SEIZURE DISORDER
Dr. Sasmita Devi
SEIZURE
DEFINITION :
It is defined as abnormal ,paroxysmal, excessive,
involuntary neurological discharge from the brain
w...
CONVULSION :
Motor manifestation of seizure.
EPILEPSY :
- Recurent seizure unrelated to fever
or
to an acute Cerebral insu...
Classifications
According to etiology.
• Primary/ Idiopathic ( etiology not identified)-85%.
• Secondary (with identified ...
ETIOLOGY
PERINATAL :
• Cerebral malformation.
• I.U.STORCH Infection.
• HIE*.
• Trauma
• Intra ventricular Hemorrhage *
* ...
INFECTIONS
• 1. Encephalitis.*
• 2. Meningitis.*
• 3. Brain Abscess.
METABOLIC CONDITIONS
1. Hypoglycemia.*
2. Hypocalcemia.*
3. Hypomagnesemia.
4. Hypo / Hypernatremia.*
5. Reye Syndrome.
6....
• NEUROCUTANEOUS SYNDROME
1. Tuberous sclerosis.
2. Neurofibromatosis.
3. Struge Weber Syndrome.
• NEURO DEGENERATIVE DISE...
Tuberus sclerosis
Sturge weber syndrome
Neurofibromatosis
SYSTEMIC DISORDER
1. Vasculitis.
2. SLE.
3. Hypertensive Encephalopathy.*
4. Renal failure.
5. Hepatic Encephalopathy.
OTHERS
1. Trauma.*
2. Febrile convulsion.*
3. Idiopathic.*
4. Tumor.
5. Familial.
6. Drug withdrawl—AED. 7. Alcohol withdr...
International classification of
epilepsy (ILAE)
1.PARTIAL SEIZURE (focal/ localized) .
2. GENERALIZED SEIZURE .
3. UNCLASS...
I. PARTIAL:
a) Simple Partial.
b) Complex Partial.
c) simple partial with
secondary generalization.
II. GENERALIZED : Typi...
SYNDROME ASSOCIATED WITH
EPILEPSY :
GENERALIZED EPILEPSY :
1. WEST SYNDROME:- Infantile Spasm.
2. Lenox- Gastaut SYNDROME:...
PARTIAL EPILEPSY :
• 1. Benign Rolandic Epilepsy :
-Benign childhood Epilepsy with centro temporal
spike (BCECTS).
• 2. Oc...
PARTIAL SEIZURE ( 40 - 60%).
Onset in one of the cerebral Hemisphere.
• SIMPLE PARTIAL SEIZURE ( SPS) :
• Begin in a small...
• Last for 10—20 seconds.
• No post ictal Phenomenon.
• When SPS spread from one part of the body to another
according to ...
TYPES
1. MOTOR :
- Hemibody or Hemifacial twitching.
2. SENSORY :
- Tingling sensation.
- Sensation of cold, Burning.
- Sp...
COMPLEX PARTIAL SEIZURE
( CPS)
• Temporal lobe seizure.
• Impaired conciousness.
• Conciousness impaired -
- at bigining o...
• Convulsions.
• Last for 1—2 min.
• EEG—interictal sharp waves or focal or
multifocal spikes (usually originating from
te...
ETIOLOGY OF PARTIAL SEIZURE
1. Inflammatory Granuloma.
2. ICSOL.
3. Head Trauma.
4. Atrophic lesion.
5. Birth Asphyxia.
II. GENERALIZED SEIZURE
• Onset in both hemisphere.
• B/L synchronus discharge.
• Symmetrical seizure.
• Loss of conciousn...
ABSENCE SEIZURE
TYPES: 1. Typical.( PETIT MAL)
2. Atypical.
TYPICAL :
• Age: 4—10 years. Sex- Female (common)
• No Aura, n...
• Sudden cessation of motor activity or Speech.
• Blank facial expression / starring look.
• Eye blinking , lip smacking ....
ATYPICAL / COMPLEX ABSENCE SEIZURE:
• Myoclonic movement of—
-Face.
- Finger.
- Extremities.
• Occasionally associated wit...
GENERALIZED TONIC CLONIC
(Grand mal )
• Most frequent type of seizure seen in children.
• It has 4 phase.
• I: Aura.
• II:...
Phase I - Aura :
presence of aura indicates the focus of origin.
Phase II. Tonic phase ( few sec—min )
• Skeletal musscles...
III CLONIC PHASE :
• Rhythmical contraction of muscle groups.
• For few min.
• Stool & urine incontinence.
IV POST ICTAL P...
TONIC SEIZURE :
• Generalized increased in muscle tone.
