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Seizure and Epilepsi
Seizure and Epilepsi
MBBS IV Group C
Tutor: Prof. V. Wong
16th Feb 2004
Outline
Definitions
Pathophysiology
Aetiology
Classification
Video demonstration
Diagnostic approach
Treatment
Quiz
Definition
Seizure (Convulsion)
• Clinical manifestation of synchronised
electrical discharges of neurons
Epilepsy
• Present when 2 or more unprovoked
seizures occur at an interval greater than 24
hours apart
Definition
Provoked seizures
Seizuresinduced by somatic disorders
originating outside the brain
E.g. fever, infection, syncope, head trauma,
hypoxia, toxins, cardiac arrhythmias
Definition
Epileptic
Idiopathic (70-80%)
Cerebral tumor
Neurodegenerative disorders
Neurocutaneous syndromes
Secondary to
Cerebral damage: e.g. congenital infections,
HIE, intraventricular hemorrhage
Cerebral dysgenesis/malformation: e.g.
hydrocephalus
Aetiology of seizures
Non-epileptic
Febrile convulsions
Metabolic
Hypoglycemia
HypoCa, HypoMg, HyperNa, HypoNa
Head trauma
Meningitis
Encephalitis
Poisons/toxins
Aetiology of Status Epilepticus
Prolonged febrile seizure
Most common cause
Idiopathic status epilepticus
Non-compliance to anti-convulsants
Sudden withdrawal of anticonvulsants
Sleep deprivation
Intercurrent infection
Symptomatic status epilepticus
Anoxic encephalopathy
Encephalitis, meningitis
Congenital malformations of the brain
Electrolyte disturbances, drug/lead intoxication,
extreme hyperpyrexia, brain tumor
Pathophysiology
Still
unknown
Some proposals:
Excitatory glutamatergic synapses
Excitatory amino acid neurotransmitter
(glutamate, aspartate)
Abnormal tissues — tumor, AVM, dead area
Genetic factors
Genetic factors
Atleast 20 %
Some examples
Benign neonatal convulsions--20q and 8q
Juvenile myoclonic epilepsy--6p
Partial Generalized
– Electrical discharges in a – Diffuse abnormal
relatively small group of electrical discharges
dysfunctional neurones in from both
one cerebral hemisphere hemispheres
– Aura may reflect site of – Symmetrically
origin involved
– + / - LOC – No warning
– Always LOC
Partial Seizures
Blank stare
Lennox-Gastaut syndrome
Characterized by seizure, mental retardation and
psychomotor slowing
Three main type:
1. tonic
2. atonic
3. atypical absence
Investigations
History
Event
Localization
Temporal relationship
Factors
Nature
Associated features
Past medical history
Developmental history
Drug and immunization history
Family history
Social history
Physical Examination
General
esp. syndromal or non-syndromal
dysmorphic features, neurocutaneous
features
Neurological
Other system as indicated
E.g. Febrile convulsion, infantile spasm
Investigations
I. Exclusion of differentials:
Bedside: urinalysis
Haematological: CBP
Toxicological: screen
Microbiological: LP
Seizure
Reassurance and
Anticonvulsant Surgery Education
Education & Support
Information leaflets and information
about support group
Avoidance of hazardous physical
activities
Management of prolonged fits
Recovery position
Rectal diazepam
Side effects of anticonvulsants
Anticonvulsants
Suppress repetitive action potentials in
epileptic foci in the brain
Sodium channel blockade
GABA-related targets
Tonic-clonic and partial Absence seizures Myoclonic seizures Status Epilepticus Infantile Spasms
Diazepam Phenytoin
Lorazepam Phenobarbital
Adverse Effects
Teratogenicity
Neural tube defects
Fetal hydantoin syndrome
Overdosage toxicity
Life-threatening toxicity
Hepatotoxicity
Stevens-Johnson syndrome
Abrupt withdrawal
Medical Intractability
No known universal definition
Risk factors
High seizure frequency
Early seizure onset
Palliative
Vagal nerve stimulation
Surgical Outcome
Medical Intractability
A well-localised epileptogenic zone
EEG, MRI
Low risk of new post-operative deficits
References
1. Stedman’s Medical Dictionary.
2. MDConsult: Nelson’s textbook.
3. Illustrated Textbook of Pediatrics.
4. Video atlas of epileptic seizures – Classical
examples, International League against
epilepsy.
5. Guberman AH, Bruni J, 1999, Essentials of
Clinical Epilepsy, 2nd edn. Butterworth
Heinemann.
6. Manford M, 2003, Practical Guide to Epilepsy,
Butterworth Heinemann.