EPILEPSY

OBJECTIVES
 At the end of the lecture, students will be
able to :
 Differentiate between convulsions and
seizures
 Understand the disease pathology, etiology
classification or types of epilepsy
 Learn and debate on Epidemiology, societal
dogma/myths, diagnostic approach and
mechanisms of the disease with an overview
of treatments available
CONVULSION
 A convulsion is a medical condition
where body muscles contract and relax
rapidly and repeatedly. Violent
involuntary contractions of skeletal
muscles

 Because a convulsion is often a symptom

of an epileptic seizure, the term
convulsion is sometimes used as a
synonym for seizure.

 Convulsions may also be referred to as

"fits" commonly
SEIZURES
 A sudden convulsion due to temporary
disruption in electrical activity of brain
paroxysmal & transient in nature is referred
as SEIZURE; -- a symptom of epilepsy.
 characterized by Abnormal/uncontrollable
body movements, sense of unusual smell
and tastes, loss of consciousness
MECHANISM OF SEIZURES

 Seizures are finite episodes of brain

dysfunction resulting from abnormal
discharge of cerebral neurons.
 A seizure occurs when a burst of electrical
impulses in the brain escape their normal
limits.
 They spread to neighboring areas and
create an uncontrolled storm of electrical
activity.
 The electrical impulses can be transmitted
to the muscles, causing twitches or
convulsions.
WHAT IS EPILEPSY ?
Epilepsy is a group of chronic neurological diseases
characterized by recurrent, seizures.
EPILEPSY
 It is characterized by paroxysmal, transient
excessive neuronal defects in cerebral
cortical areas leading to episodic impairment
of neurological activity. Then loss of
consciousness may occur resulting in
abnormal motor activity. Hence, causing
sensory defects and alterations of ANS
 Epilepsy is the tendency to have
seizures But not all people who appear to
have seizures have epilepsy.
 Epilepsy is usually diagnosed only after a
person has had more than one seizure.
STATUS EPILEPTICUS
 Fatal medical emergency which requires
urgent hospitalization and effective
treatment.

 State of continuous or repeated epileptic

seizures lasting more than 5 minutes.

 Consciousness is not regained in between

the attacks.
 DIAGNOSIS
 Electroencephalogram (EEG):
An EEG, is a test that can help diagnose epilepsy.
During an EEG, the electrical signals of the brain
are recorded. This electrical activity is detected
by electrodes, or sensors, placed on the patient's
scalp and transmitted to a polygraph that records
the activity.
 Other tests, as needed, including:
 Magnetic resonance spectroscopy (MRS),
 Positron emission tomography (PET) and
 Single photon emission computed tomography
WHAT ARE THE SYMPTOMS OF EPILEPSY?

Because epilepsy is caused by abnormal

activity in brain cells, seizures can affect
any process your brain coordinates.
Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of
the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms
CAUSES OF EPILEPSY
 Low oxygen during birth,
 Head injuries that occur during birth or from
accidents during youth or adulthood,
 Brain Tumors,
 Genetic conditions that result in brain injury,
such as tuberous sclerosis,
 Infections such as meningitis or encephalitis,
 Stroke or any other type of damage to the
brain, abnormal levels of substances such as
sodium or blood sugar.
 In up to 70% of all case of epilepsy in adults
and children, no cause can ever be
discovered.

MECHANISM OF EPILEPSY
 High-frequency bursts of action potentials,
Hypersynchronization.
 The bursting activity is caused by a relatively
long-lasting depolarization of the neuronal
membrane due to influx of extracellular
calcium (Ca2+), which leads to the opening of
voltage-dependent sodium (Na+) channels,
influx of Na+, and generation of repetitive
action potentials.
 The synchronized bursts from a sufficient
number of neurons result in a so-called spike
discharge on the EEG.
TYPES OF EPILEPSY SEIZURES

 I.Partial Seizures
 II. Generalized Seizures
 III.Secondarily Generalized Seizures
When epileptic discharges
arise from one part of the
cortex & remain limited
there without spreading to
any other area, clinically
result in ‘focal’ signs /
symptoms. Such seizures
are called

PARTIAL SEIZURES
When epileptic discharges
arise from the midline/deeper
structures, they spreads to all
parts of the cortex at the
same
time & produce synchronous,
symmetrical signs/symptoms.
Such seizures are called

GENERALIZED
SEIZURES
In some, epileptic
discharges
arise from one part & then
spread to rest of the cortex.
Clinically this results in a
progression of signs /
symptoms from one part of
the body to another;
initially
limited the one side & then
involving the other. Such
seizures are called

SECONDARILY
GENERALIZED
SEIZURES
TYPES OF PARTIAL SEIZURES
SIMPLE PARTIAL SEIZURES:
 Patients retain awareness.
 Without loss of consciousness.