ATONIC SEIZURE :
• Often combined with myoclonic jerks.
• Sudden l...
MYOCLONIC SEIZURE.
• Quick , brief, paroxysmal often repetative Jerky
movement of limbs , Neck , Trunks.
• Loss of body to...
INFANTILE SPASM
(Salam seizure)
• Age of onset : 4—8 month.
• Characterized by brief contraction of neck , trunk,
extremit...
• Occurs in :
- Drowsy state.
- Immidiately after getting up.
• EEG : Hypsarrythmia.
- high voltage, bilaterally asynchron...
Idiopathic
Normal
develpoment
before onset
Secondary
Secondary to
TS, TORCH
absent corpus
callosum
Cryptogenic
Delayed
dev...
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Seizure i

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DEFINITION :
It is defined as abnormal ,paroxysmal, excessive, involuntary neurological discharge from the brain which may be manifested as –

Loss of Conciousness,
Abnormal- Motor
- Sensory ,
- Behavioral disturbance
- and Autonomic dysfunction.

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Seizure i

  1. 1. SEIZURE DISORDER Dr. Sasmita Devi
  2. 2. SEIZURE DEFINITION : It is defined as abnormal ,paroxysmal, excessive, involuntary neurological discharge from the brain which may be manifested as – Loss of Conciousness, Abnormal- Motor - Sensory , - Behavioral disturbance - and Autonomic dysfunction.
  3. 3. CONVULSION : Motor manifestation of seizure. EPILEPSY : - Recurent seizure unrelated to fever or to an acute Cerebral insult .
  4. 4. Classifications According to etiology. • Primary/ Idiopathic ( etiology not identified)-85%. • Secondary (with identified etiology) –15%. According to type. • Generalized. • Focal/ partial. • Unclassified.
  5. 5. ETIOLOGY PERINATAL : • Cerebral malformation. • I.U.STORCH Infection. • HIE*. • Trauma • Intra ventricular Hemorrhage * * Common causes of convulsion.
  6. 6. INFECTIONS • 1. Encephalitis.* • 2. Meningitis.* • 3. Brain Abscess.
  7. 7. METABOLIC CONDITIONS 1. Hypoglycemia.* 2. Hypocalcemia.* 3. Hypomagnesemia. 4. Hypo / Hypernatremia.* 5. Reye Syndrome. 6. Pyridoxine dependancy. 7. IEM
  8. 8. • NEUROCUTANEOUS SYNDROME 1. Tuberous sclerosis. 2. Neurofibromatosis. 3. Struge Weber Syndrome. • NEURO DEGENERATIVE DISEASE
  9. 9. Tuberus sclerosis Sturge weber syndrome Neurofibromatosis
  10. 10. SYSTEMIC DISORDER 1. Vasculitis. 2. SLE. 3. Hypertensive Encephalopathy.* 4. Renal failure. 5. Hepatic Encephalopathy.
  11. 11. OTHERS 1. Trauma.* 2. Febrile convulsion.* 3. Idiopathic.* 4. Tumor. 5. Familial. 6. Drug withdrawl—AED. 7. Alcohol withdrawl.
  12. 12. International classification of epilepsy (ILAE) 1.PARTIAL SEIZURE (focal/ localized) . 2. GENERALIZED SEIZURE . 3. UNCLASSIFIED .
  13. 13. I. PARTIAL: a) Simple Partial. b) Complex Partial. c) simple partial with secondary generalization. II. GENERALIZED : Typical 1. Absence ( petit mal) Atypical. 2. Tonic clonic. ( Grand mal) 3. Tonic 4. Clonic 5. Myoclonic. 6. Atonic. 7. infantile spasm.
  14. 14. SYNDROME ASSOCIATED WITH EPILEPSY : GENERALIZED EPILEPSY : 1. WEST SYNDROME:- Infantile Spasm. 2. Lenox- Gastaut SYNDROME:- Benign Myoclonic Epilepsy. 3. JANJ Syndrome : Juvenile Myoclonic Epilepsy. 4. LANDAU—KLEFFNER Syndrome: Febrile convulsion.
  15. 15. PARTIAL EPILEPSY : • 1. Benign Rolandic Epilepsy : -Benign childhood Epilepsy with centro temporal spike (BCECTS). • 2. Occipital Epilepsy:
  16. 16. PARTIAL SEIZURE ( 40 - 60%). Onset in one of the cerebral Hemisphere. • SIMPLE PARTIAL SEIZURE ( SPS) : • Begin in a small group of dysfunctional neuron. • Conciousness remains intact, may talk during seizure. • Patient experience deja’ vu’/ Aura which reflets site of origin. Eg- abdominal pain, thoracic pain.
