Epilepsy

What disorder is characterized by uncontrolled excessive activity of either part or all of the CNS?

Epilepsy

What is another name for epilepsy?

Seizure

When does an epileptic attack happen?

When the basal level of excitability rises above a certain critical threshold.

What are the 3 classifications of epilepsy?

1- Grand mal epilepsy
2- Petit mal epilepsy
3- Focal epilepsy

Is epilepsy a common neurological disorder?

Yes

What is the incidence of epilepsy in new cases per year?

125,00 to 180,000 new cases per year

What is the total annual epilepsy-associated costs?

$12.5 billion

What age does epilepsy occur at?

All ages

What are the 8 major affects of a grand mal epilepsy episode?

1- Loss of consciousness
2- Fall or Cry
3- Muscular rigidity (tonic)
4- Rhythmic jerking (clonic)
5- Respiration inhibited (cyanosis occurs)
6- Tongue bite (incontinence) injury can occur
7- Usually lasts 1-3 minutes
8- Post-seizure depression, stupor, fatigue, and sleepiness

How long does the tonic phase last in a grand mal epileptic episode?

10-20 seconds

What is another name for grand mal epilepsy?

Generalized tonic clonic seizure

What is involved in the clonic phase of a grand mal epileptic episode, and what does this induce on the body?

Its a flexion, extension, tremor lasting for about 30 seconds and causes brief, violent, flexor spasms of the whole body

What are the 6 things that usually follow postictal CNS depression due to a grand mal epileptic episode?

1- Autonomic changes
2- Increased heart rate, blood pressure, and bladder pressure
3- Pupillary mydriasis
4- Skin cyanotic
5- Glandular hypersecretion
6- Brief apnea

What parts of the brain are affected by extreme neuronal discharges in grand mal epilepsy?

All areas of the brain, especially;

1-Cerebral cortex
2- Deeper parts of the cerebrum
3- The brain stem

Discharges are transmitted all the way to what structure below the brain in grand mal epilepsy?

The spinal cord

Is a grand mal epileptic episode usually unilateral or bilateral?

Bilateral (involves both sides of the cerebral hemispheres simultaneously)

What are the 7 major inducers of Grand mal attack?

1- Genetic predisposition (1-50 to 100 people)
2- Strong emotional stimuli
3- Drugs
4- Fever
5- Loud noises
6- Flashing lights
7- Brain trauma

What are the 2 things that stop Grand mal attack?

1- Neuronal fatigue
2- Active inhibition by inhibitory neurons that have been activated by the attack

What is another name for petit mal epilepsy?

Absence epilepsy

What part of the brain does petit mal epilepsy involve?

Thalmocortical brain activating system

How long does a patient become unconscious for suffering from petit mal epilepsy?

3-30 seconds

What happens to the head and neck muscles and the eyes in a person suffering from petit mal epilepsy petit mal epilepsy?

Contraction of the head and neck muscles and blinking of the eyes

What type of pattern is seen on an EEG due to oscillation of inhibitory and excitatory thalamocortical neurons in petit mal epilepsy?

Spike and dome patterns

What is the onset age of petit mal epilepsy and when does it usually disappear?

Onset = 5-10 years
Disappears by the age of 30

Is there any postictal confusion after a petit mal epileptic attack?

No

Where are clonic jerks seen in patients with petit mal epilepsy?

The eyes

What are the 4 things that focal epilepsy result from?

1- Scar tissue in the brain
2- Brain tumor
3- Destroyed area of the brain tissue
4- Congenitally deranged local circuitry

What type of focal epilepsy is marked by motor seizures with unilateral clonic movements that start in one muscle group and spread systematically to adjacent groups, reflecting the march of epileptic activity through the motor cortex?

Jacksonian epilepsy

Psychomotor epilepsy is a type of focal epilepsy that can cause what 4 things?

1- Short period of amnesia
2- Attack of abnormal rage
3- Sudden anxiety, discomfort or fear
4- A moment of incoherent speech

What parts of the brain does psychomotor epilepsy involve?

The limbic system:

1- Hippocampus
2- Amygdala
3- Septum
4- Portion of the temporal cortex

What is the definition of status epilepticus?

When 2 or more seizures without recovery of consciousness in between

What are the 3 types of status epilepticus?

1- Generalized convulsive
2- Non-convulsive
3- Simple partial

How long do single status epilepticus seizures last for?

Greater then 20-30 minutes

Keeping a person away from dangerous situations, speaking quietly and reassuringly, and using restraint only if necessary are first aid precautions to what type of seizure?

Grand mal epilepsy

When should a physician or ambulance be called in order to manage a seizure?

1- Seizures last more than 5 minutes
2- Patient has recurrent seizures
3- Patient dose not begin to regain consciousness soon after seizure
4- Patient has major injuries from the seizure
5- First seizure experienced by the patient

Open head injury produced by bullets or shrapnel is associated with what percentage of chance for developing epilepsy?

50% +

What chance does closed head trauma, such as after an automobile accident or blunt injury carry a chance of epilepsy?

5% or less

What factors predispose the development of epilepsy after head trauma?

1- seizure within 2 weeks of injury
2- Depressed skull fracture
3- Loss of consciousness for longer than 24 hours
4- Cerebral contusion
5- Subdural hematoma
6- Subarachnoid blood
7- Above the age of 65

What hormone tends to decrease cortical excitability, lowering the seizure threshold, and increases the intericital spike frequency?

Progesterone

A rise in what hormone just before ovulation can increase the chance of epilepsy in mid-cycle?

Estrogen

What are the 2 major treatments of epilepsy?

1- Antiepileptic drugs
2- Surgery

The choice of antiepileptic drugs usually depends upon what factors?

1- Type of seizure/epileptic syndrome
2- Potential side effects
3- Frequency of dosing
4- Comorbid conditions
5- Drug interactions
6- Age/Gender
7- Cost of the drug

What should sexually active and fertile women with epilepsy take on a daily basis to prevent neural tube defects caused by some anti-epileptic drugs?

Folate (folic acid) (1-5 mg/day)