COMPLEX PARTIAL SEIZURES:

 Patients lost awareness.
 With loss of consciousness.
 Staring in to space.
 Automatisms may result.
 Automatisms consist of involuntary but
coordinated movements that tend to be
purposeless and repetitive.
 Common automatisms include lip
smacking, chewing, and walking.
TYPES OF GENERALIZED
SEIZURES
There are six types of generalized seizures.
1. Grand-mal seizure: In this type of seizure,
the patient loses consciousness and usually
collapses. The loss of consciousness is followed
by generalized body stiffening (called the
"tonic" phase of the seizure) for 30 to 60
seconds, then by violent jerking (the "clonic"
phase) for 30 to 60 seconds, after which the
patient goes into a deep sleep (the "postictal"
or after-seizure phase). During grand-mal
seizures, injuries and accidents may occur,
such as tongue biting and urinary incontinence.
2. Absence seizures: cause a short loss of
consciousness (just a few seconds) with few
or no symptoms. The patient, most often a
child, typically interrupts an activity and
stares blankly. These seizures begin and end
abruptly and may occur several times a day.
Patients are usually not aware that they are
having a seizure, except that they may be
aware of "losing time."
3. Myoclonic seizures: consist of sporadic
jerks, usually on both sides of the body.
Patients sometimes describe the jerks as
brief electrical shocks. When violent, these
seizures may result in dropping or
involuntarily throwing objects.
4. Clonic seizures: are repetitive, rhythmic
jerks that involve both sides of the body at
the same time.
5. Tonic seizures: are characterized by
stiffening of the muscles.
6. Atonic seizures: consist of a sudden and
general loss of muscle tone, particularly in
the arms and legs, which often results in a
fall.
WHAT ARE THE additional CAUSES
OF EPILEPSY?
Anything that interrupts the normal
connections between nerve cells in
the Brain can cause a seizure.
• High fever.
• Low blood sugar.
• Alcohol or drug withdrawal.
• Brain concussion.
Focal seizures with secondary
generalised tonic clonic seizures:
Carbamazepine ,Lamotrigine ,
Oxcarbazepine

Lennox-Gastaut syndrome (seizures

related to):
Lamotrigine , Topiramate

Myoclonic seizures:
Clonazepam , Ethosuximide ,
Phenobarbital , Phenytoin , Primidone ,
Sodium valproate
Tonic seizures:
Phenobarbital , Phenytoin , Primidone ,
Sodium valproate

Tonic clonic seizures:

Carbamazepine , Clonazepam ,
Lamotrigine, Phenobarbital , Phenytoin,
Primidone, Sodium valproate, Topiramate
Absence seizure:
Clonazepam, Ethosuximide , Lamotrigine , Sodium valproate

Atonic seizures:
Phenobarbital , Phenytoin , Primidone , Sodium valproate

Focal (partial) seizures:

Carbamazepine , Clonazepam , Gabapentin , Lamotrigine , Levetiracetam ,
Oxcarbazepine , Phenobarbital , Phenytoin , Pregabalin , Primidone ,
Retigabine , Sodium valproate , Tiagabine , Topiramate , Vigabatrin ,
Zonisamide

Focal (partial) seizures with secondary generalisation:

Gabapentin , Phenobarbital , Phenytoin , Pregabalin , Primidone ,
Retigabine, Sodium valproate , Tiagabine , Topiramate , Vigabatrin ,
Zonisamide
REFERENCES
 Pharmacology Review, Lippincott’s
 Basic and clinical Pharmacology, Bertarm G
Katzung, latest edition
 1. DO WE NEED FIRST AID FOR
EPILEPTIC PATIENTS?
SAIMA MAHMOOD MALHI1, DR.FARINA HANIF2, TAYYABA
NAEEM3, QURATULAIN MOHAMMEDI1, REMSHA SALEEM1,
SEHRISH KHAN1, MUSTAFA RASHEED1

1
Dow College of Pharmacy, Faculty of Pharmaceutical Sciences, Dow
University of Health Sciences, OJHA Campus, Karachi, PAKISTAN.
2
Departemnt of Biochemistry, Dow International Medical College, Dow
University of Health Sciences, OJHA Campus, Karachi, PAKISTAN.
3
Sindh Institute of Urology and Translplant (SIUT), Saddar, Karachi,
PAKISTAN.

Presented at 6th DICE-

DUHS HEALTH Exhibition
on 30th December, 2021
venue: DUHS OJHA
Campus.
 EPILEPSY: A MYTH OR REALITY!
 SAIMA MAHMOOD MALHI1, SHABANA USMAN SIMJEE2,
ERUM FAREED1, AREESHA ALI1, SAMAR IQBAL1, MANAL
AHMED1
DOW COLLEGE OF PHARMACY, FACULTY OF PHARMACEUTICAL SCIENCES, DOW

UNIVERSITY OF HEALTH SCIENCES OJHA CAMPUS KARACHI, PAKISTAN

HEJ RESEARCH INSTITUTE OF CHEMISTRY, INTERNATIONAL CENTER FOR

CHEMICAL & BIOLOGICAL SCIENCES, UNIVERSITY OF KARACHI, KARACHI,

PAKISTAN.
Presented at AEIRC
(Advanced Educational
Institute and Research
Centre, Karachi University
on 5th Jan, 2022.
venue: ICCBS