Seizure and Epilepsy Overview
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Questions and Answers

What is a seizure?

A seizure is a sudden behavior change caused by electrical hyper-synchronization of neuronal networks in the cerebral cortex.

What is epilepsy?

Epilepsy is a disorder of the brain characterized by an enduring predisposition to epileptic seizures.

According to the ILAE 2014 definition, which of the following conditions defines epilepsy?

  • At least two unprovoked seizures occurring more than 24 hours apart.
  • One unprovoked seizure and a probability of future seizures similar to the risk of two unprovoked seizures over the next ten years.
  • Diagnosis of an epilepsy syndrome.
  • All of the above (correct)

    • The incidence of epilepsy is higher in early childhood and late adulthood.

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

    Why is it important to classify seizures?

    <p>All of the above (F)</p> Signup and view all the answers

    Which of the following are NOT considered in the International League Against Epilepsy classification system?

    <p>Etiology (A), Cellular substrate (C)</p> Signup and view all the answers

    Focal seizures are classified based on which two factors?

    <p>Awareness and nature of the onset (C)</p> Signup and view all the answers

    Focal seizures can evolve into generalized seizures.

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

    What are three additional features of focal motor seizures?

    <p>Jacksonian march, Todd's paralysis, and epilepsia partialis continua.</p> Signup and view all the answers

    Focal seizures with impaired awareness frequently begin with an aura.

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

    What are common signs of focal seizures with intact awareness?

    <p>Motor manifestations such as tonic, clonic, or myoclonic movements, or nonmotor manifestations such as sensory, autonomic, or emotional symptoms.</p> Signup and view all the answers

    Generalized seizures arise at some point in the brain but rapidly engage neuronal networks in both cerebral hemispheres.

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

    Which of the following are types of generalized onset seizures?

    <p>All of the above (E)</p> Signup and view all the answers

    What are the typical characteristics of a typical absence seizure?

    <p>A sudden blank stare with motor arrest, lasting less than 15 seconds. The individual is unresponsive and unaware.</p> Signup and view all the answers

    Typical absence seizures usually end abruptly and the patient returns to normal consciousness with no postictal confusion.

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

    What is the difference between a typical and atypical absence seizure?

    <p>All of the above (D)</p> Signup and view all the answers

    Generalized Tonic-Clonic Seizures are the most common seizure type.

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

    The Tonic phase of a Generalized Tonic-Clonic seizure usually occurs before the Clonic phase.

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

    Atonic seizures involve sudden loss of muscle tone that can last for several minutes.

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

    Myoclonic seizures are most common in individuals with metabolic disorders, degenerative CNS diseases, or anoxic brain injuries.

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

    What is an epilepsy syndrome?

    <p>An epilepsy syndrome represents a complex of clinical features, signs, and symptoms that together define a specific seizure disorder.</p> Signup and view all the answers

    What is the triad that defines Lennox-Gastaut syndrome?

    <p>Multiple seizure types, an EEG showing slow spike-and-wave discharges, and impaired cognitive function.</p> Signup and view all the answers

    What is the most common underlying cause of mesial temporal lobe epilepsy syndrome?

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

    Seizures are the result of disruptions in the balance of excitation and inhibition within the central nervous system.

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

    Which of the following is NOT a clinical observation that supports the understanding of seizures and epilepsy?

    <p>Seizures are always triggered by specific external stimuli. (A)</p> Signup and view all the answers

    Which of these is NOT a potential cause of seizures in neonates?

    <p>High blood pressure (A)</p> Signup and view all the answers

    Which of the following drugs is classified as Category X, meaning it is contraindicated during pregnancy?

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

    Pregnant women should be discontinued from AED therapy.

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

    A first seizure is usually more serious than a recurrent seizure.

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

    Status epilepticus refers to a single, prolonged seizure.

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

    What are the two main types of status epilepticus?

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

    The management of status epilepticus always involves immediate surgical intervention.

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

    Which of the following is NOT considered a comorbidity associated with epilepsy?

