Seizure Disorder

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Seizure Disorder

  1. 1. An overview 5/7/2009 1 Sushant Satyal
  2. 2.        5/7/2009 2 Sushant Satyal
  3. 3.       5/7/2009 3 Sushant Satyal
  4. 4. Normal brain function requires  an orderly, organized, coordinate d discharge of electrical impulses. Electrical impulses enable the  brain to communicate with the spinal cord, nerves, and muscles as well as within itself. Seizures may result when the  brain's electrical activity is disrupted. 5/7/2009 4 Sushant Satyal
  5. 5. Classified as involving parts of the brain  Involving a small part of the brain: Focal  Involving the whole part of the brain: Generalized  Focal Seizures can be simple or complex  Also classified in terms of body affected  5/7/2009 5 Sushant Satyal
  6. 6. Whole body affected : Generalized  Small part or side of the body affected: Focal  Symptom may vary depending on what parts of brain  are involved. Some Seizures may hard to notice as they consist of  staring spells May cause loss of awareness and shaking of body  5/7/2009 6 Sushant Satyal
  7. 7. A sudden, involuntary, time-limited alteration in  behavior, motor activity, autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain. Seizure (medicine), sudden attack or spasm, as in epilepsy  or a similar disorder. Seizures differ with the type of condition and may consist of loss of consciousness, convulsive jerking of parts of the body, emotional explosions, or periods of mental confusion. 5/7/2009 7 Sushant Satyal
  8. 8. An electroencephalogram (an EEG) is a  recording of the brain's electrical activity. The procedure is simple and painless. About 20 small adhesive electrodes are placed on the scalp, and the brain's activity is recorded under normal conditions. Then the person is exposed to various stimuli, such as bright or flashing lights, to try to provoke a seizure. During a seizure, electrical activity in the brain accelerates, producing a jagged wave pattern. Such recordings of brain waves help identify a seizure disorder. Different types of seizures have different wave patterns. 5/7/2009 8 Sushant Satyal
  9. 9. Primary generalized seizure: A.  Begins with a widespread electrical discharge  Involves both sides of the brain at once  Hereditary factors are important Partial Seizure: B.  Begins with an electrical discharge in one limited area of the brain  Related to head injury, brain infection, stroke, or tumor 5/7/2009 9 Sushant Satyal
  10. 10. Types of Primary generalized seizure 1. Absence seizures: ▪ Brief episodes of staring ▪ Absence seizures are considered complex absence seizures ▪ Include a change in muscle activity 5/7/2009 10 Sushant Satyal
  11. 11. ▪ Most common movement are eye blinks ▪ Complex absence seizures are often more than 10 seconds long ▪ Usually begin between ages 4 and 14 ▪ no warning before a seizure, and the person is completely alert immediately afterward 5/7/2009 11 Sushant Satyal
  12. 12. ▪ Other movements include slight tasting movements of the mouth, hand movements such as rubbing the fingers together ,etc ▪ Children who get them usually have normal development and intelligence ▪ 70% of cases, absence seizures stop by age 18 5/7/2009 12 Sushant Satyal
  13. 13. 2. Atypical absence seizure: ▪ Atypical (a-TIP-i-kul) means unusual or not typical ▪ Person will stare but often is somewhat responsive ▪ Eye blinking or slight jerking movements of the lips may occur 5/7/2009 13 Sushant Satyal
  14. 14. ▪ Hard to distinguish from the person's usual behavior, especially in those with cognitive impairment ▪ Generally begins at the age of 6 ▪ Most of the children affected have below-average intelligence 5/7/2009 14 Sushant Satyal
  15. 15. ▪ Other types of seizures that are difficult to control ▪ Seizures usually continue till adulthood ▪ Daydreaming and inattentiveness can mimic these seizures ▪ Diagnosis can be difficult if the behavior during seizures is similar to the child's usual behavior 5/7/2009 15 Sushant Satyal
  16. 16. 3. Monoclonic seizures: ▪ Very brief jerks, last only for 2 to 3 sec ▪ seizures usually cause abnormal movements on both sides of the body at the same time ▪ Myoquot; means muscle and quot;clonusquot; (KLOH-nus) means rapidly alternating contraction and relaxation 5/7/2009 16 Sushant Satyal
