Epilepsy Overview and Key Concepts
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Questions and Answers

What is the approximate prevalence of epilepsy in the population?

  • 0.5%
  • 2.5%
  • 1% (correct)
  • 5%

The term 'fit' is currently preferred over 'seizure' when discussing epilepsy.

False (B)

Define epilepsy in your own words.

A chronic disorder characterized by recurrent seizures.

Epilepsy is a disorder characterized by chronic neuronal ________.

<p>hyperexcitability</p> Signup and view all the answers

Match the following types of seizures with their descriptions:

<p>Partial seizures = Affect one part of the brain Generalised seizures = Affect both hemispheres of the brain Tonic-clonic seizures = Characterized by convulsions Absence seizures = Characterized by brief lapses in consciousness</p> Signup and view all the answers

Which term is now preferred when referring to patients with epilepsy?

<p>Person with epilepsy (PWE) (B)</p> Signup and view all the answers

Different types of epilepsy can affect motor activity, consciousness, perception, and behavior.

<p>True (A)</p> Signup and view all the answers

What are the principal types of seizure?

<p>Partial seizures and generalized seizures.</p> Signup and view all the answers

What is defined as a convulsion?

<p>A sudden involuntary contraction of muscles causing irregular movement (B)</p> Signup and view all the answers

Isolated seizures are considered a form of epilepsy.

<p>False (B)</p> Signup and view all the answers

What is the lifetime prevalence of epilepsy worldwide?

<p>Approximately 1%</p> Signup and view all the answers

Around 30% of individuals who have a _______ will subsequently develop epilepsy.

<p>seizure</p> Signup and view all the answers

Match the following triggers with their corresponding description:

<p>CNS infection/inflammation = An alteration in brain function due to infection or inflammation Stroboscopic lighting = Flashing lights that can provoke seizures in some individuals Metabolic dysfunction = Imbalance in body chemistry potentially leading to seizures Fever = A common cause of seizures, especially in infants and young children</p> Signup and view all the answers

Which of the following is NOT a possible trigger for isolated seizures?

<p>Epilepsy (C)</p> Signup and view all the answers

Epilepsy is the third most prevalent neurological disorder.

<p>True (A)</p> Signup and view all the answers

What percentage of the global burden of disease is accounted for by epilepsy?

<p>1%</p> Signup and view all the answers

The UK law prohibiting the marriage of epilepsy patients was only repealed in _______.

<p>1970</p> Signup and view all the answers

Which of the following is considered a psychiatric disorder until around 1930?

<p>Epilepsy (B)</p> Signup and view all the answers

What is one of the principal aims of pharmacotherapy for epilepsy?

<p>To maximize quality of life (A)</p> Signup and view all the answers

New anti-epileptic drugs (AEDs) have significantly reduced the number of pharmacoresistant patients.

<p>False (B)</p> Signup and view all the answers

Name one type of treatment strategy used for epilepsy.

<p>Sodium channel blockers</p> Signup and view all the answers

The decision to treat epilepsy is complicated due to significant __________ associated with current drugs.

<p>side effects</p> Signup and view all the answers

Match the following anti-epileptic drugs (AEDs) with their mechanism of action:

<p>Phenytoin = Sodium channel blocker Diazepam = Enhancement of GABA actions Levetiracetam = SV2A-mediated effects Phenobarbitone = Enhancement of GABA actions</p> Signup and view all the answers

Which of the following statements regarding the treatment of epilepsy is NOT true?

<p>New AEDs have effectively eradicated seizure episodes in all patients. (D)</p> Signup and view all the answers

What percentage of newly diagnosed epilepsy patients remained seizure-free after 2–16 years of follow-up?

<p>63%</p> Signup and view all the answers

What is the estimated annual disease burden of epilepsy in the US according to CDC 2008?

<p>$15.5 billion (B)</p> Signup and view all the answers

Premature mortality in epilepsy patients is lower than in the general population.

<p>False (B)</p> Signup and view all the answers

Name one significant cause of premature mortality in epilepsy patients.

