• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Epilepsy
 

Epilepsy

on

  • 231 views

 

Statistics

Views

Total Views
231
Views on SlideShare
231
Embed Views
0

Actions

Likes
0
Downloads
10
Comments
0

0 Embeds 0

No embeds

Accessibility

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Epilepsy Epilepsy Presentation Transcript

    • If you are on right path and you are not facing difficulties… then think for a while: you may be on wrong path…because right path always contains difficulties. HAZRAT ALI R.A
    • DR. ARSHAD RABBANI
    • CASE 1  A young girl of age 10 is brough to medical OPD with c/o deteriorating performance in her studies. According to her teacher, she stops doing her work & seems to have day-dreaming. This happens at home too. No h/o loss of consciousness or any altered mental status.  What may be the possible cause?
    • CASE 2  A 40 yrs old gentleman is brought to ER with h/o GTCF.patient is drowsy. there is h/o low grade fever, cough & anorexia for last 1 month. CXR is shown. Give your diagnosis.
    • His CT brain is shown
    • CASE 3  A 35 years old lady is brought to ER with c/o left sided weakness. Pt is slightly confused & shows features of left UMN lesion. There is history of epilepsy for which she takes medicine continuously.her weakness recovered within 6 hrs. give your diagnosis.
    • Case 4  A 67 yrs old man is brought to ER with H/O focal fits in right arm. There is h/o some neurosurgical procedure 14 yrs back. Pt remained well since then.  What may be the cause?
    • CASE 5  A 34 yrs old gentleman with history of epilepsy for last 15 yrs, on regular treatment presents with c/o multiple swellings over his body. No h/o fever, anorexia or weight loss. o/E there is generalised lymphadenopathy.  What rare possibility comes to your mind?
    • CASE 6 A 34 yrs old lady comes to gynaecology OPD with bad obstetric history. There is h/o 2 abortions & 1 baby with cleft palate. She is also an epileptic and takes medicine irregularly/  What advice should be given to her? 
    • CASE 7  A 13 yrs old boy is brought to ER with c/o GTCF at home about 30 min back. In ER again he has an episode of GTCF. He is given INJ DIAZEPAM 10mg IV. The boy is mentally retarded. Examination reveals small white oval lesions on skin. There is family history of epilepsy.  What condition comes to your mind?
    • CASE 8  A 65 yrs old gentleman is brought to OPD with c/o abnormal movements of right hand. According to patient, this problem aggravates when he attempts to write or perform some skilled work .his uncle also had similar problem. No other finding in history and examination.  What may be the cause?
    • CASE 9  A 45 yr old diabetic is brought to OPD with 2 days history of difficulty in walking and inability to hold the objects. O /E:  Pt is conscious oriented  There are intention tremors on right side  Patient falls to right side when asked to walk.  What is your diagnosis?
    • CASE 10 A young girl of age 17 is brought to hospital with c/o difficulty in walking and increasing clumsiness of hands for last 6 months. o/e a young girl with rapid involuntary movements of both hands. She has a broad-based gait. eye examination reveals a characteristic lesion. What is your impression?
    • DEFINITION  Epilepsy is a tendency to have recurrent seizures. It is a symptom of brain disease rather than a disease itself.  A seizure is any clinical event caused by abnormal electrical discharge in the brain.
    • Seizures types
    • ETIOLOGY
    • Incidence according to age
    •  PRIMARY GENERALISED EPILEPSY  SECONDARY GENERALISED EPILEPSY  PARTIAL EPILEPSY
    • 1) 2) 3) 4) It has four types: Childhood absence epilepsy Juvenile absence epilepsy Juvenile myoclonic epilepsy GTCS on awakening
    • PRIMARY GENERALISED EPILEPSY  Onset mostly in childhood or adolescence  Mostly due to genetic predisposition without a structural cause  It comprises upto 10% of all epilepsies and upto 40% of tonic clonic seizures.
    • It may be caused by:  Spread of partial seizures due to structural disease OR  May be secondary to drugs or metabolic disorders.  Epilepsy presenting in adult life is almost always secondarily generelised.
    • CAUSES OF SECONDARY GENERALISED EPILEPSY  secondary  Inflammatory: generalisation from partial seizures Multiple sclerosis  Genetic SLE  Cerebral birth injury  Metabolic:  Alcohol Hypocalcemia  Toxins Hyponatremia  Infective: Hypoglycemia meningitis Renal failure Postinfectious Liver failure encephalopathy  Drugs  Degenerative disease
    • FOCAL LESIONS IN BRAIN CAUSING EPILEPSY
    • DRUGS CAUSING SEIZURES  Penicillin, isoniazid , metronidazole  Chloroquine, mefloquine  Ciclosporin  Lidocaine, disopyramide  Amphetamines (withdrawal)  Psychotropic agents: phenothiazines, tricyclic antidepressants lithium
    • 1: IDIOPATHIC 2: FOCAL STRUCTURAL LESIONS:  Genetic: Tuberous sclerosis Neurofibromatosis  CVA  Trauma  tumours  Infective: Cerebral abscess Toxoplasmosis Tuberculoma Subdural empyema Encephalitis  Inflammatory: Sarcoidosis vasculitis
    •  Sleep deprivation  Alcohol withdrawal  Physical & mental exhaustion  Recreational drug misuse  Intercurrent infections  Metabolic disorders  Flickering lights including TV & computer  Loud noise, music, hot bath, reading (uncommon)
    •  EEG  CT scan brain  MRI  TESTS FOR SECONDARY CAUSES:  RFTs, LFTs , blood glucose, s electrolytes  CXR  CP, ESR, CRP,  CSF examination
    • IMMEDIATE CARE  FIRST AID BY RELATIVES  IMMEDIATE MEDICAL ATTENTION: ENSURE PATENT AIRWAY GIVE OXYGEN GIVE IV ANTICONVULSANT TAKE BLOOD FOR DRUG LEVELS INVESTIGATE THE CAUSE
    • ANTICONVULSANT DRUGS  Carbamazepine  Sodium valproate  diazepam  Clonazepam  Phenytoin  phenobarbitone  Topiramate  Gabapentin  Lamotrigine  ethosuximide
    • Guidelines for anticonvulsant therapy  Start with one first-line drug.  Start with low dose & increase to effective dose.  If first drug fails, start second drug while gradually withdrawing first.  Try three agents singly before using combination.  Don’t use more than 2 drugs at a time.
    • Withdrawal of AEDs  After complete control of seizures for 2-4 yrs, consider AED withdrawal.  Childhood epilepsy carries the best prognosis for successful drug withdrawal.  Seizures that begin in adult life particularly those with partial features are likely to recur esp if there is underlying structural cause.  Overall recurrence rate after withdrawal is 40%  Withdrawal should be gradual over 6-12 months.
    • Status epilepticus exists when a series of seizures occur without the patient regaining awareness between attacks over a period of 30 minutes.
    • MANAGEMENT  GENERAL CARE  IV line  Diazepam 10mg IV or rectally, can be repeated once OR lorazepam 4mg IV  If seizures continue after 30 minutes : IV infusion phenytoin or phenobarbital  If seizures still continue after 30 -60 min: Intubation & ventilation  Once status controlled: Commence longterm anticonvulsant medication
    • EPILEPSY OUTCOME AFTER 20 YRS  50% seizure free without drugs for last 5 years  20% seizure-free for last 5 years but continue to take medication  30% seizures continue inspite of anti-epileptic therapy