  17. 17. ▪ Seizures usually begin in childhood, but the seizures can occur at any age ▪ Seizures occur in reflex epilepsies, triggered by flashing lights or other things in the environment ▪ Syndromes usually can be diagnosed on the basis of the medical history and often EEG patterns 5/7/2009 17 Sushant Satyal
  18. 18. 4. Atonic Seizures: ▪ Atonicquot; (a-TON-ik) means quot;without tone ▪ In an atonic seizure, muscles suddenly lose strength ▪ Eyelids may droop, the head may nod, and the person may drop things and often falls to the ground ▪ Also known as quot;drop attacksquot; or quot;drop seizures 5/7/2009 18 Sushant Satyal
  19. 19. ▪ The person usually remains conscious ▪ Another name for this type of seizure is “akinetic” ▪ (A-kin-ET-ik), which means quot;without movement“ ▪ Seizures often begin in childhood ▪ Often last into adulthood ▪ People with atonic seizures are injured when they fall 5/7/2009 19 Sushant Satyal
  20. 20. ▪ Seizures may cause people to fall when they're standing often have tonic seizures rather than atonic seizures ▪ Syndromes usually can be diagnosed on the basis of the medical history and often EEG patterns 5/7/2009 20 Sushant Satyal
  21. 21. 5. Tonic Seizures: ▪ Usually last less than 20 sec ▪ In such seizures, the tone is greatly increased and the body, arms, or legs make sudden stiffening movements ▪ Consciousness is usually preserved ▪ Seizures most often occur during sleep 5/7/2009 21 Sushant Satyal
  22. 22. ▪ Usually involve all or most of the brain, affecting both sides of the body ▪ Common in people who have the epilepsy syndrome called Lennox-Gastaut syndrome ▪ Seizures in Lennox-Gastaut syndrome may become more difficult to control over time 5/7/2009 22 Sushant Satyal
  23. 23. 6. Clonic seizures: ▪ Seizures consist of rhythmic jerking movements of the arms and legs ▪ Length vary according to the case ▪ Clonusquot; (KLOH-nus) means rapidly alternating contraction and relaxation of a muscle 5/7/2009 23 Sushant Satyal
  24. 24. ▪ Movements cannot be stopped by restraining or repositioning the arms or legs ▪ These seizures are rarely found ▪ Common are tonic-clonic seizures, in which the jerking is preceded by stiffening (the quot;tonicquot; part) 5/7/2009 24 Sushant Satyal
  25. 25. ▪ Sometimes tonic-clonic seizures start with jerking alone ▪ These are called clonic-tonic-clonic seizures ▪ Occur at various ages, including in newborns ▪ Brief and infrequent clonic seizures in infants usually disappear within very short period 5/7/2009 25 Sushant Satyal
  26. 26. ▪ Occasionally quot;jitterinessquot; in a young infant can be mistaken for a clonic seizure ▪ Children with neurological impairments with repetitive movements that could be mistaken for clonic seizures ▪ The EEG pattern will change during a seizure, so video- EEG is very useful for diagnosis 5/7/2009 26 Sushant Satyal
  27. 27. 7. Tonic-clonic seizures: ▪ Normally last for 2 to 3 min ▪ More than 5 min calls for immediate medical help ▪ Seizure that lasts more than 30 minutes indicate convulsion ▪ Person loses consciousness and falls to the floor 5/7/2009 27 Sushant Satyal
  28. 28. ▪ Tongue or cheek may be bitten, so bloody saliva may come from the mouth ▪ Person may turn a bit blue in the face ▪ After the tonic phase comes the clonic phase ▪ Arms and usually the legs begin to jerk rapidly and rhythmically 5/7/2009 28 Sushant Satyal
  29. 29. ▪ Bending and relaxing at the elbows, hips, and knees ▪ After a few minutes, the jerking slows and stops ▪ Bladder or bowel control sometimes is lost as the body relaxes ▪ Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed 5/7/2009 29 Sushant Satyal
  30. 30. ▪ They affect both children and adults ▪ Children who have had a single tonic-clonic seizure, the risk that they will have more seizures ▪ Some children will outgrow their epilepsy ▪ Tonic-clonic seizures can be controlled by seizure medicines 5/7/2009 30 Sushant Satyal