<p>SUDEP</p> Signup and view all the answers

The International League Against Epilepsy (ILAE) has revised the definitions of epilepsies to accommodate more advanced _____ approaches.

<p>diagnostic</p> Signup and view all the answers

Match the following seizure types with their description:

<p>Generalised = Involves the whole brain Partial = Involves one specific brain area Secondary generalisation = Partial seizures spreading to whole brain</p> Signup and view all the answers

What is the previous name for generalized tonic-clonic seizures?

<p>Grand mal (C)</p> Signup and view all the answers

Which of the following is NOT a co-morbidity related to epilepsy?

<p>Heart disease (A)</p> Signup and view all the answers

Generalized absence seizures are characterized by muscle rigidity and violent jerks.

<p>False (B)</p> Signup and view all the answers

What typically happens to a patient during a generalized tonic-clonic seizure?

<p>The patient experiences limb extension and rigidity followed by violent jerks.</p> Signup and view all the answers

Knowing about seizure types is essential for understanding the classification of epileptic syndromes.

<p>True (A)</p> Signup and view all the answers

How much more likely are epilepsy patients to commit suicide compared to the general population?

<p>5-15 times more likely</p> Signup and view all the answers

Partial seizures are characterized by symptoms such as ______ and ______.

<p>involuntary movements, abnormal sensory experiences</p> Signup and view all the answers

Cognitive decline can be related to both ______ and disease in epilepsy patients.

<p>drug</p> Signup and view all the answers

Match the type of seizure with its characteristics:

<p>Generalized Tonic-Clonic Seizures = Limb extension and violent jerks Generalized Absence Seizures = Staring vacantly, quick recovery Partial Seizures = Localized discharge with simple symptoms Jacksonian Epilepsy = Type of partial seizure with motor symptoms</p> Signup and view all the answers

How long does a generalized tonic-clonic seizure typically last?

<p>About 1 minute (A), 2 to 4 minutes (C)</p> Signup and view all the answers

What does the term 'refractory patients' refer to in the context of epilepsy?

<p>Patients who do not respond to treatment (C)</p> Signup and view all the answers

Patients experiencing generalized absence seizures are usually aware of their surroundings.

<p>False (B)</p> Signup and view all the answers

What sensation might a patient feel after regaining consciousness from a generalized tonic-clonic seizure?

<p>Confused, ill, and disorientated</p> Signup and view all the answers

The onset of epilepsy is often defined when a patient experiences ______ than one isolated seizure.

<p>more</p> Signup and view all the answers

Which type of seizure is most likely to occur frequently and typically does not have any after-effects?

<p>Generalized Absence Seizures (A)</p> Signup and view all the answers

Flashcards

Epilepsy

A chronic disorder characterized by recurrent seizures, affecting approximately 1% of the population.

Neuronal hyperexcitability

A state of heightened neuronal activity that can lead to abnormal brain activity.

Partial seizures

Seizures that affect a specific area of the brain.

Generalised seizures

Seizures that affect the entire brain.

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Seizure

The preferred term for an epileptic event, replacing the outdated term "fit".

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Person with epilepsy (PWE)

The preferred way to refer to people with epilepsy, promoting inclusivity and respect.

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Anticonvulsant drugs

Treatments aiming to reduce seizure frequency and improve quality of life for individuals with epilepsy.

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Anticonvulsant drug discovery

The study and development of new anticonvulsant drugs to address unmet needs in epilepsy treatment.

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What is a convulsion?

A sudden, violent, irregular movement of a limb or of the body, caused by involuntary contraction of muscles. It does not necessarily have to be epileptic in origin.

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What is a Seizure?

A seizure caused by epileptiform brain activity.

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What is Epilepsy?

A neurological disorder characterized by recurrent seizures.

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What is an isolated seizure?

A seizure that occurs as an isolated event not related to an underlying disorder.

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What is an idiopathic seizure?

A seizure that occurs in the absence of a known underlying cause or trigger.

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What are possible triggers of isolated seizures?

Factors that can trigger seizures, such as CNS infections, stroboscopic lighting, metabolic dysfunction, head injury, fever, and drug use.

