Epilepsy & Seizures

Seizures: Abnormal, excessive, synchronized electrical According to WHO, Epilepsy is defined as having two or
activity period of brain neurons more unprovoked seizures.

Pathogenesis

↑ Excitation: Long lasting/ fast stimulation of NMDA Epileptic seizures

C receptors via glutamate.
↓ Inhibition: genetic mutation leading to dysfunctional
A GABA receptors
Provoked Seizures:
U Abnormal brain activity caused by trigger, return to
normal after trigger removal
S Medications
 Aminophylline,
E bupivacaine
 Bupropion
S  butyrophenones
Alcohol consumption
Fever: febrile seizures
Recurring unpridictable seizures due to brain dysfunction
Idiopathic Brain Disorders
Systemic disorders  Brain injury
 Uremic encephlopathy  Brain abcess
 Hepatic encephlopathy  Brain tumor
 Electrolyte imbalances  Encephlitis
 Hypoglycemia  Eclampsia
Recreational drugs  Thiamine deficiency Cerebrovascular disease
 Amphitamine  Vitamin B12 deficiency  Intracranial bleeding
 Cocaine  Perinatal hypoxia
 Psilocybin  Ischemic stroke
 pcilocin
Flashing lights
Non- epileptic seizzures
Fainting spells due to stress or psychological conditions
Photosensitive epilepsy
Non-epileptic brain activity

Signs & Symptoms Diagnosis

FBC: ↑ TLC 9indicate infection provoking epilepsy)
Glucose: extreme hypoglycemia/ hyperglycemia
Electrolyte panel: electrolyte imbalance,
hyponatremia, hypernatremia, or uremia,
CT & MRI Brain: structural lesion
Toxicology scan: illicit drugs
EEG: generalized epileptiform activity or focal,
localizing abnormality
Serum creatine Kinase (CK): levels >200
mU/mL (>200 units/L) or sequential increase in levels
after 24 hours
Serum prolactin: > twice of baseline
 Treatment Differential Diagnosis
Barbiturate Phenobaribitone Psychogenic Non Epileptic Spells: normal Serum Prolactin
Cardiac arrhythmias: ECG indicate arrhythmias
Phenytoin
Hydantoin Transient Ischemic Attack (TIA): CT brain indicates vascular
Fosphenytoin
abnormalities in TIA.
Succinimide Ethosuxinmide Convulsive Syncope: a typical syncope is often position-
dependent and briefly preceded by light-headedness and
Deoxybarbitturate Primidone
Antiepileptic drugs

tunneling of vision
Carbaamezepine
Iminostilbene
Oxcarbazepine
Prognosis
50%
Aliphatic Carboxylic Valporic Acid 40%
Acid Divalproex 30%
20%
Phenyltriazine Lamotrigine 10%
0%
Cyclic GABA Gabapentin Excellent Good prognosis Poor prognosis
analogues Pregabalin prognosis (seizure (Remission) (Persistent
free) seizures)
Clonazepam
Diazepam
Complications
Benzodiazepine
Lorazepam
Clobazepam

Topiramate
Zonisamide
Newer Drugs
Vigabatrin
Tiagabine Injury Brain Damage Comatose Death

Surgical procedures for epilepsy Diet Therapies

1. Classic Ketogenic Diet
2. Medium Chain Triglyceride (MCT) Diet
3. Modified Atkins Diet (MAD)
4. Low Glycemic Index Treatment (LGIT)

Emerging Treatment
Topiramate Injections: for focal seizures & generalized tonic clonic seizures
Diazepam Nasal Spray: for 6 years old children & older with acute
intermittent stereotypic episodes of seizures
Cannabidiol: Oral solution for the treatment of seizures associated with
Lennox Gastaut Syndrome or Dravet Syndrome
Seizures Detection Devices: implantable devices able to detect & prevent
seizures
 Types of seizures

Seizures Sub-Types Cause Signs & Symptoms Treatment

Absence Unknown Sudden loss of awareness, Valporic acid,
Seizures responsiveness for sec- half ethosuximide
(Petite Mal) min, Blank stare, end abruptly
Simple febrile Trigger by High body temp. >38⁰C Anticonvulsants
Febrile Complex febrile fever Tonic phase→ Clonic phase→ Anti pyretics (Ibuprofen,
seizures Convulsions→ Postictal state acetaminophen)
Arm/ leg weakness
Focal aware seizures Localized brain Muscle jerk, twitch, unusual Lamotrigine,
Focal Focal impaired lesion sensations, piloerection, carbamazepine,
seizures awareness seizures dilation of pupil, impaired oxcarbazepine, surgical
consciousness, amnesia resection of tumor
Epileptic Associated Sudden brief involuntary jerk Clonazepam, valproate,
Non- epileptic with epileptic for 1-2 sec of facial /limb levetriacetam,
Myoclonic
syndromes muscles with preserved carbamazepine,
seizures consciousness oxcarbazepine,
pregabalin.
Convulsive Epilepsy Seizures resting for >5 min or Benzodiazepine,
Status Non-convulsive CVS disease, repeated without recovery phenytoin, valporic acid,
epilepticus alcohol, acute Tonic- clonic phase propofol, ketamine,
brain injury, Long lasting stupor, staring Oxygen, IV fluids