Epilepsy Part 1 PDF

Seizures and epilepsy Dr katz Division of neurology  DEFINITION Seizure : Transient signs and/or symptoms due to abnormal excessive neuronal activity in the brain Epilepsy: Tendency to recurrent unprovoked seizures:  epilepsy AT LEAST 2 UNPROVOKED SEIZURES...

Seizures and epilepsy Dr katz Division of neurology  DEFINITION Seizure : Transient signs and/or symptoms due to abnormal excessive neuronal activity in the brain Epilepsy: Tendency to recurrent unprovoked seizures:  epilepsy AT LEAST 2 UNPROVOKED SEIZURES >24 hours apart OR 1 UNPROVOKED SEIZURE And >60 % chance of second unprovoked seizure (Or if epilepsy syndrome ) SEIZURES 7-10% people at some time in their life have a seizure EPILEPSY PREVALENCE 1% population Birth trauma Cns infections TBI 60 % NO ANTIEPILEPTICS DT ECONOMIC AND SOCIAL REASONS  Approach focal Generalised Focal to bilateral tonic clonic unknown FOCAL SEIZURES(partial seizure) - abnormal electrical discharge begins in a focal area. GENERALISED SEIZURES electrical discharge begins in both cerebral hemispheres simultaneously FOCAL SEIZURES(partial seizure) - abnormal electrical discharge begins in a focal area. GENERALISED SEIZURES electrical discharge begins in both cerebral hemispheres simultaneously  Focal seizures (partial) Retained awareness (simple) Impaired awareness (complex)  FOCAL /Partial : Electrical discharge originating from one focus motor sensory/ autonomic/ Cognitive emotional  CLINICAL FEATURES MOTOR NON MOTOR – eg sensory/ autonomic/ Cognitive emotional - This seizure can SPREAD - within the motor area.- - or can develop impaired consciousness - or can become bilateral tonic clonic  COMPLEX PARTIAL ) SEIZURES (FOCAL IMPAIRED AWARENESS TEMPORAL LOBE: commonest Impairment of awareness– required symptom. Psychiatric symptoms common Together with motor symptom – automatism  COMPLEX PARTIAL ) SEIZURES (FOCAL IMPAIRED AWARENESS TEMPORAL LOBE: commonest Impairment of awareness– required symptom. Psychiatric symptoms common Together with motor symptom – automatism  COMPLEX PARTIAL SEIZURES (FOCAL IMPAIRED AWARENESS PSYCHIATRIC SYMPTOMS 1) Abnormal affect : Fear is common Agitated, anger 2) Illusions : Visual-----macropsia micropsia 3) Hallucinations 4) Dyscognitive States De-ja-vu …….. MOTOR Automatisms – highly integrated complex involuntary motors acts - Lip smacking - Fumbling with hands  GENERALISED seizures From ONSET Discharge IN BOTH HEMISPHERES SIMULTANEOUSLY (previously primary generalised ) FOCAL TO BILATERAL TONIC CLONIC PREVIOUSLY CALLED – SECONDARILY GENERALISED TONIC CLONIC  GENERALISED SEIZURE MOTOR – – E.G. TONIC CLONIC – CLONIC – TONIC – MYOCLONIC – ATONIC NON MOTOR ABSENCE ATYPICAL ABSENCE  PRIMARY GENERALISED EPILEPSY ABSENCE Peak age of onset 5 – 10 years. NB Lack of any warning Attack very brief – usually seconds The attack ends as quickly as it starts No post ictal No recall ATTACK - Unresponsive – BLANK STARE - Possibly associated - Rhythmical flutters of eyelids - The movement of corner of mouth - May drop the head or even slump into the chair - Automatism EEG Typical 3Hz spike and wave.  EEG: Typical absence seizure, 3 Hz spike and wave American Epilepsy Society 2015 PC Slide-22  GENERALISED TONIC-CLONIC SEIZURES Tonic phase - generalised increased tone - Consciousness is lost - Mouth snaps shut which might result in tongue biting - Thoracic, abdominal muscles contract producing an epileptic shout as air is forced out over the vocal cords. Clonic phase - bilateral symmetrical jerking Postictal phase - complete muscle relaxation - Headache, confusion, muscle pains NB : Autonomic activity is increased during seizure FOCAL SPREADS BILATERAL –TONIC CLONIC (old classification Secondary generalised )  ETIOLOGY OF EPILEPSY IDIOPATHIC (PRIMARY) No cause found Genetic basis SYMPTOMATIC (SECONDARY) e.g. Infection-cysticercosis stroke brain tumor, head trauma birth injury  Etiology of epilepsy GENETIC STRUCTURAL INFECTIOUS METABOLIC IMMUNE UNKNOWN ETIOLOGY useful to consider in terms of age