  17. 17. • Last for 10—20 seconds. • No post ictal Phenomenon. • When SPS spread from one part of the body to another according to the representation in Precentral gyrus is Called JACKSONIAN MARCH. • EEG –Spikes or sharp waves, unilaterally or bilaterally or a multifocal spike pattern.
  18. 18. TYPES 1. MOTOR : - Hemibody or Hemifacial twitching. 2. SENSORY : - Tingling sensation. - Sensation of cold, Burning. - Special sensation – (visual, auditory, gustatory, somatosensory). 3. AUTONOMIC. 4. PSYCHIC: Feeling of fear, dizziness.
  19. 19. COMPLEX PARTIAL SEIZURE ( CPS) • Temporal lobe seizure. • Impaired conciousness. • Conciousness impaired - - at bigining or - SPS followed by loss of conciousness. • Usually presents with Motor Automatism(50—75%) : - - Lip smacking. - Chewing, Swallowing. - Running , Walking, picking or pulling at bed sheet. - Hallucinations/ strange sensations.
  20. 20. • Convulsions. • Last for 1—2 min. • EEG—interictal sharp waves or focal or multifocal spikes (usually originating from temporal lobe). • CT/ MRI to detect temporal lobe lesion.
  21. 21. ETIOLOGY OF PARTIAL SEIZURE 1. Inflammatory Granuloma. 2. ICSOL. 3. Head Trauma. 4. Atrophic lesion. 5. Birth Asphyxia.
  22. 22. II. GENERALIZED SEIZURE • Onset in both hemisphere. • B/L synchronus discharge. • Symmetrical seizure. • Loss of conciousness.
  23. 23. ABSENCE SEIZURE TYPES: 1. Typical.( PETIT MAL) 2. Atypical. TYPICAL : • Age: 4—10 years. Sex- Female (common) • No Aura, no post ictal phase. • Transient loss of Conciousness ( 2—10 sec). • With abrupt onset and Termination.
  24. 24. • Sudden cessation of motor activity or Speech. • Blank facial expression / starring look. • Eye blinking , lip smacking . • Rare before 4 years. • Hyperventillation for 3—4 min. induce Absence seizure due to alkalosis.
  25. 25. ATYPICAL / COMPLEX ABSENCE SEIZURE: • Myoclonic movement of— -Face. - Finger. - Extremities. • Occasionally associated with loss of body tone.
  26. 26. GENERALIZED TONIC CLONIC (Grand mal ) • Most frequent type of seizure seen in children. • It has 4 phase. • I: Aura. • II: Tonic phase. • III : Clonic phase. • IV : Post ictal phase.
  27. 27. Phase I - Aura : presence of aura indicates the focus of origin. Phase II. Tonic phase ( few sec—min ) • Skeletal musscles under goes sustained spasm. • May fall on the ground and sustain injury. • Upward rolling of eye ball. • apnea & Cyanosis. • Frothing form mouth, tongue bite.
  28. 28. III CLONIC PHASE : • Rhythmical contraction of muscle groups. • For few min. • Stool & urine incontinence. IV POST ICTAL PHASE : • Child may complain of Head ache, Confusion. • Transient paresis (Todd’s palsy). • Prolonged deep sleep for several hours. • Rarely personality change , loss of bladder & Bowel
  29. 29. TONIC SEIZURE : • Generalized increased in muscle tone. ATONIC SEIZURE : • Often combined with myoclonic jerks. • Sudden loss of body tone leading to sudden fall on floor Or drop of head.
  30. 30. MYOCLONIC SEIZURE. • Quick , brief, paroxysmal often repetative Jerky movement of limbs , Neck , Trunks. • Loss of body tone & falling forward. • Sustains injury. • Usually idiopathic (genetic) or sec. to HIE. • Mental retardation is common.
  31. 31. INFANTILE SPASM (Salam seizure) • Age of onset : 4—8 month. • Characterized by brief contraction of neck , trunk, extremities, multiple attack/day. • Occurs mainly due to underlying brain disease. • TYPES: 3 types • 1. Flexor. 2. Extensor. 3. Mixed.
  32. 32. • Occurs in : - Drowsy state. - Immidiately after getting up. • EEG : Hypsarrythmia. - high voltage, bilaterally asynchronous, slow wave activity.
  33. 33. Idiopathic Normal develpoment before onset Secondary Secondary to TS, TORCH absent corpus callosum Cryptogenic Delayed development before onset -ve family hist Normal invesigations. Good response +ve family hist Poor response -ve family hist. Good response
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