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.

1. SEIZURE DISORDER
Dr. Sasmita Devi

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. CONVULSION :
Motor manifestation of seizure.
EPILEPSY :
- Recurent seizure unrelated to fever
or
to an acute Cerebral insult .

4. Classifications
According to etiology.
• Primary/ Idiopathic ( etiology not identified)-85%.
• Secondary (with identified etiology) –15%.
According to type.
• Generalized.
• Focal/ partial.
• Unclassified.

5. ETIOLOGY
PERINATAL :
• Cerebral malformation.
• I.U.STORCH Infection.
• HIE*.
• Trauma
• Intra ventricular Hemorrhage *
* Common causes of convulsion.

6. INFECTIONS
• 1. Encephalitis.*
• 2. Meningitis.*
• 3. Brain Abscess.

7. METABOLIC CONDITIONS
1. Hypoglycemia.*
2. Hypocalcemia.*
3. Hypomagnesemia.
4. Hypo / Hypernatremia.*
5. Reye Syndrome.
6. Pyridoxine dependancy. 7. IEM

8. • NEUROCUTANEOUS SYNDROME
1. Tuberous sclerosis.
2. Neurofibromatosis.
3. Struge Weber Syndrome.
• NEURO DEGENERATIVE DISEASE

9. Tuberus sclerosis
Sturge weber syndrome
Neurofibromatosis

10. SYSTEMIC DISORDER
1. Vasculitis.
2. SLE.
3. Hypertensive Encephalopathy.*
4. Renal failure.
5. Hepatic Encephalopathy.

11. OTHERS
1. Trauma.*
2. Febrile convulsion.*
3. Idiopathic.*
4. Tumor.
5. Familial.
6. Drug withdrawl—AED. 7. Alcohol withdrawl.

12. International classification of
epilepsy (ILAE)
1.PARTIAL SEIZURE (focal/ localized) .
2. GENERALIZED SEIZURE .
3. UNCLASSIFIED .

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. 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. PARTIAL EPILEPSY :
• 1. Benign Rolandic Epilepsy :
-Benign childhood Epilepsy with centro temporal
spike (BCECTS).
• 2. Occipital Epilepsy:

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. • 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. 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. 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. • 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. ETIOLOGY OF PARTIAL SEIZURE
1. Inflammatory Granuloma.
2. ICSOL.
3. Head Trauma.
4. Atrophic lesion.
5. Birth Asphyxia.

22. II. GENERALIZED SEIZURE
• Onset in both hemisphere.
• B/L synchronus discharge.
• Symmetrical seizure.
• Loss of conciousness.

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. • 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. ATYPICAL / COMPLEX ABSENCE SEIZURE:
• Myoclonic movement of—
-Face.
- Finger.
- Extremities.
• Occasionally associated with loss of body tone.

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. 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. 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. 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. 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. 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. • Occurs in :
- Drowsy state.
- Immidiately after getting up.
• EEG : Hypsarrythmia.
- high voltage, bilaterally asynchronous, slow wave
activity.

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