  31. 31. ▪ Patients who are seizure-free for a year or two while taking seizure medicine will stay seizure-free ▪ Medicine can be stopped gradually ▪ Patients with no epilepsy wave in EEG can stay free with any medication ▪ People who faint sometimes may develop tonic or clonic seizure 5/7/2009 31 Sushant Satyal
  32. 32. Types of Partial seizures 1. Simple partial seizures: ▪ Different from person to person, depending on the part of the brain where they begin ▪ One thing they all have in common is that the person remains alert and can remember what happens ▪ Usually last for less than 2 min 5/7/2009 32 Sushant Satyal
  33. 33. ▪ Doctors often divide simple partial seizures into categories depending on the type of symptoms the person experiences i. Motor seizures ii. Sensory seizures iii. Autonomic seizures iv. Psychic seizures ▪ Anyone can get these seizures ▪ People who have had a head injury, brain infection, stroke, or brain tumor likely to get them 5/7/2009 33 Sushant Satyal
  34. 34. ▪ These seizures often can be controlled by seizure medicines ▪ Medical disorders such as, stomach disorders or a pinched nerve can cause some similar symptoms ▪ Some symptoms (such as déja vu) are experienced by almost everyone at some time 5/7/2009 34 Sushant Satyal
  35. 35. 2. Complex Partial Seizures: ▪ Usually last between 30 seconds and 2 minutes ▪ Afterward, the person may be tired or confused for about 15 minutes and may not be fully normal for hours ▪ Seizures usually start in a small area of the temporal lobe or frontal lobe of the brain 5/7/2009 35 Sushant Satyal
  36. 36. ▪ Quickly involve other areas of the brain that affect alertness and awareness ▪ These seizures (usually ones beginning in the temporal lobe) start with a simple partial seizure ▪ Also called an aura, this warning seizure often includes an odd feeling in the stomach 5/7/2009 36 Sushant Satyal
  37. 37. ▪ Person loses awareness and stares blankly ▪ Most people move their mouth, pick at the air or their clothing, or perform other purposeless actions ▪ These movements are called quot;automatismsquot; ▪ Less often, people may repeat words or phrases, laugh, scream, or cry 5/7/2009 37 Sushant Satyal
  38. 38. ▪ Some people do things during these seizures that can be dangerous or embarrassing ▪ People need to take precautions in advance ▪ Complex partial seizures starting in the frontal lobe tend to be shorter than the ones from the temporal lobe ▪ Some complex partial seizures turn into secondarily generalized seizures 5/7/2009 38 Sushant Satyal
  39. 39. ▪ people who have had a head injury, brain infection, stroke, or brain tumor are more likely to get seizures ▪ If medication is not effective, some can be eliminated by epilepsy surgery ▪ Complex partial seizures sometimes resemble daydreaming or absence sezuires 5/7/2009 39 Sushant Satyal
  40. 40. Secondarily generalized seizures: 3. ▪ Start in one limited area of the brain ▪ Can also spread throughout the brain becoming generalized ▪ Convulsive phase of these seizures usually lasts no more than a few minutes ▪ Preceding partial seizure is usually not very long 5/7/2009 40 Sushant Satyal
  41. 41. ▪ Happen when a burst of electrical activity in a limited area (the partial seizure) spreads throughout the brain ▪ Seizures occur in more than 30% of people with partial epilepsy ▪ Can affect people of all ages who have partial seizures ▪ Seizures of this kind can be controlled with medication 5/7/2009 41 Sushant Satyal
  42. 42. ▪ Seizures of this kind can be controlled with medication ▪ If not controlled with medication, surgery is another option ▪ Easily diagnosed through EEG or MRI tests 5/7/2009 42 Sushant Satyal
  43. 43. 7% 7% 34% Simple partial 15% Other generalized Partial unknown Absence 17% Myoclonic 20% Unclassified 5/7/2009 43 Sushant Satyal
  44. 44. Change in consciousness, so that you can't remember  some period of time Change in emotion, like unexplainable  fear, panic, joy, or laughter Change in sensation of the skin, usually spreading  over the arm, leg, or trunk 5/7/2009 44 Sushant Satyal
  45. 45. Changes in vision, including flashing lights, or (rarely)  hallucinations (seeing things that aren't there) Loss of muscle control and falling, often very suddenly  Muscle movement such as twitching that might  spread up an arm or leg 5/7/2009 45 Sushant Satyal
