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Epilepsy

Epilepsy is characterized by recurrent seizures caused by abnormal electrical activity in the brain. Seizures can be either focal, originating in one area of the brain, or generalized, spreading across both hemispheres. Diagnosis involves determining if events are true seizures, the seizure type, and potential triggers. Tests like EEG, CT, MRI are used. Treatment aims to control seizures with anti-epileptic drugs like carbamazepine, sodium valproate, lamotrigine tailored to the seizure type. Women require counseling on teratogenic risks and contraception options.

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AliMalik
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409 views21 pages

Epilepsy

Epilepsy is characterized by recurrent seizures caused by abnormal electrical activity in the brain. Seizures can be either focal, originating in one area of the brain, or generalized, spreading across both hemispheres. Diagnosis involves determining if events are true seizures, the seizure type, and potential triggers. Tests like EEG, CT, MRI are used. Treatment aims to control seizures with anti-epileptic drugs like carbamazepine, sodium valproate, lamotrigine tailored to the seizure type. Women require counseling on teratogenic risks and contraception options.

Uploaded by

AliMalik
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
  • Definition: Defines epilepsy, its characteristics and related terminology such as convulsions.
  • Elements of a Seizure: Describes the stages and manifestations of a seizure including prodrome and aura.
  • Causes: Explains the various causes of epilepsy including idiopathic and structural factors.
  • Risk Factors: Discusses population risk statistics and conditions increasing epilepsy risk.
  • Seizure Development: Details the development process of seizures and the diagnostic criteria.
  • Seizure Classification: Classifies seizures into types such as partial and generalized seizures.
  • Primary Generalised Seizures: Explains primary generalized seizures with examples like absence seizures.
  • Myoclonic and Atonic Seizures: Describes specific types of seizures, focusing on myoclonic and atonic seizures.
  • Localising Features of Partial Seizures: Discusses the localization in the brain of partial seizures and their symptoms.
  • Diagnosis: Outlines key diagnostic questions and identifies potential triggers for seizures.
  • Tests and Examinations: Lists medical tests for diagnosing epilepsy, including MRI and EEG.
  • Management: Details management strategies for different types of seizures.
  • Drugs and Dosages: Provides dosage information and side effects for anti-epileptic drugs.
  • Sodium Valproate: Discusses specifics on sodium valproate dosage and side effects.
  • Phenytoin: Explores Phenytoin usage, including its administration and side effects.
  • Diazepam: Describes Diazepam usage and its applications in seizure treatment.
  • Others: Lists other anti-epileptic drugs beyond the main ones discussed.
  • Women with Epilepsy: Addresses specific considerations for women with epilepsy, including medication and pregnancy advice.

Kavneel Chand

20130101
Definition
• Epilepsy is the recurrent tendency to spontaneous,
intermittent, abnormal electrical activity in part of
the brain, manifesting as seizures.
• Convulsions are the motor signs of electrical
discharges.
Elements of a seizure
• A prodrome lasting hours or days may rarely
precede the seizure
• An aura is part of the seizure of which the patient is
aware, and may precede its other manifestations.
• Post- ictally there may be headache, confusion,
myalgia, and a sore tongue; or temporary weakness
after a focal seizure in motor cortex or dysphasia
following a focal seizure in the temporal lobe.
Causes
• 2/3 are idiopathic

• Structural :cortical scarring, developmental, space-


occupying lesion, hippocampal sclerosis, vascular
malformations.
• Non epileptic causes of seizures: trauma, stroke,
haemorrhage, increased ICP, alcohol or
benzodiazepine withdrawal, liver disease, infection,
and drugs.
• About 3 out of 10 children with autism spectrum
disorder may also have seizures.
• In people over 65, stroke is the most common cause
of new onset seizures.
RISK FACTORS
• About 1% of the general population develops
epilepsy.
• The risk is higher in people with certain medical
conditions.
• Mental retardation
• Cerebral palsy
• Alzheimer's disease
• Stroke
Seizure development
 Imbalance between excitatory and inhibitory
neuronal activity.
 Causes bursts of high frequency abnormal
discharge.
 Abnormal discharge may remain local (focal
seizure) or spread to adjacent areas
(generalized seizure)
•it is only when attacks are recurrent that a
diagnosis of epilepsy should be made.
•A person is typically diagnosed as having
epilepsy after experiencing two or more
seizures.
6
Seizure Classification
• Partial seizures: focal onset, with features referable
to one part of the hemisphere.
• Simple partial: awareness is unimpaired, with focal
motor, sensory autonomic or psychic symptoms.
• Complex partial seizures: awareness is impaired.
Most commonly arise from the temporal lobe. Post
ictal confusion is common.
• Partial seizure with secondary generalization:
Electrical disturbance starting focally, then
spreading widely, causing a secondary generalized
seizure.
Primary generalised seizures
• Absences: Brief (<10s) pauses, eg suddenly stops
talking in midsentence, then carries on where left
off. Presents in childhood.
• Tonic-clonic. Sudden onset, loss of consciousness,
limbs stiffen (tonic) then jerk (clonic); may have one
without the other. Presence of post-ictal confusion
and drowsiness.
• Myoclonic seizures: sudden jerk of a limb, face or
trunk (eg thrown suddenly to ground, or a violently
disobedient limb.
• Atonic or Akinetic seizures: sudden loss of muscle
tone causing a fall, no LOC.
• Infantile spasms: commonly associated with
tuberous sclerosis.
Localising features of partial(focal)
seizures
• Temporal lobe
automatisms: complex motor phenomenon, but
with impaired awareness afterwards varying from
primitive oral or manual to complex actions.
Abdominal rising sensation or pain
Dysphasia
Memory phenomena( déjà vu and jamais vu)
Hippocampal involvement may cause emotional
disturbance
Uncal involvement may cause hallucinations
Delusional behaviour.
• Frontal lobe
• Motor features such as posturing , versive
movements of the head and eyes, or peddling
movements of the legs.
• Jacksonian march
• Motor rest
• Subtle behavioural disturbances
• Dysphasia or speech arrest
• Posy-ictal todds palsy
• Parietal lobe
• Sensory disturbances- tingling, numbness, pain
• Motor symptoms
• Occipital lobe
• Visual phenomena such as spots, lines or flashes.
DIAGNOSIS