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How can isolated seizures increase the risk of epilepsy?

One or more isolated seizures can increase the risk of developing epilepsy.

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What is the impact of Epilepsy on Public Health?

Epilepsy is a common neurological disorder affecting approximately 1% of the world's population. It also affects approximately 50 million people worldwide and is considered the third most prevalent neurological disorder after migraine and Parkinson's Disease.

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Generalized Tonic-Clonic Seizures

A type of seizure characterized by the entire brain being affected, featuring a distinctive sequence of events.

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Generalized Absence Seizures

Short-lived seizures involving the whole brain, often characterized by a temporary loss of consciousness.

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Simple Partial Seizures

A seizure with a clear onset originating in a specific region of the brain, with minimal or no loss of consciousness.

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Complex Partial Seizures

A seizure that starts in a localized area of the brain, but may spread to other parts of the brain, often involving loss of consciousness.

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Jacksonian Epilepsy

An involuntary movement or sensation that arises from a specific region of the brain and is often associated with Partial Seizures.

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Psychomotor Epilepsy

A seizure disorder that primarily affects the temporal lobe of the brain, often accompanied by alterations in consciousness, behavior, and memory.

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Decision to treat epilepsy

The decision to treat epilepsy is complex due to the significant side effects of current medications, the legal ramifications of an epilepsy diagnosis, and the impact it can have on daily life.

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Aims of pharmacotherapy for epilepsy

The main goals of epilepsy treatment are reducing seizure frequency and improving the overall quality of life for the patient.

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Treatment strategy for epilepsy

The aim of epilepsy treatment is to reduce seizure activity, ideally to the point of seizure freedom, and improve overall quality of life.

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Sodium channel blockers

Sodium channel blockers are a type of AED that works by inhibiting the opening of voltage-gated sodium channels, which are essential for the generation of action potentials. Examples include phenytoin, carbamazepine, and valproate.

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Enhancement of GABA actions

Enhancement of GABA actions is another approach to treat epilepsy. Some AEDs enhance GABA's inhibitory activity, leading to increased chloride influx and reduced neuronal excitability. Examples include phenobarbitone and diazepam.

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Levetiracetam

Levetiracetam is a newer AED that acts on a different mechanism. It blocks the release of glutamate and calcium influx, leading to reduced neuronal excitability.

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Limitations of new AEDs

The introduction of new antiepileptic drugs (AEDs) since 1990 has not significantly improved the number of patients who are pharmacologically intractable (refractory) to epilepsy. This means many patients continue to experience seizures even with multiple drug trials.

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Disease Burden

The overall impact of a disease on individuals and society, including factors such as mortality, morbidity, and healthcare costs.

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Co-morbidities

Conditions that occur alongside a primary disease, often affecting its course and treatment.

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Secondary generalization

The spread of seizure activity from a localized area to involve the entire brain.

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Epileptic Syndromes

A classification system for epileptic syndromes based on seizure types, EEG findings, and clinical features.

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Refractory Epilepsy

Epilepsy syndromes that are more difficult to control with medication and are associated with a higher risk of complications.

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Co-morbidities in Epilepsy

Conditions that are frequently seen in people with epilepsy, such as cognitive decline, anxiety, depression, and insomnia.

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Status Epilepticus

A severe, potentially life-threatening complication of epilepsy that can occur during or after a seizure.

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Study Notes

Epilepsy Overview

  • Epilepsy is a chronic disorder characterized by recurrent seizures.
  • It affects approximately 1% of the global population.
  • The term "fit" is now avoided as it implies voluntariness, "seizure" is the preferred term instead.
  • The term "epileptic" when referring to patients is avoided in favor of "person with epilepsy" (PWE).
  • Epilepsy is a neuronal hyperexcitability disorder arising from excess excitability or disinhibition.

Learning Outcomes

  • Students will be able to define epilepsy and describe its incidence and prevalence.
  • Students will be able to state the principal seizure types and their defining characteristics.
  • Students will be able to state existing treatments, their suitability, mechanisms and biological targets.
  • Students will be able to describe principal targets for anticonvulsant drug discovery.

