ABPN Epilepsy flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Epileptogenesis

The process by which a previously normal brain becomes capable of generating recurrent unprovoked seizures, often after injury, and may take months to years to develop.

Ictogenesis

The cellular and network mechanisms that generate an individual seizure, involving hypersynchronous neuronal firing and failure of inhibitory restraint within the seizure onset zone.

SCN1A

Gene encoding the neuronal sodium channel Nav1.1; loss-of-function variants cause Dravet syndrome, a severe infantile-onset epileptic encephalopathy with febrile and prolonged seizures.

Focal cortical dysplasia

A malformation of cortical development causing drug-resistant focal epilepsy; type II shows dysmorphic neurons, balloon cells, and mTOR pathway activation on histology.

Seizure onset zone

The cortical region where seizures actually begin, identified by ictal EEG or intracranial recordings, and the primary surgical target in epilepsy surgery.

Kindling

Progressive increase in seizure susceptibility and severity produced by repeated subthreshold electrical stimulation, a model supporting the concept of secondary epileptogenesis.

Psychogenic nonepileptic seizure

Paroxysmal behavioral events resembling seizures but without epileptiform EEG correlate, often with psychiatric comorbidity; diagnosis requires video-EEG capture of a typical event.

SUDEP

Sudden unexpected death in epilepsy, occurring without another cause; risk is highest with frequent generalized tonic-clonic seizures, nocturnal seizures, and poor medication adherence.

ILAE 2017 classification

Epilepsy classified by seizure onset as focal, generalized, combined, or unknown, with further descriptors of motor versus nonmotor and level of awareness.

Ictal dystonic posturing

Sustained unnatural limb posturing during a seizure that lateralizes the seizure onset to the contralateral cerebral hemisphere in temporal lobe epilepsy.

Drug-resistant epilepsy

Failure of adequate trials of two appropriately chosen and tolerated antiepileptic drugs, whether as monotherapy or in combination, to achieve sustained seizure freedom.

Postictal language dysfunction

Transient aphasia or naming difficulty after a seizure, suggesting involvement of the language-dominant hemisphere, usually the left temporal lobe.

Hypsarrhythmia

A chaotic, high-amplitude, disorganized EEG background with multifocal spikes and slow waves, characteristic of infantile spasms and West syndrome.

Hippocampal sclerosis

Hippocampal atrophy with T2/FLAIR hyperintensity and loss of internal architecture on MRI; the most common structural cause of drug-resistant temporal lobe epilepsy.

PLEDs

Periodic lateralized epileptiform discharges, a repeating unilateral EEG pattern suggesting acute structural or infectious brain lesion and associated with high seizure risk.

3 Hz spike-and-wave

Generalized bilaterally synchronous 3 Hz spike-and-wave discharges on a normal background, the classic EEG finding in childhood absence epilepsy.

Interictal FDG-PET

A functional imaging study showing regional hypometabolism in the epileptogenic zone between seizures, useful in presurgical evaluation when MRI is nonlesional.

Ictal SPECT

Imaging performed during a seizure showing regional cerebral hyperperfusion at the seizure focus, used to localize the epileptogenic zone in presurgical evaluation.

Valproate teratogenicity

In utero valproate exposure increases risk of neural tube defects and impaired cognitive development, so it should be avoided in pregnancy when alternatives exist.

Lamotrigine titration

Lamotrigine must be started at low dose and slowly titrated to reduce risk of serious rash; dose is halved when co-administered with valproate.

Status epilepticus first-line

Intravenous lorazepam is the initial treatment for convulsive status epilepticus, followed by a longer-acting agent such as fosphenytoin, valproate, or levetiracetam.

Enzyme-inducing antiepileptics

Carbamazepine, phenytoin, phenobarbital, and oxcarbazepine induce hepatic enzymes, lowering levels of oral contraceptives, warfarin, and many co-administered drugs.

Phenytoin kinetics

Phenytoin exhibits nonlinear (zero-order) kinetics at therapeutic doses, so small dose increases can produce disproportionate and toxic serum level rises.

Anterior temporal lobectomy

Resection of the anterior temporal lobe and mesial structures, producing seizure freedom in roughly 60-70% of drug-resistant temporal lobe epilepsy, best with hippocampal sclerosis.

Corpus callosotomy

A palliative disconnection procedure most effective for drop attacks and atonic seizures in Lennox-Gastaut syndrome; it reduces seizure severity rather than curing epilepsy.

Vagus nerve stimulation

A palliative device delivering intermittent left vagal stimulation, reducing seizure frequency in about half of responders; side effects include hoarseness, cough, and dyspnea.

Responsive neurostimulation

A closed-loop device that detects epileptiform activity and delivers stimulation to the seizure focus; indicated for drug-resistant focal epilepsy with one or two foci.

Ketogenic diet

A high-fat, low-carbohydrate diet that reduces seizure frequency in drug-resistant epilepsy, especially in children; requires monitoring for dyslipidemia, stones, and growth.

Wada test

Intracarotid amobarbital procedure assessing language and memory lateralization before temporal lobe resection; increasingly replaced by fMRI for language mapping.

Juvenile myoclonic epilepsy

An adolescent-onset generalized epilepsy with morning myoclonic jerks, often with generalized tonic-clonic seizures; usually requires lifelong treatment with valproate or levetiracetam.

Lennox-Gastaut syndrome

A severe childhood epileptic encephalopathy with multiple seizure types, slow spike-and-wave EEG, and intellectual disability; treated with valproate, clobazam, rufinamide, or felbamate.

Simple febrile seizure

A generalized febrile seizure lasting under 15 minutes without recurrence within 24 hours in a child aged 6 months to 5 years; carries low risk of later epilepsy.