Three key questions:

1. Are these real seizures?

2.What type of seizures is it, partial or


generalised?
3.Are there trigger factors? E.g.
alcohol, stress, etc.
Tests and examinations
• Neurological examination
• Blood tests
• Electroencephalogram (EEG).
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Functional MRI (fMRI)
• Positron emission tomography (PET)
• Neuropsychological tests
Management
• Generalised tonic-clonic seizures: sodium valproate
or lamotrigine- 1st line then carbamazepine or
topiramate.
• Absence seizures: sodium valproate, lamotrigine,
ethosuximide.
• Tonic atonic and myoclinic seizures: same for
generalised but avoid carbamazepine.
• Partial seizure +/- secondary generalisation:
carbamazepine- 1st line then sodium valproate,
lamotrigine and others.
Drugs and dosages
• Carbamazepine:
• Start with 100mg/12h PO; maximum dose: 800-
1000mg/12h. A slow-release form is available,
which is useful if intermittent side-effects
experienced when dose peaks. Toxic effects: rash,
nausea, diplopia, dizziness, fluid retention,
hyponatraemia, blood dyscrasias.
Sodium valproate
• initially 300mg/ 12h, increase by 100mg/12hr every 3
days up to max 30mg/kg( 2.5) daily.
• Valproate side effects
• Vomiting
• Alopecia, increase in appetite.
• Liver toxicity
• Pancreatitis/ Pancytopenia
• Retention of fats (weight gain)
• Oedema (peripheral oedema)
• Anorexia, ataxia
• Tremor, teratogenicity, thrombocytopenia
• Enzyme inhibition, encephalopathy( due to
hyperammonaemia)
Phenytoin
• Used in status eplileticus
• Dose of 10-15 mg/kg
• Maintenance 100mg IV q6-8hr PRN.
• When administering IV administer it slowly; not to
exceed 50mg/min.
• Anti-convulsant
• 100mg PO TID
• Maintenance 300-400mg/day increase to 600
mg/day if necessary.
• Toxicity : nystagmus, diplopia, tremor, dysarthria,
ataxia
• Side effects: decrease intellectual, depression, coarse
facial features, acne, gum hypertrophy,
polyneuropathy, blood dyscrasias.
Diazepam
• Seizure disorder
• 2-10mg PO q6hr as adjunct, or
• 0.2mg/kg PR, repeat after 4-12 hrs PRN.
• Status epilepticus
• 5-10 mg IV/IM Q5-10 mins; not to exceed 3omg or
• 0.5 mg /kg PR (using parenteral solution), then 0.25
mg/kg in 10 mins PRN.
Others
• Ethosuximide
• Magnesium sulphate
• Midazolam
• Phenobarbitone
• Primidone
• Lamotrigine
• Levetiracetam
• vigabatrin
Women with epilepsy
• Teratogenicity of AEDs : women of child- bearing
age should take folic acid 5mg/day. Valproate in
particular should be avoided.
• Pre- conception counselling is vital
• Breastfeeding: most AEDs except carbamazepine
and valproate are present in breastmilk.
• The pill: non enzyme inducing AEDs have no effect
on the pill. With other AEDs ≥ 50 ūg of estrogen
may be needed.

Kavneel Chand 20130101
Definition •Epilepsy is the recurrent tendency to spontaneous, intermittent, abnormal electrical activity in part of the
Elements of a seizure •A prodrome lasting hours or days may rarely precede the seizure •An aura is part of the seizure of wh
Causes •2/3 are idiopathic •Structural :cortical scarring, developmental, space- occupying lesion, hippocampal sclerosis, vas
RISK FACTORS •About 1% of the general population develops epilepsy. •The risk is higher in people with certain medical cond
Seizure development Imbalance between excitatory and inhibitory neuronal activity. Causes bursts of high frequency abnorma
Seizure Classification •Partial seizures: focal onset, with features referable to one part of the hemisphere. •Simple partia
Primary generalised seizures •Absences: Brief (<10s) pauses, eg suddenly stops talking in midsentence, then carries on where
•Myoclonic seizures: sudden jerk of a limb, face or trunk (eg thrown suddenly to ground, or a violently disobedient limb. •
Localising features of partial(focal) seizures •Temporal lobe automatisms: complex motor phenomenon, but with impaired awa

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