    <p>Vision loss (D)</p> Signup and view all the answers

    The risk of death is significantly higher in people with epilepsy compared to the general population.

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

    The majority of increased mortality in people with epilepsy is due to the underlying cause of the epilepsy.

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

    What are three key considerations in managing a first time unprovoked seizure?

    <p>The risk of recurrent seizures, the relative risk reduction with anticonvulsant therapy, and the risks of not treating.</p> Signup and view all the answers

    Anticonvulsant therapy should always be initiated after a first unprovoked seizure.

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

    Which of the following is NOT a risk factor for recurrent seizures after a first unprovoked seizure?

    <p>Normal brain imaging (D)</p> Signup and view all the answers

    What is the primary role of seizure classification in managing a patient with epilepsy?

    <p>Designing the treatment plan (C)</p> Signup and view all the answers

    It is generally recommended to start anti-seizure medication with a high dose to quickly control seizures.

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

    Serum drug levels are NOT helpful in monitoring patients on anti-seizure medication.

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

    Treatment of underlying conditions that contribute to epilepsy is not a crucial part of management.

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

    Avoidance of precipitating factors for seizures is only necessary in cases of newly diagnosed epilepsy.

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

    Discontinuing anti-seizure medication is often recommended shortly after a seizure-free period.

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

    A patient with a history of epilepsy is more likely to be seizure-free after drug withdrawal if they have a single seizure type, normal neurologic examination, and no family history of epilepsy.

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

    Newer drugs are more effective than older drugs in treating epilepsy.

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

    Flashcards

    Seizure

    A sudden change in behavior caused by excessive electrical activity in the brain's cortex.

    Epilepsy

    A chronic neurological disorder characterized by recurrent seizures.

    Focal seizure

    A seizure that originates in a specific area of the brain.

    Generalized seizure

    A seizure that affects both sides of the brain.

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    Absence seizure

    A brief loss of consciousness without any significant motor activity.

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    Focal seizures with impaired awareness

    Seizures that begin in a localized area and spread to other parts of the brain.

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    Tonic-clonic seizure

    A seizure characterized by sudden, forceful muscle contractions.

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    Atonic seizure

    A brief loss of muscle tone.

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    Myoclonic seizure

    A brief, involuntary muscle contraction.

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    Juvenile myoclonic epilepsy

    An epilepsy syndrome with the hallmark of recurrent myoclonic seizures.

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    Lennox-Gastaut syndrome

    An epilepsy syndrome characterized by a triad of multiple seizure types, slow spike-wave discharges on EEG, and cognitive impairment.

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    Probability of further seizures

    The recurrence risk of one unprovoked seizure over ten years is similar to the recurrence risk of two unprovoked seizures.

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    Unprovoked seizures

    Seizures that occur without any identifiable trigger or cause.

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    Provoked seizures

    Seizures that are caused by a specific event or situation.

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    Epilepsy syndrome

    A group of clinical features that together define a specific seizure disorder.

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    Jacksonian march

    The spread of seizure activity through the brain, which can be observed as progressive muscle contractions.

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    Postictal state

    The period following a seizure, which can involve confusion, drowsiness, or weakness.

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    Todd's paralysis

    A short-term weakness or paralysis that can occur following a seizure.

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    Status epilepticus

    A continuous series of seizures that can last for hours or days.

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    Anticonvulsant therapy

    The use of anti-seizure medication to prevent future seizures.

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    Dose escalation

    The process of slowly increasing the dose of anti-seizure medication until the desired effect is achieved.

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    Discontinuation of anti-seizure medication

    The process of withdrawing anti-seizure medication when a patient has been seizure-free for a certain period.

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    Epileptiform abnormalities

    An abnormal EEG pattern that suggests an increased risk for seizures.

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    Epilepsy surgery

    The use of surgery to treat epilepsy by removing the area of the brain where seizures originate.

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    Vagal nerve stimulation

    The use of a vagal nerve stimulator to treat epilepsy.

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    Sudden unexpected death in epilepsy (SUDEP)

    A sudden unexpected death in a person with epilepsy, typically during a seizure.

