Sleep/Epilepsy

Question 0

ARAS

Answer 0

• thalamic connections: cholinergic
• cortical connections: monoaminergic
• responsible for coordination of atonia and sleep cycles

Question 1

Wave sleep

Answer 1

• nonREM (1,2)
• deep sleep (slow wave sleep) - K complexes appear in stage 2: 3-4
  ~ REM: high brain activity, looks like more like wakefullness

Question 2

ARAS lesion: cause presentation

Answer 2

• Lewy body dementia
• Parkinson’s
• loss of muscle atonia -> injury

Question 3

REM generators

Answer 3

• In SLD and PC nuclei in pons
• ascending: dreaming
• descending: muscle atonia
• REM off neurons are GABA

Question 4

Orexin neurons

Answer 4

• modulate ARAS to control sleep wake transitions

- damage = narcolepsy

Question 5

Narcolepsy

Answer 5

Cataplexy: (narcolepsy only) weakness triggered by laughter or excessive emotion

• hypnagogic hallucinations: dreams at sleep onset
• sleep paralysis

Question 6

Seizure basics

Answer 6

• rhythmic excitations; Normal rhythms abnormally recruited
• Maybe simple complex or secondary; bi or uni
  ~ simple: consciousness not impaired
  ~ complex: consciousness impaired
  ~ secondary: imp. Conc. + additional motor sequence

Question 7

Childhood epilepsy

Answer 7

• 6 y/o peak onset/occurrence
• frequent, brief (milliseconds-seconds)
• no post ictal confusion

Question 8

Temporal lobe epilepsy: etiology and presentation

Answer 8

• most common: type of partial
• damaged hippocampus
• auras in 90%
• unilateral typically involves motor
• frequently intractable
• often accompanied by strange experimental symptoms

Question 9

West syndrome: presentation

Answer 9

• infantile spasms, frequent, brief tonic flexor/extensor spasms
• developmental regression
• EEG hypsarrythmia
• associated with development of cog disability
• trt with topiramate/vigabatrin

Question 10

Psychogenic seizures

Answer 10

• non epileptic (not faking)

- EEG + video to diagnose

Question 11

Febrile seizures

Answer 11

• no brain infxn
• results from rapid fever spike
• usually longer, but self limiting
• focal onset with recurrence w/in 24 hrs -> increased risk of dev epilepsy

Question 12

Status Epilepticus

Answer 12

• sustained, after 20-30 minutes may become pharm resistant
• trt: most stop seizure. IV/rectal benzos (diazepam/lorazepam)
• hypoxia, acidosis, rhabdo, hypotension, hyperarrythmias

Question 13

Absence seizures

Answer 13

• trt with Ca channel blockers: valproic acid, lam, ethosuximide, Clonazepam
• triggered by hyperventilation
• brief, frequent, no post ictal confusion
• assoc with GTC at least once 30% of the time

Question 14

Frontal lobe hypermotor seizures

Answer 14

• occurs in sleep
• lots of motor involvement
• impaired consciousness/PI confusion

Question 15

Trt for generalized and simple partial seizures

Answer 15

Phenobarbital

Fosphenytoin

Question 16

Cataplexy

Answer 16

• weakness assoc with laughter or strong emotion

- narcolepsy

Question 17

Hypnagogic hallucinations

Answer 17

• early onset dreaming

- narcolepsy

Question 18

Sleep paralysis

Answer 18

• muscle atonia as when asleep, during period if wakefulness

Question 19

3 Hz spike on EEG

Answer 19

• absence seizure
• hyperventilation precipitates
• girl with pinwheel