Consciousness is preserved in which of the following types of seizures?
B. Epilepsy is a common disorder, affecting approximately 1% of the population and may involve individuals of any age. Seizures are convulsions that may be produced by a wide variety of events, including alcohol and drug withdrawal syndromes, hypoglycaemia, transient cerebral anoxia, and epileptic syndromes. Epilepsies are characterized by recurrent seizures and their classification is based on seizure type, age of onset, intellectual development, findings on neurological examination, and results of neuroimaging studies. Seizures are broadly classified into partial and general forms. Partial seizures are further divided into simple and complex. In simple partial seizures consciousness is preserved; complex seizures are characterized by disturbances in consciousness. Partial seizures pertain to one half or one particular area of the brain. Generalized seizures involve both hemispheres from the beginning of the seizure but, at times, they may be secondary to spread from a partial seizure. Tonic–clonic seizures and absence seizures are examples of primary generalized seizures. They are usually associated with a loss of conscious awareness.
Reference:
A 45-year-old lady developed recurrent seizures with aura, automatism, and lip smacking. Ictal EEG showed spike and sharp waves complex along the right temporal region.
Which of the following statements regarding her diagnosis is not true?
D. Left-sided foci are associated with an increased risk of depression and right-sided foci with an increased risk of mania. Mood disorders are the most common type of psychopathology encountered in patients with epilepsy. Prevalence rates of depression range from 30 to 50% in patients with epilepsy. With intractable disorders, up to 60% have lifetime histories of depressive syndromes. In contrast to the incidence of depression in epilepsy, the incidence of mania and bipolar disorder are at normal or near-normal levels. Some retrospective chart reviews state a lifetime prevalence of 20%. The incidence of suicide in epilepsy patients is fi ve to 10-fold greater than in the general population. In those with temporal lobe epilepsy, suicide rates are around 25 times that of the general population.
Features suggestive of Geschwind’s syndrome include all except:
B. Geschwind’s syndrome is an eponymous syndrome of interictal behaviour/personality disorder which has been described in temporal lobe epilepsy (TLE). Clinical features of this syndrome include preoccupation with philosophical and religious concerns, anger, excessive emotionality, viscosity (noted especially in speech), circumstantiality, altered sexuality, and hypergraphia. Recent reviews state that personality traits, rather than a personality disorder per se, seems more likely in these disorders and they tend to resemble the cluster C category of disorders in DSM-IV.
References:
A 23-year-old patient previously diagnosed with epilepsy presents to casualty with intractable seizures following the breakup of a relationship. She has been compliant on her medications. The neurologist suspects psychogenic non-epileptic seizures.
Which of the following statements is true with regard to her condition?
E. Psychogenic non-epileptic seizures were previously referred to as ‘pseudoseizures’. They are seizure-like behavioural events that occur in the absence of abnormal electrical discharge in the brain. The gold standard for diagnosis is video-EEG monitoring. People who present with non-epileptic seizures commonly have comorbid epilepsy. Nearly 30 to 50% of patients who have non-epileptic seizures have epilepsy and 20 to 60% of patients who have epilepsy have non-epileptic seizures. The average age of onset is between 20 and 30 years and it is three times more common in women than men. Prevalence rates of a history of sexual abuse in non-epileptic seizures range from 25 to 75%. An elevated prolactin level (usually two times baseline or three standard deviations above normal) could be due to seizures or any neurological event, such as syncope. Some patients with pseudoseizures may have modest elevations in prolactin levels. A normal prolactin may not always be diagnostic of pseudoseizures, since it is frequently normal in partial seizures and sampling may be mistimed following convulsions.
Early onset of major depression is most commonly associated with stroke pertaining to which of the following regions of the brain?
C. Historically, left anterior stroke has been associated with depression. This has been questioned in more recent times—including a few meta-analysis that did not show such a relationship. The laterality hypothesis of post-stroke depression may hold true only in the acute stage of illness of less than 2 months’ duration. As time passes, the chance of getting a depressive episode is equal in all kinds of stroke. Major depression occurs in approximately 10–25% of patients. Anxiety occurs without depression in up to 10%. Apathy occurs in 20% of patients. Anosognosia with denial of illness is present in 25–45% of patients, particularly those with right posterior lesions. Catastrophic reactions appear in approximately 20% and emotional lability is present in 20%. The mean duration of major depression appears to be about 9 months, but can be chronic, lasting for years in hospitalized patients.
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