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Seizures and epilepsy (mechanism of disease)

This is a flowchart on seizures and epilepsy, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Atonic seizure ("drop attack"): Nonmotor (absence) seizure: Autoimmune encephalitides (anti-NMDA receptor encephalitis) Brain cancer/mets → cranial radiation therapy Brain tumors and metastases Tuberous sclerosis; hippocampal sclerosis Perinatal injury (hypoxic-ischemic injury) Congenital cerebral or arteriovenous malformations Hormones (menstrual cycle; post menopause) Flashing lights (strobe lights, video games) Medication side effects Autoimmune flares (SLE) Metabolic disturbances (uremia) Risk factors / SDOH Cell / tissue damage Structural factors Seizures and epilepsy Medicine / drugs Infectious / microbial Biochem / electrolytes Immunology / inflammation Signs / symptoms Tests / imaging / labs Neurological pathology Genetic / hereditary Flow physiology Pathophysiology Etiology Manifestations Amnesia of the event Seizure: excessive and/or hypersynchronous episode of transient electrical brain activity Epilepsy: chronic neurologic disorder characterized by a predisposition to seizures Traumatic brain injury Stroke, cerebral vascular accident Intracranial surgery Meningitis, encephalitis Hypocalcemia, hypoglycemia Alcohol withdrawal Recreational drugs Excessive physical exertion Alcohol consumption Fever (especially in children) Sleep deprivation Music → emotional response Medication issues (adherence; changes) Seizure triggers (with and without epilepsy): Microcephaly, megalocephaly, cortical dysgenesis Chromosomal abnormalities (Angelman, Prader-Willi, Rett syndromes) Metabolic d/o (PKU, glycosylation d/o, lysosomal storage dz, peroxisomal biogenesis d/o) Traumatic brain injury (with seizures starting 1 week after TBI) Acute CNS infxn complication (meningitis or encephalitis) Chronic CNS infection (toxoplasmosis, malaria, neurocysticercosis) Inborn errors of metabolism (e.g., organic acidemias, phenylketonuria) Neurodegenerative diseases (in older adults, aged 60) Mitochondrial diseases (e.g., MELAS) Mutations in channels or receptors (KCNQ2 or SCN1A genes) Unresponsive Confusion Aphasia Fatigue Muscular flaccidity Muscle pain Headache Hypersalivation Ictal Postictal Generalized- onset seizures: Caused by focal structural problem Focal (formerly partial) seizures: Prodrome: sleep/mood change, lightheadedness, anxiety, irritability, poor concentration Loss of consciousness (sudden, without warning) Motor: Tonic: rotated eyes, apnea, lateral tongue biting → Clonic: rhythmic muscle twitching Bowel and/or bladder incontinence Sudden loss of muscle tone → head drop or collapse (lasting 15 sec) Tonic-clinic (grand mal) seizure: Sudden blank stare, unresponsive, occurs frequently, lasts 10 seconds +/- lip-smacking, eye fluttering, or head nodding Involves entire hemisphere(s) Prodrome: anxiety, fear, deja vu; lasting sec to min Affecting temporal lobe → impaired awareness Residual transient deficit according to affected region (often mistaken for CVA/TIA) Focal hypoperfusion, prolonged refractory period after cell depolarization, and prolonged local inhibition → Todd paralysis: weakness / paralysis of involved limb of facial muscles Motor: automatisms (lip smacking, blinking, tapping); atonic (loss of tone); myoclonus (twitching); clonic repetitive movement; pedaling; jumping; Jacksonian march (march of convulsions) Autonomic (flushing, sweating) Cognitive (dyslexia, aphasia, anomia, amnesia) Emotional (laughing, crying, feeling fear) Sensory: visual hallucinations); paresthesias; vertigo; auditory (ringing); olfactory (unusual / intense smells); gustatory hallucinations ↑ Upwards Arrow 24 ↓ Downwards Arrow 25 → Rightwards Arrow 26 ← Leftwards Arrow 27 ↔ Left-Right Arrow 29 ↕ Up-Down Arrow 18