Questions and Answers
Which symptom is NOT typically associated with postictal states following an epileptic seizure?
What is the primary recording difference between referential and bipolar EEG recordings?
What duration characterizes spikes in interictal epileptiform activity?
Which of the following family history aspects should be optimized to assess epilepsy?
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How long is a routine EEG recording typically performed?
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Which EEG pattern indicates that a discharge is likely to be considered epileptiform?
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During the physical examination of a child suspected of having epilepsy, what specific aspect should be carefully examined?
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What activation procedure is typically included in a routine EEG?
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Which of the following statements about the significance of the EEG in diagnosing epilepsy is true?
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What aspect of the family history is crucial when assessing for afebrile seizures?
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Study Notes
What to Do in Case of an Epileptic Seizure
- Collect a thorough description of the seizure event, including stages like prodrome, aura, objective findings, and postictal symptoms.
- Assess for additional symptoms: urinary incontinence, tongue biting, muscle soreness, postictal confusion, and postictal memory issues.
- Tailor additional inquiries based on potential differential diagnoses.
Important Information to Acquire from the Family
- Gather the family’s past medical history, including details on gestation, birth, developmental milestones, and illnesses in infancy and childhood.
- Investigate any history of febrile seizures or central nervous system (CNS) infections.
- Document any trauma history and, if applicable, request video recordings of multiple seizure episodes for analysis.
Family History
- Compile information about afebrile seizures and other paroxysmal disorders within the family.
- Ask about the number of first- and second-degree relatives with relevant medical histories to enhance family history accuracy.
- Consult senior female relatives for more detailed family health history.
Review of Systems
- Evaluate for CNS abnormalities and assess symptoms from other organs that may indicate specific syndromes.
Physical and Neurological Examination
- The examination's key aspects should be adapted based on the patient’s age and circumstances.
- In pediatric cases, a thorough skin examination is vital for identifying neurocutaneous disorders.
- Look for dysmorphic features which may suggest chromosomal abnormalities.
Electroencephalography (EEG)
- EEG represents voltage changes over time and records the potential difference between electrode positions on the scalp.
- Utilize referential recordings for neutral reference input and bipolar recordings for adjacent electrode comparisons.
- Digital EEG recordings are increasingly common, allowing for enhanced visualization of interictal and ictal activities.
- EEG serves as a critical diagnostic tool for classifying epilepsy as focal or generalized and identifying specific syndromes.
- Routine EEG typically lasts 20-30 minutes and incorporates activation procedures like hyperventilation and photic stimulation.
- Recordings should include both eyes-open and eyes-closed conditions, plus drowsiness and sleep states.
- Note that deep sleep deprivation in routine EEG is less likely to capture seizure activity.
- The primary utility of routine EEG lies in documenting interictal epileptiform activity, including spikes, sharp waves, and spike-and-wave discharges.
- Criteria for identifying epileptiform discharges include high voltage relative to the surrounding EEG, duration of 70-200 ms for sharp waves and less than 70 ms for spikes, and pronounced negative components when recorded from the scalp.
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Description
Test your knowledge on the critical aspects of epileptic seizures with this Chapter 100 quiz. The quiz covers key elements such as symptoms, differential diagnosis, and important family history information. Enhance your understanding of managing and identifying various forms of epilepsy.