  46. 46. Muscle movement such as twitching that might  spread up an arm or leg Muscle tension/tightening that causes twisting of the  body, head, arms or leg Tasting a bitter or metallic flavor  5/7/2009 46 Sushant Satyal
  47. 47. Beginning State:   This stage can be said as warning or aura  Sometimes an individual may not be aware of such aura  In middle stage this aura is followed by other symptoms  It may be considered as simple partial seizure Middle State:   People have aura in beginning, the aura may convert into convulsion  For those who don’t have aura, the seizure may continue as complex partial seizure 5/7/2009 47 Sushant Satyal
  48. 48. End state:   This state represents a transition from seizure back to normal state  Also referred as the “Post-ictal period”  Signifies recovery period of brain  May last from a second to minutes to hours 5/7/2009 48 Sushant Satyal
  49. 49.  If a person has a convulsion, the level of awareness gradually improves during the post-ictal period, much like a person waking up from anesthesia after an operation 5/7/2009 49 Sushant Satyal
  50. 50.  Emotional Early seizure symptoms:  ▪ Fear/Panic  Sensory/ thoughts ▪ Pleasant feeling ▪ Déjà vu  Physical ▪ Jamais vu ▪ ▪ Dizziness Smell ▪ Headache ▪ Sound ▪ Lightheadedness ▪ Taste ▪ Nausea ▪ Visual loss or blurring ▪ Numbness ▪ Racing thoughts  No Warnings ▪ Stomach feelings ▪ ▪ Sometimes seizures come with Strange feelings ▪ no warnings Tingling feeling 5/7/2009 50 Sushant Satyal
  51. 51.  Emotional: Middle Seizure Symptoms :  ▪ Fear/Panic  Sensory/ thoughts ▪ Black out  Physical: ▪ Confusion ▪ Chewing movements ▪ Deafness/Sounds ▪ Convulsion ▪ Electric Shock Feeling ▪ Eyes rolling up ▪ Loss of consciousness ▪ Falling down ▪ Smell ▪ Foot stomping ▪ Spacing out ▪ Hand waving ▪ Out of body experience ▪ Inability to move ▪ Visual loss or blurring 5/7/2009 51 Sushant Satyal
  52. 52. • Incontinence ▪ Staring ▪ Stiffening ▪ Swallowing ▪ Sweating ▪ Teeth clenching/grind ▪ Tongue biting ▪ Tremors ▪ Twitching movement ▪ Breathing difficulty ▪ Heart racing 5/7/2009 52 Sushant Satyal
  53. 53.  Physical Post-ical state:  ▪ Bruising  Thought ▪ Difficulty talking ▪ Memory loss ▪ Injuries ▪ Writing Difficulty ▪ Sleeping ▪ Exhaustion  Emotional ▪ Headache ▪ Confusion ▪ Nausea ▪ Depression and Sadness ▪ Pain ▪ ▪ Fear Thirst ▪ ▪ Frustration Weakness ▪ ▪ Urge to Shame/ Embarrassment urinate/defecate 5/7/2009 53 Sushant Satyal
  54. 54. Causes Examples •Heatstroke High fever •Infections •Abscess Brain infections •AIDS •Malaria •Meningitis •Rabies •Syphilis •Tetanus •Toxoplasmosis •Viral encephalitis 5/7/2009 54 Sushant Satyal
  55. 55. Causes Examples •High blood levels of sugar or sodium Metabolic disorders •Kidney or liver failure •Low blood levels of sugar, calcium, magnesium, or sodium •Underactive parathyroid gland •Vitamin B6 deficiency (in newborns) •Abnormal heart rhythms Inadequate oxygen supply to the brain •Carbon monoxide poisoning •Near drowning •Near suffocation •Stroke •Vasculiti 5/7/2009 55 Sushant Satyal
  56. 56. Causes Examples •Brain tumor Structural damage to the brain •Head injury •Hydrocephalus •Intracranial hemorrhage •Stroke •Birth defect Abnormalities present or occurring at •Hereditary metabolic disorders, such as birth Tay-Sachs disease or phenylketonuria •Injury during birth •Eclampsia luid accumulation in the brain (cerebral •Hypertensive encephalopathy edema) 5/7/2009 56 Sushant Satyal
  57. 57. Drug Use Possible side-effects Acetazolamide Absence seizures when Kidney stones and other anticonvulsants are chemical imbalance in ineffective blood Carbamazepine Generalized seizures A low white blood cell Partial seizures count (granulocytopenia), production of too few blood cells (aplastic anemia, which can be fatal disorder), a low platelet count (thrombocytopenia), digestive upset, inability to articulate words, lethargy, dizziness, and visual disturbances 5/7/2009 57 Sushant Satyal
