Epilepsy Flashcards

Flashcards for reviewing key vocabulary and concepts related to epilepsy.

Epilepsy

Paroxysmal cerebral neuronal discharge that may or may not have disturbed level of consciousness, perceptual or behavioral disturbances.

Seizure

The clinical manifestation of an abnormal and excessive excitation and synchronization of a population of cortical neurons.

Epilepsy

A tendency toward recurrent seizures unprovoked by any systemic or acute neurologic insults.

Epileptogenesis

Sequence of events that converts a normal neuronal network into a hyperexcitable network.

Glutamate

The brain’s major excitatory neurotransmitter.

GABA

Major inhibitory neurotransmitter in the CNS.

Epilepsy - Neurotransmission Shift

Shift in balance between inhibitory GABA and excitatory glutamate neurotransmission.

Hyperexcitable Networks Mechanisms

Excitatory axonal “sprouting”, loss of inhibitory neurons or loss of excitatory neurons “driving” inhibitory neurons.

Seizure Types

Self-limiting seizures (Generalized: Tonic-clonic, Clonic, Absence, Tonic, Spasms, Myoclonic, Atonic) or Focal (Focal sensory, Focal Motor, Gelastic, Hemiclonic, Secondary generalised).

Continuous Seizure Types

Generalized status epilepticus or Focal status.

Epileptic Seizures

Generalized epilepsy (impaired/loss-of consciousness) or Partial Epilepsy +/- generalisation.

Simple partial seizures

“Aura” – sensory, motor, psychic or autonomic. Consciousness retained

Complex partial seizures

“Psychomotor seizures”. Characterised by fugue states, automatisms and twilight states. Consciousness is disturbed at onset.

Intracranial causes of Epilepsy

Cerebral Tumours, TBI, abscesses, Mesial temporal Sclerosis.

Congenital Diseases causing Epilepsy

porcephaly, AVF (Sturge- Weber), cortical dysgenesis, dysembronic neuroepithelial tumours (DNET), Tuberous Sclerosis.

Tuberous Sclerosis

ASHLEAF spots, SHAGREEN patches, HEART rhabdomyoscarcoma, LUNG hamartomas, EPILEPSY from cortical tubers, ANGIOMYOLIPOMA in kidney, FACIAL Angiofibroma

Simple Partial Seizure

Last a minute or two. No LOC. Can be described as …with motor signs, somatosensory, autonomic, psychic

Complex Partial (Psychomotor) Seizure

Last > 1 minute. +/- aura, ictus, then post-ictal confusion/LOC

Petit Mal (Absence, ‘stop and stare’) Seizure

Abrupt onset, < 1 minute, arrest in all activity acc. By a blank stare

Grand mal (Tonic-Clonic) Seizure

Typical – abrupt LOC, accompanied by a cry, then tonic followed by clonic mvts. Cyanosis, tongue biting and incontinence occur. Coma and stupor

Atonic (Astatic/’drop attacks’) Seizure

No aura. Sudden complete/partial loss of tone. Usually no aura or postictal confusion

Somatic Symptom and Related Disorders in Epilepsy

Also known as functional neurological symptom disorder, psychogenic/non-epileptic d/o, non-epileptic seizures.

PNES: PSYCHOGENIC NON-EPILEPTIC SYNDROME

After age 10, F>M, hx of abuse, failed control of seizures or breakthrough in a previously well-controlled pt, co-morbid psychiatric d/o.

Ictal - related anxiety disorders

Anxiety is one of the most common affective states during a seizure.

Ictal depression

Depressed feelings during seizures are less common than ictal anxiety.

Neurocognitive Decline in Epilepsy

Decline in intellectual ability, Personality change, Behavioural changes, Persistent anxiety and psychotic symptoms

Frontal Lobe Seizures

Difficult to diagnose as they mimic a number of psychiatric and medical presentations

Temporal lobe epilepsy

TLE tend to be managed predominantly by psychiatrists due to the prominence of neuropsychiatric symptoms