Types of Seizures

  • Principal seizure types include partial and generalized seizures.
  • Partial seizures are localized to one brain area.
  • Generalized seizures involve the whole brain.
  • Partial seizures can further develop into secondary generalized seizures, spreading to the whole brain.
  • Terminology differences exist between seizures and convulsions; convulsions are a specific type of seizure.

Epilepsy and Public Health

  • Approximately 10% of people will experience a seizure in their lifetime; ~30% of these individuals will subsequently develop epilepsy.
  • Epilepsy is the third most prevalent neurological disorder after migraines and Parkinson's disease.
  • Globally, it affects 50 million people and accounts for 1% of the global disease burden.
  • Incidence is higher in developing countries compared to industrialized nations.

Isolated Seizures

  • Many individuals can experience isolated seizures due to exposure to various stimuli.
  • An isolated seizure isn't considered epilepsy.
  • Possible triggers for isolated seizures include: CNS infection/inflammation, stroboscopic lighting, metabolic dysfunction, head injury, fever (especially in children), and drug-related issues (prescription and recreational).

Isolated Seizures and Epilepsy Risk

  • Repeated isolated seizures increase a person's risk of developing epilepsy

Patient-Centric Approach

  • Terminology like "fit", "epileptic" should be replaced with more patient-centered language like "seizure" and "person with epilepsy."
  • Phrases like "brain-storming" may be viewed as inappropriate by some, and the use of such terms should be approached with caution.

Defining Epilepsy Types

  • Historically, epilepsies were classified based on the predominant seizure type.
  • The International League Against Epilepsy (ILAE) has revised definitions to incorporate advancements in diagnostic approaches (EEG, brain imaging).
  • Classifications have become more complex but have also improved optimal treatment sooner.

Seizure Types (Generalised and Partial)

  • Generalised seizures affect the whole brain.
  • Partial seizures are confined to a specific brain area.
  • Seizures can further progress from partial to generalized if the spread affects the whole brain causing impairment of consciousness.
  • The severity of symptoms determines whether a seizure is described as simple or complex based on consciousness level during.

Co-morbidities of epilepsy

  • People with epilepsy have a significantly higher risk of premature mortality than the general population (2-3 times higher).
  • Co-morbidities, including anxiety, depression, and cognitive decline, are more frequent and severe in refractory patients.

Aims of Pharmacotherapy

  • The main goal is to achieve seizure freedom or a reduced number of breakthrough seizures.
  • Maximizing quality of life is equally important.

Treatment Strategies

  • Treatment decisions should begin with detailed patient history.
  • Initial strategy often involves a single anti-seizure drug (AED) to determine efficacy.
  • If a first-line treatment fails or toxicity issues arise, the addition of a second drug is considered.
  • Ultimately, the goal is optimized therapy with minimal adverse effects to ensure patient well-being.

Principal Treatments for Epilepsy

  • Sodium channel blockers (e.g., phenytoin, carbamazepine, valproate).
  • GABA enhancement (e.g., phenobarbital, diazepam).
  • Ketogenic diet.

Clinical Need for New AEDs

  • Despite significant efforts to develop new antiepileptic drugs, there's no improvement in reducing the number of intractable/refractory epilepsy patients.
  • Some new drugs exhibit improved tolerability profiles.
  • Continued efforts to develop new antiepileptic drugs are desirable for patients who do not respond to existing medication options.

Epilepsy and CBD

  • The exact mechanism of action (MoA) of CBD in epilepsy is still unknown.

AED Options by Seizure Type

  • Table of AEDs (anti-epileptic drugs) categorized by different seizure types.
  • Table to guide usage based on seizure type (NICE 2011).

Treatment Strategies for Specific Seizures

  • Lists specific treatment strategies for various seizure types and conditions as identified in the provided patient information.

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Description

Test your knowledge on epilepsy, including its prevalence, definitions, types of seizures, and triggers. This quiz covers critical concepts related to epilepsy and its impact on individuals. Assess your understanding of this important neurological disorder.

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