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    Anticonvulsant therapy during pregnancy

    The use of medication to treat seizures during pregnancy.

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    Category X drug

    A medication that can cause birth defects.

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    Postpartum seizure

    A seizure that occurs during the postpartum period.

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    Eclampsia

    A condition characterized by seizures, hypertension, and proteinuria that occurs during pregnancy.

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    Study Notes

    Seizure and Epilepsy

    • Seizures are sudden changes in behavior caused by electrical hyper-synchronization in the cerebral cortex.
    • Seizures can be provoked or unprovoked.
    • Epilepsy is a clinical brain disorder characterized by a predisposition to seizures.
    • The ILAE (International League Against Epilepsy) 2014 definition of epilepsy includes two unprovoked seizures greater than 24 hours apart, OR one unprovoked seizure and a 60% or higher chance of further seizures in the next ten years. Also includes diagnosis of epilepsy syndrome.
    • The incidence of epilepsy is approximately 0.3–0.5% globally, and the prevalence is estimated to be 5–30 people per 1000.
    • The highest incidence is in early childhood and late adulthood.
    • Seizures are classified for several important reasons including for appropriate diagnosis, identifying triggers and etiologies, selecting treatment, and understanding prognosis and risk of comorbidities and mortality.
    • The classification system is based on clinical features of seizures and associated electroencephalographic findings; etiology or cellular substrate is not currently included.
    • Focal seizures arise within a localized area of the brain, and can be further classified by their awareness state (intact or impaired) during the seizure and the type of onset (motor or non-motor).
    • Focal seizures can evolve into generalized seizures..
    • Focal seizures with intact awareness can have motor manifestations or non-motor manifestations without impairment of consciousness.
    • Three notable additional features of focal motor seizures are: Jacksonian march, Todd's paralysis, and epilepsia partialis continua. (Jacksonian march is the progression of a seizure through different regions of the brain. Todd's paralysis is temporary paralysis following a focal seizure, epilepsia partialis continua refers to a focal seizure that lasts for a long time.)
    • Focal seizures with impaired awareness often start with an aura followed by automatisms, postictal confusion. and antegrade amnesia and transient postictal neurologic deficits.
    • Generalized seizures involve both cerebral hemispheres, and include absence seizures (typical or atypical), generalized tonic-clonic seizures, atonic seizures, and myoclonic seizures.
    • Typical absence seizures are marked by sudden blank stares and motor arrest, typically lasting less than 15 seconds.
    • Atypical absence seizures have longer durations, more noticeable motor signs, are often associated with diffuse or multifocal brain abnormalities and are less responsive to anticonvulsants
    • The main seizure type in ~10% of people with epilepsy is generalized tonic-clonic seizures.
    • Generalized tonic-clonic seizures often start abruptly without warning and do not commonly have an aura.
    • These seizures have two phases: tonic (muscle stiffening, loss of consciousness) followed by clonic (rhythmic jerking). Post-ictal effects include headache, confusion, muscle soreness, and fast heart rate, elevated blood pressure, and possible respiratory and metabolic acidosis.
    • Atonic seizures are characterized by sudden loss of muscle tone.
    • Myoclonic seizures are sudden brief muscle contractions that can involve one or multiple body parts.
    • Pathologic myoclonus is commonly linked to metabolic disorders, degenerative CNS diseases and anoxia brain injuries.
    • Epilepsy syndromes are recognizable by grouped clinical features. Some syndromes are highly correlated to single etiologies, while others result from various causations, i.e. infantile spasm syndrome or Lennox-Gastaut syndrome..
    • Mesial Temporal Lobe Epilepsy (TLE) is a common epilepsy syndrome characterized by focal seizures often accompanied by impairment of consciousness and possibly hippocampal sclerosis or other structural neurologic damage..
    • Common causes of seizures include changes in the balance of excitation and inhibition within the central nervous system (CNS) as well as several medical conditions, such as CNS infection, or metabolic imbalances.
    • Several types of medications and substances can also cause seizures.
