Seizures & Epilepsy, chapt. #1: Diagnosis, at a glance, for beginners

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di-request adek2 Dokter Muda buat nentir ttg kejang, so, yang singkat n praktis2 aja dalam diagnosis kejang.. (sambil bertanya-tanya, ujian bakal kayak apa ya?)
met belajar!^^v

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  • Seizures & Epilepsy, chapt. #1: Diagnosis, at a glance, for beginners

    1. 1. Seizure & Epilepsy Ersifa Fatimah, dr. PPDS-1 Neurologi FK UNAIR – RS Dr Soetomo Surabaya, 2013 Chapter #1: Diagnosis
    2. 2. 1st-thing First Chief complaint “Seizure” Non- seizure Seizure Pseudo / Non-epileptic True / Epileptic Non-epilepsy Epilepsy
    3. 3. Hints Non-seizure Seizure: gejala menghebat, paroxysmal Epileptic/True-seizure listrik, sinkron, ritmis EEG (+) Non-epileptic/ Pseudo-seizure Epilepsi: Unprovoked Non-Epilepsi
    4. 4. Systemic Disturbances • Metabolic, Endocrine • Syncope Neurologic Disturbances • Migraine, Vertigo • Cerebrovascular disorder • Sleep disorder • Myoclonus • Movement disorder Psychiatric Disturbance • PNES • Episodic dyscontrol • Discociative disorder • Panic disorder • OCD • Psychoses Engel & Pedley, Epilepsy: A Comprehensive Textbook, 2nd Ed, 2008 Disorders That Can Be Confused with Epilepsy 4Ersifa's
    5. 5. ATTACK FEATURE PSYCHOGENIC SEIZURE EPILEPTIC SEIZURE Stereotypy of attack May be variable Usually stereotypical Duration May be prolonged Brief Diurnal variation Daytime Nocturnal or daytime Injury Rare Can occur with tonic- clonic seizures Tongue biting Rare Can occur with tonic- clonic seizures Ictal eye closure Common Rare (eyes generally open) Urinary incontinence Rare Frequent Motor activity Prolonged, uncoordinated; pelvic thrusting Automatisms or coordinated tonic- clonic activity Prolonged loss of muscle tone Common Rare Postictal confusion Rare Common Postictal crying Common Rare Relation to medication changes Unrelated Usually related Triggers Emotional disturbances No Interictal EEG findings Normal Frequently abnormal Reproduction of attack by suggestion Sometimes No Ictal EEG findings Normal Abnormal Presence of secondary gain Common Uncommon Psychiatric disturbances Common Uncommon Bradley: Neurology in Clinical Practice, 5th ed 5Ersifa's
    6. 6. Epileptic Seizure • Manifestasi klinik – tiba-tiba – sementara – perubahan perilaku stereotipik – gangguan kesadaran / motorik / sensorik/ otonomik/ psikik • Aktivitas listrik otak abnormal-berlebihan sekelompok neuron Epilepsi • Bangkitan epileptik • Berulang • Selang >24 jam • Tanpa provokasi Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
    7. 7. Status Epileptikus • Kejang > 30 menit (mulai terapi: 5 menit) • Kejang >= 2x, diantara kejang px tidak sadar Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012 Sindrom Epilepsi • Tipe bangkitan • Etiologi • Anatomi • Faktor presipitasi • Usia onset • Severitas • Kronisitas • Siklus diurnal / sikardian • Prognosis • Klasifikasi sindrom ILAE 1989 Serial Seizure: Diantara 2 kejang px sadar
    8. 8. 5 Axes of Epilepsy Diagnosis 1. Ictal phenomenology 2. Seizure type 3. Syndrome 4. Etiology 5. Impairment
    9. 9. Ictal Phenomenology pre - durante - post Kondisi saat bangkitan Duduk, berdiri, berbaring, tidur berkemih Gejala awitan Aura, gerakan/ sensasi awal Apa yg tampak selama bangkitan Bentuk bangkitan, lidah tergigit, inkontinensia, deviasi mata, pucat, berkeringat Kondisi setelah kejadian Bingung, terjaga, nyeri kepala, tidur, gaduh gelisah, Todd’s Faktor pencetus Alkohol, kurang tidur, hormonal, dll Pola bangkitan lain/perubahan Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
