
- Immune
- Unknown
What are the most common causes of seizures in infancy and childhood (3)
- Prenatal or birth injury
- Errors of metabolism
- Congenital malformations
What is the most common cause of seizures in childhood & adolescence (3)
- Idiopathic/Genetic syndrome
- Head trauma
- CNS infections
