The word “EPILEPSY” comes from the Greek word
meaning “to seize”.
An epileptic seizure is a transient paroxysm of
uncontrolled discharges of neurons causing an event
that is discernible by the person experiencing the
seizure and / or observer. The tendency to have
recurrent attacks is known as epilepsy.
A patient with epilepsy will show recurrent epileptic
seizures that occur unexpectedly and stop
spontaneously.
Produced by abnormal discharges of neurons that may
be caused by any pathological process that affects the
brain.
1.Primary or acquired neurological disorders-
Alzheimer’s disease, Brain tumor,head trauma.Febrile
seizures of childhood.
2.Systemic or metabolic disorders:electrolyte
imbalance,Eclampsia,Alcohol abuse and withdrawal.
Cerebrovascular disease( both ischemic and
hemorrhagic stroke)
Neurodegenerative disorders
CNS infections
Sleep disturbances, sensory stimuli, emotional stress
Hormonal changes
Alcohol abuse
Antipsychotics, anti depressants, street drug use.
Brain tumour
Repetitive hypersynchronous discharges of neurons,
either localised in an area of cerebral cortex or
generalized throughout the cortex.
Neurons are interconnected in a complex network in
which each individual neuron is linked through
synapses with hundreds of others.
Neurons electric current synapse
neurotransmitter release inhibitory/ excitatory
communication with another neuron
A normal neuron discharges repetitively at a low
baseline frequency.
Damage , injury or chemical/mechanical insult
change in discharge pattern
burst of high frequency discharges usually
followed by periods of inactivity.
It is only when a whole population of neurons
discharges synchronously in an abnormal way, epilepsy
is triggered.
The area from which the abnormal discharge
originates is known as epileptic focus.
Abnormality of K conductance, defect in voltage
sensitive ion channels or deficiency in membrane
ATPase linked to ion transport may result in neuronal
membrane instability and a seizure.
Neurotransmitters ( Ach, NE,glutamate aspartate,
histamine, steroid hormones, purines, peptides)
enhance excitability and propogation of neuronal
activity, whereas GABA and dopamine inhibit
neuronal activity
A relative deficiency of inhibitory or increase in
excitatory neurotransmitters would promote abnormal
activity.
During a seizure , there is a large increase in demand
for blood flow to the brain to carry off CO2 and to
bring substrates for neuronal metabolic activity. Brain
has limited capacity to increase blood flow , leads to
ischemia , neuronal destruction, brain damage.
1. Partial seizures ( seizures begun locally)
a. simple ( without impairment of consciousness)
b. complex ( with impairment of consciousness)
c. secondarily generalised ( partial onset evolving to
generalised tonic clonic)
2. Generalized seizures ( bilaterally symmetrical and
without local onset)
a. Absence seizures
b. Myoclonic seizures
c. Tonic clonic seizures
d. Atonic seizures
3. Unclassified seizures
4. Status epilepticus
Generalised seizures
impairment of consciouness from the onset
o Tonic clonic seizures / Grandmal
- common type
-without warning, patient goes stiff,falls and
convulses, laboured breathing and salivation
-cyanosis, incontinence,tongue biting
- convulsion ceases after a few min, followed by
drowsiness, confusion, headache and sleep.
o Absence / petitmal
- rare
- childhood and early adolescence
- child goes blank and stares, fluttering of eyelids,
flopping of head.
-last only for few seconds and go unrecognised even by
the child.
o Atonic seizures
- sudden lose of muscle tone, head drop,dropping of
limb, person collapse to ground
- recovery is quick.
- rare form
o Myoclonic seizures
- abrupt, brief involuntary shock like jerks, which may
involve whole body, or arms or head.
- usually happen in morning, shortly after waking
- cause the person to fall, but recovery is immediate.
partial seizures
o Simple partial seizures
- no loss of consciousness
- localized jerking of limbs or face, stiffness/ twitching,
numbness, abnormal sensations
o Complex partial seizures
- altered behavior : plucking clothes, fiddling with
other objects, acting in confused manner
- lip smacking/ chewing movements, grimacing,
performing aimless activities, wandering around in
drunken fashion.
o Secondarily generalized seizures
- convulsive attack with same characteristics as GTC.
- only EEG can demonstrate partial nature of the
seizure.
Careful and accurate patient history.
Other conditions ( syncope, transient ischemic attacks)
should be ruled out.
Must only be diagnosed when seizures occur
spontaneously and are recurrent.
EEG is only examination required and aim to record
abnormal neuronal changes. It records voltage
fluctuations from scalp electrodes placed in specific
location of head.
Ambulatory EEG allows recording in day to day
circumstances using a small cassette recorder.
EEG video telemetry is useful in assessment of difficult
cases, particularly if surgery is required. Video
cameras are used to record seizures as they occur.
Characteristics of persons behaviour during a seizure
can help to find focus.
Neuroimaging with MRI , when stroke, tumour,
hydrocephalus are suspected.
MRI should be carried out in anyone presenting with
partial seizures or where a structural lesion on the brain
may be responsible for seizures.
Magnetic Resonance Spectroscopy: same
equipment as MRI, but uses different software that can
measure the chemical components of brain tissue.
Positron Emission Tomography : scanning
technique that measures cellular activity in brain and
other organs, providing information of organ function.
Areas of decreased usage of glucose may point to
seizure focus.
Neuropsychological testing : this test can help to
pinpoint the location of seizure focus by identifying
the areas of decreased brain function. Repeated after
surgery to see if there is any change in mental
functioning
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