14. Epilepsy 1.pptx

Epilepsy seizure Syncope Syncope  Syncope (faint): LOC due to transient impairment of cerebral blood flow.  Seizure (fits): convulsive / nonconvulsive Transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain. Major seizure- fall to ground, LOC...

Epilepsy seizure Syncope Syncope  Syncope (faint): LOC due to transient impairment of cerebral blood flow.  Seizure (fits): convulsive / nonconvulsive Transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain. Major seizure- fall to ground, LOC. Minor seizure- no fall, altered consciousness. GOOD HISTORY ESSENTIAL Ask the person who has had the suspected TLoC, as well as any witnesses, to describe what happened before, during, and after the event. Record details about: Circumstances of the event; Person's posture immediately before TLoC; Presence or absence of any prodromal symptoms (such as sweating or feeling warm/hot) and movement during event (for example, jerking of the limbs and duration); GOOD HISTORY ESSENTIAL appearance (for example, whether eyes were open or shut) and colour of the person during the event; any biting of the tongue (record whether the side or the tip ofthe tongue was bitten); injury occurring during the event (record site and severity); Duration of the event (onset to regaining consciousness); Presence or absence during the recovery period of confusion or weakness down one side; and Current medication that may have contributed to TLoC (for example, diuretics). Past history Ask also about details of any previous TLoC, including number of episodes and frequency, as well as the person's medical history family history of cardiac disease/epilepsy (for example, Seizure Suggests diagnosis SEIZURE Prodromal symptoms Uprolling of eyes Tonic/clonic convulsions Frothing of mouth Urinary/Faecal incontinence Post ictal drowsiness Seizure Is this the first seizure? Look for the cause Is this pt. a known epileptic? Med- compliance? Triggering factors? Causes of seizures Aetiology of seizures           Idiopthic / constitutional Congenital abnormalities & perinatal injuries Metabolic Drugs / Toxins / withdrawal Trauma Tumors Vascular Degenerative : Alzheimer’s disease Infection Inflammatory : SLE, PAN, MS Trigger factors for seizures         Sleep deprivation; some have fits only in the night Missed meals Alcohol (bingeing & withdrawal) Recreational drug abuseamphetamines, barbiturates Physical & mental exhaustion Fever & infection Flickering lights, loud noises, music, looking at certain patterns & reading Hot water bath Mechanism of seizure formation • Excitation of a group of nerves discharging independently. This is caused by inward currents of Na, Ca and involvement of excitatoryneurotransmitters like Glutamate and Aspartate. • Too little inhibition. • Epileptogenesis and hyperexcitability and hypersynchronization of neurons that facilitates spread. EPILEPSY Chronic neurological disorder marked by sudden recurring attacks of motor, sensory, or cognitive dysfunction, with or without convulsive seizures or loss of consciousness. Also called seizure disorder. Epilepsy    Tendency to have episodes of seizures A single seizure is not epilepsy, but an indication for investigation Start medication if evidence of a tendency for recurrent seizures – neurological def/fly.h/o  Most recurrent attacks occur within a month or two of the first Classification of seizures A) Partial 1. 2. 3. seizures : Simple partial- sensory, motor, autonomic Complex partial Partial seizure evolving into secondary generalisation B) Generalised 4. 5. 6. 7. 8. seizures (primary): Absence (petit mal & atypical) Tonic– clonic ( grand mal) Myoclonic Tonic Atonic (akinetic / drop attacks) Classification of seizures Management