Epilepsy = disorder involving recurrent seizures. Hippocampus is frequently affected, leading to memory problems. Each seizure causes cell death. It is diagnosed by vitnessing a seizure, neurological exam with history, and EEG (hyperventilation is used to induce seizures, it is best to use both sleeping and waking EEG). EEG has 55-60 % hit rate, 10-15% of the population have abnormal EEG and no seizures, frontal and lower temporal seizures are very difficult to detect.
Risk factors: 50% are ideopatic (etiology unknown), birth trauma, genetic factors (run in family), 5% of children with febrile (high fever) seizures develop epilepsy, physical or chemical trauma to the brain. 90-95% of patients are diagnosed before 20 years of age; new cases mainly appear after 65 due to strokes, subdural hematomas, metabolic disturbances, etc..
Common auras: bad taste or smell, intense fear, visual and auditory auras are rare.
Treatment: mostly meds, behavioral – for some pts., surgery – last ditch, lower stress, improve diet, decrease toxins, increase sleep, consider support groups, psychosocial consequences of epilepsy, secondary anxiety and depression, difficulties with driving, work, and recreational activities.
Measures
(pp. 751-753 in Lezak)
Washington Psychosocial Seizure Inventory – measures social functioning and concerns of epileptic pts..
Bear-Fedio Inventories – for temporal lobe epilepsy and impairment level.
Structured Clinical Interview for Complex Partial Seizure-Like Symptoms – symptom assessment.
Psychosocial Rating Scale – psychosocial ramifications of temporal lobectomies.
Types of seizures
Generalized seizures – involve whole brain & body:
Petit Mal – absence – attention lapse & blinking
Tonic-clonic seizure = Grand Mal – may be followed by 8-10 hrs. of paralysis = Todd’s paralysis, confusion, exhaustion, & sleep.
Reflexogenic seizures – caused by a cue (music, patterns, certain miovements, etc.)
Jacksonian seizure – frequent after mechanical head trauma – twitches starting at the thumb and going along the “homunculus” in prefrontal gyrus.
Partial = local = focal seizures:
Partial Complex – alteration or impairment in consciousness (if in temporal lobe pts. show repetitive behaviors: picking at clothes, lip smacking, etc.)
Partial Simple – motor or sensory, no alteration or impairment in consciousness.
Non-epileptic (psychogenic) seizures = seizures with no EEG correlates: distinguished by pelvic thrusting, gradual onset, discontinuous seizure activity, disjointed progression (not going along the “homunculus” in prefrontal gyrus), dyscoordinated (out-of-phase) movements, prolonged duration, dystonic posturing, face not involved in generalized seizure, crying during or after seizure, gradual cessation, disoriented to person after seizure, obvious emotional trigger, can be induced by suggestion, eyes often closed, if one pulls an arm up and let it go over the face the arm avoids the face in falling.