  58. 58. Drugs Uses Possible side-effects Clonazepam Atonic seizures Atypical Drowsiness, abnormal absence seizures behavior, loss of Infantile spasms coordination, and lost Myo clonic seizures effectiveness of the drug after 1 to 6 months Divalproex Absence seizures Nausea, vomiting, Febrile seizures abdominal pain, diarrhea, Generalized tonic-clonic temporary drowsiness, seizures dizziness, shaking Infantile spasms (tremor), reversible hair Juvenile myoclonic loss, weight gain, and liver epilepsy damage Myoclonic seizures 5/7/2009 58 Sushant Satyal
  59. 59. Drugs Uses Possible side-effects Ethosuximide Absence seizures Nausea, lethargy, dizziness, a low white blood cell count and a low red blood cell count Felbamate Atypical absence seizures, Headache, fatigue, liver Partial seizures failure, and, rarely, aplastic anemia (which can be fatal) Fosphenytoin Status Epilepticus Loss of coordination, drowsiness, headache, rash, and tingling sensations 5/7/2009 59 Sushant Satyal
  60. 60. Drugs Uses Possible side-effects Gabapentin Partial seizures Drowsiness, dizziness, weight gain, and headache In children, aggressive behavior, mood swings, and hyperactivity Lamotrigine Generalized seizures Nausea, vomiting, Partial seizures indigestion, headache, drowsiness, dizziness, insomnia, fatigue, loss of coordination, double vision, tremor, rash, and abnormal menstrual periods 5/7/2009 60 Sushant Satyal
  61. 61. Drugs Uses Possible side-effects Levetiracetam Juvenile myoclonic Dizziness, weakness, epilepsy fatigue, loss of Myoclonic seizures coordination, changes in Partial seizures mood and behavior, and increased risk of infection Oxcarbazepine Partial seizures Headache, abdominal pain, double vision, drowsiness, dizziness, fatigue, nausea, low sodium levels in the blood, and a low white blood cell count 5/7/2009 61 Sushant Satyal
  62. 62. Drugs Uses Possible side-effects Topiramate Atypical absence seizures Confusion, reduced Partial seizures concentration, difficulty Primarily generalized finding words, fatigue, loss tonic-clonic seizures of appetite and weight, numbness or tingling, reduced sweating, and kidney stones Valproate Absence seizures Nausea, vomiting, Febrile seizures abdominal pain, diarrhea, Generalized tonic-clonic weight gain, reversible hair seizures loss, temporary Infantile spasms drowsiness, shaking Juvenile myoclonic (tremor), and, rarely, liver epilepsy damage 5/7/2009 62 Sushant Satyal
  63. 63. Stay with the person until recovery or you have  professional medical help Monitor pulse ,rate of breathing, and blood pressure  Do not give the person anything by mouth until  convulsions have stopped and the person is fully awake and alert 5/7/2009 63 Sushant Satyal
  64. 64. Do not move the person unless he or she is in danger  or near something hazardous Do not place anything including your fingers between  the person’s teeth. You can break person’s teeth, if you do so. 5/7/2009 64 Sushant Satyal
  65. 65. The doctor will perform a physical examination and ask questions to help understand the cause of the seizures, such as: Are there any risk factors ( such as recent head  injury)? Did it occur or start on one side of the body?  Did the person remain awake and aware during  seizure? How long the seizure last?  5/7/2009 65 Sushant Satyal
  66. 66. How often do the seizures happen?  Was there any aura of the seizures?  Were there any other symptoms present (visual  changes, abnormal smells)? 5/7/2009 66 Sushant Satyal
  67. 67. The following tests may be performed: Blood tests  Ct scan or MRI of the brain   EEG  Lumbar puncture 5/7/2009 67 Sushant Satyal
  68. 68. People with uncontrolled seizures should not drive.  Drinking should be avoided  Medicines should be taken regularly  Avoid activities such as climbing to high  places, biking, and swimming Use of sharp instruments such as knife should be avoided  5/7/2009 68 Sushant Satyal
  69. 69. Seizure is life threatening disease  No specific way to prevent seizures  But it is curable if instruction are followed  Good habits may help to control seizures  5/7/2009 69 Sushant Satyal
  70. 70. Sleep deprivation, and poor diet must be avoided  Good sleep habits, stress reduction, proper  exercise, and sound nutrition may help Use helmets to avoid head injury  Have faith in yourself, and seizure is curable!!  5/7/2009 70 Sushant Satyal
  71. 71. 5/7/2009 71 Sushant Satyal

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