    10. 10. Adams & Victor’s Principles in Neurology, 8th ed, 2005
    11. 11. Seizure Type ILAE 1981 Bradley, Neurology in Clinical practice, 2010
    12. 12. Adams & Victor’s Principles in Neurology, 8th ed, 2005
    13. 13. Syndrome ILAE 1989 (Bradley, Neurology in Clinical Practice, 2010)
    14. 14. Etiologi Idiopatik Lesi struktural otak (-) Defisit neurologik (-) Predisposisi genetik Berkaitan dengan usia Kriptogenik (dianggap) simtomatik Penyebab belum diketahui Klinis ~ ensefalopati difus ~Sindrom epilepsi Simtomatik Kelainan/ lesi struktural otak Causa: “CEMENTED” Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
    15. 15. Adams & Victor’s Principles in Neurology, 8th ed, 2005
    16. 16. Adams & Victor’s Principles in Neurology, 8th ed, 2005
    17. 17. “Unprovoked” vs “Symptomatic Epilepsy” Kapan “Acute symptomatic seizure” menjadi “Epilepsi” ?
    18. 18. Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
    19. 19. Beleza P Acute Symptomatic Seizures A Clinically Oriented Review The Neurologist Volume 18, Number 3, May 2012
    20. 20. General rules Seizure in the setting of two causes where one cause would classify the seizure as acute symptomatic If a person has preexisting epilepsy, a seizure that meets criteria for acute symptomatic will still be so classified. Cerebrovascular disease, cerebral hypoxia Within 7 days onset TBI, intracranial surgery Within 7 days onset CNS infections Beyond 7 days, ~ clinical & lab findings Multipe sclerosis Within 7 days of relapse Metabolic Blood sample within 24 h of seizure Alcohol Within 7-48 h of last drink Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
    21. 21. Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
    22. 22. “Kenapa saya kejang, sedangkan kamu tidak kejang?” Beghi et al, Recommendation for a definition of acute symptomatic seizure. Epilepsia,51(4):671–675,2010
    23. 23. Impairment Classification: WHO ICDH-2
    24. 24. Anamnesis Kejang Gejala sebelum, selama, sesudah bangkitan Riwayat penyakit saat ini yang mungkin menjadi penyebab Usia onset, durasi, frekuensi, interval terpanjang Riwayat epilepsi dalam keluarga Riwayat keluarga dengan penyakit neurologik lain/ psikiatrik/ sistemik Riwayat saat dalam kandungan/ kelahiran/ tumbuh kembang Riwayat bangkitan neonatal/ kejang demam Riwayat trauma kepala/ infeksi SSP, dll Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
    25. 25. Pemeriksaan Fisik • Umum • Neurologik
    26. 26. Pemeriksaan Penunjang EEG • CT-scan • MRI • PET, SPECT, MRS Neuroimaging • Hb, WBC, Hct, Plt, HDT • Na, K, Ca, Mg • Glu • RFT • LFT • (LP) • (Toksikologi) • Kadar OAE Laboratoris Pedoman Tatalaksana Epilepsi, PERDOSSI, 2012
    27. 27. Seizure & Epilepsy At a Glance Chapter #1.5: Patofisiologi
    28. 28. Hipotesis Secondary epileptogenesis Kindling
    29. 29. Gangguan Membran Neuron Kalium Natrium Perubahan permeabilitas & potensial membranNormal Intrasel Buku Ajar Ilmu Penyakit Saraf, FK Unair, 2011
    30. 30. Imbalance! Inhibisi Eksitasi Buku Ajar Ilmu Penyakit Saraf, FK Unair, 2011
    31. 31. Disfungsi Sel Glia • Mengatur fungsi konsentrasi ion Kalium ekstrasel di sekitar neuron & terminal presinaps Buku Ajar Ilmu Penyakit Saraf, FK Unair, 2011
    32. 32. ..to be continued.

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