    • The mechanisms of seizure initiation and propagation involve high-frequency bursts of action potentials and hyper-synchronization within neurons, typically prevented by hyperpolarization and inhibitory neurons.
    • Epileptogenesis is the process by which a normal neural network becomes overly excitable, which can be triggered by prior head trauma, stroke, tumors, or CNS infections.
    • When approaching a patient shortly after a seizure, the priorities are attending to the ABCDs (Airway, Breathing, Circulation, and Disability), vital signs, and respiratory and cardiovascular support and immediately treatment for life-threatening conditions like infections, metabolic disturbances, or drug toxicity.
    • Further assessment of the seizure by neurological examination to determine type and cause is required including risk factors and precipitating events. For prior seizure patients, determining current therapy adherence and adequacy are important.
    • Investigations include blood tests (RBS, CBC, blood cultures), serum electrolytes, vitamins, urine tests, X-rays, and imaging (EEG, LP, CT, MRI, PET, and SPECT).
    • Several disorders have similar symptoms to seizures, including psychological or cardiac disorders. Differentiating these conditions can often be complex. Some conditions are more likely to present in children or specific age groups.
    • The goal for managing seizures is to determine whether the patient has a seizure disorder and not a condition (e.g., psychological issues or cardiac disorders) that mimics epilepsy. Determining if it's a provoked or unprovoked seizure. Initial management includes determining if it is the first time or recurrent seizure.
    • Acute symptomatic seizures are managed by addressing the source provoking the illness.
    • When determining if the patient with an unprovoked seizure needs anti-seizure medication, the factors include the risk of recurrent seizures, the risk reduction that initiating treatment, risks of not treating, and risks of chronic antiseizure medication therapy.
    • The risk factors associated with recurrent seizures include abnormal neurologic examination, prior brain insult, epileptiform abnormalities in EEG, significant brain abnormalities, and nocturnal seizures.
    • Initiating anti-seizure medication should consider seizure classification, starting with 10-20% of the maintenance dose of single-drug therapy.
    • Adding additional anti-seizure medication and monitoring seizure control, serum drug levels, adverse events is required.
    • The treatment of underlying conditions, avoiding precipitating factors, suppressing recurrent seizures with medications or surgery, is important. Address psychological and social issues that might exist.
    • Factors that help determine when anti-seizure therapy can be discontinued include length of time seizure-free (1–5 years), single seizure type, normal neurological exam, no family hx of epilepsy, and normal EEG.
    • Pregnant women should be maintained on effective anti-seizure medications using the fewest prescribed medications at the lowest possible dose. Folate supplementation (1–4mg/day) and vitamin K injections during delivery are recommended and required..
    • Some anti-seizure medications (e.g., valproic acid) are considered high-risk for pregnancy, while others (e.g., topiramate) are considered safer.
    • Management of status epilepticus includes ABCDs, ruling out causes of seizures (e.g. hypoglycemia or eclampsia), starting anticonvulsants quickly, and determining underlying cause of status epilepticus.
    • Important comorbid factors for epilepsy to consider include psychiatric concerns, psychosocial issues, driving implications and employment support.
    • Mortality rates are higher in people suffering from epilepsy compared to a matched population without epilepsy. Increased risk is often connected to conditions that cause or increase the risk of seizures.

    Status Epilepticus

    • Refers to continuous seizures or repetitive, discrete seizures with impaired consciousness.
    • There are several types, including generalized convulsive (GCSE) and nonconvulsive status epilepticus.

    Other Management Issues

    • Key considerations include treatment of comorbid conditions (psychiatric, psychosocial, driving) and employment considerations.

    Mortality of Epilepsy

    • Risk of death 2-3 times higher than in matched populations without epilepsy and is often due to underlying causes or injuries related to seizures.

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    Seizure and Epilepsy PDF

    Description

    Explore the definitions, classifications, and key statistics of seizures and epilepsy in this informative quiz. Understand the criteria for diagnosing epilepsy as outlined by the ILAE and learn about the incidence rates across different age groups. Test your knowledge on this important neurological condition.

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