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HISTORY : Description about seizure activity. …

HISTORY : Description about seizure activity.
Age of Onset.

Duration.

Focal / Generalized.

Loss of conciousness, associated features .

H/o previous attack.

H/O Trauma, Drug ingestion.


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  • 1. DIAGNOSIS : HISTORY : Description about seizure activity. • Age of Onset. • Duration. • Focal / Generalized. • Loss of conciousness, associated features . • H/o previous attack.
  • 2. • Meningitis , encephalitis. • Precipitating factor (fever, viral illness, diarrhoea). • Frequency. • Time of day –early morning ,in drowsy state  childhood epilepsy. • Detail treatment hist, response to treatment. • Prolonged personality change or intellectual deterioration, regression of milestone –neurogenerative disorder. • Family history. • Developmental history.
  • 3. PHYSICAL EXAMINATION : • Head Cicumference & Fontanale. • Facial abnormality. • Sign of degenerative, Metabolic and Congenital disease. • Hepatosplenomegaly –storage disease. • Neurocutaneous marker. Skin rash –Meningitis, Sepsis.
  • 4. • CVS— H.R , BP , Peripheral perfusion. • RESPIRATORY : Cyanosis, Irregular breathing. • CNS : • Pupil . Fundus --Papilledema. • Cranial Nerves. • Sign of meningeal irritation.↑ ICP. • Sensory , Motor system examination.
  • 5. INVESTIGATIONS : EEG : Support diagnosis. Confirm diagnosis. Classification type. Locate the epileptic focus. • A normal EEG does not R/o epilepsy. • Abnormal EEG always not indicates Epilepsy. • If standard EEG normal -- • sleep/ sleep deprived EEG. • 24 hrs Ambulatory EEG. • Vediotelemetry.
  • 6. EEG It is a record of the underlying neuronal activity of brain. • What are normal brain waves? • β wave (fast ) >13Hz/sec --alert state. • α wave (intermediate) 8—13Hz/sec –quite awareness. • Theta wave (slow) 4—7 Hz/sec –drowsiness. • δ wave (slower) <4Hz/sec –deep sleep. • α Activity seen is normally seen in children.
  • 7. • Depression of normal activity. • Slow waves. • Spikes. • Spikes & waves. • Sharp waves.
  • 8. BLOOD EXAMINATION : • Serum electrolytes. • Serum Ca+ , Mg +. Blood sugar. • CBC, Septic work up Including LP. • RFT , LFT. • Toxicological screening. OTHERS : CT / USG/ MRI.
  • 9. DIFFERENTIAL DIAGNOSIS : 1.BREATH HOLDING SPELL : • Age group — 6month — 2years. - rarely upto 5 years. • Precipitated by Fear , Frustration , Anger & Anxeity. • Cry vigorously  holds breath apnea  cyanosis  LOC  Convulsion. • But in seizure , convulsion  cyanosis.
  • 10. 2.REFLEX ANOXIC SEIZURE: • Age group : Toddler. • Precipitated by : Pain, Discomfort, Fright, cold food , Head trauma. • Severe pain stop breathing  Hypoxia  Pale  convulsion  rapid recovery. • This episode occurs due to cardiac asystole from vagal inhibition.
  • 11. 3.SYNCOPE : • Preceeds by pallor , Nausia , Vomiting , Sweating , Blurring of vision ,Hypotension. • POSITION : Prolonged standing. • Precipitating Factor : Emotional upset , Pain , Anxiety. • Duration : few min. • Bradycardia , Hypotension, Clonic convulsion. • H/o heart disease .
  • 12. 4.MIGRAINE : • Paroxysmal headache. • Unsteadiness or Light headedness. • Visual or Gastro intestinal disturbance.
  • 13. 5.BENIGN PAROXYSMAL VERTIGO : • Recurrent attack of vertigo lasting for several minutes. • Nystagmus. • Unsteadiness or even Falling. • Occurs as a result of Viral Labyrinthitis.
  • 14. 6.CARDIAC ARRYTHMIA : • Prolonged Q T Interval may some time cause Collapse or Cardiac Syncope. • Usually occurs after Exercise. 7. NIGHT TERROR.
  • 15. 8.NON EPILEPTIC ATTACK DISORDER:( NEAD) 1. Pseudoseizure. 2. Fabricated illness.– fabricated by parents. 3. Induced illness.- Induced by hypoglycemia or Insulin over dose. • PSEUDOSEIZURE : • Incidence –5—10 %. • Female.
  • 16. • Age – 10—12yr. • Unresponsive to AED. • Precipitating factor –Emotional upset. • Tendency to occur in company. • Never occur when the patient is alone. • Poor psychosocial history.
  • 17. TREATMENT : • Confirm diagnosis before starting treatment. • Explain to the parents about AED. • Monotherapy at minimum dose should be attempted first.( the single most effective drug should be started) • If not control by monotherapy switch to poly therapy. • Drug level may be measured routinely. • Anti epileptic therapy can usually be discontinued after 2 years
  • 18. • Anti epileptic therapy can be discontinued after 2 years of Seizure free period over a period of 3—6 month. • Indications of Polytherapy : 1. Worsening seizure. 2. Status epilepticus. 3. Non compliance. 4. Adverse effect.
  • 19. SEIZURE TYPE 1st LINE 2ND LINE. GENERALIZED: - Sodium valproate. - Lamotrigine 1. Tonic clonic. - Carbamazepine. 2. Absence - Valproate. - Lamotrigine. - Ethosuximide. 3. Myoclonic - Valproate. - Lamotrigine. 4. Infantile Spasm - ACTH. - Prednisolone - Vigabatrine. - Valproate.
  • 20. PARTIAL SEIZURE : Simple partial - Carbamazepin Gabapentine. & - Valproate. Lamotrigine. Complex partial Topiramate.
  • 21. DRUGS , DOSES & SIDE EFFECTS OF AED : CARBAMAZEPINE : ( Tegretol) DOSE : 10 mg / kg/ day. - Increase upto 20—40 mg /kg /day B.D. SIDE EFFECTS : - Hepatotoxic . - Bone Marrow depression ( Aplastic Anaemia ). - Skin Rash.
  • 22. PHENOBARBITONE (Luminal) • DOSE : - 15—20 mg/ kg loading dose . - 5 mg/ kg/ day . B.d. • SIDE EFFECTS : - Drowsiness. - Hyperkinesia. - Drug dependency.
  • 23. PHENYTOIN ( EPANOTIN) • DOSE : - 15—20 mg /kg loading dose . - 5mg/kg/day B.D. • SIDE EFFECTS : • Gingival hyperplasia. • Hirsutism. • Rickets. , Megaloblastic anaemia. Skin Rash , Nystagmus , Ataxia.
  • 24. VALPROATE ( DEPAKINE ) • DOSE : - 15—20mg/kg day stat. - increase 5mg/week maximum 60mg/kg/day. BD ,TID , QID. • SIDE EFFECTS: - Hepatic Necrosis. - Pancreatitis. - Weight gain.
  • 25. ETHOSUXIMIDE (Zanotin) • DOSE : - 20—30 mg/kg/day B.D. • SIDE EFFECTS : - Nausia, Lethargy. - Blood dyscrasias. - SLE , Steven johnson Syndrome.
  • 26. GABAPENTINE (Neurontin) • DOSE : - 30—60 mg/kg/day T. i. d. • SIDE EFFECT: Nausia. LAMOTRIGINE (lamictal) • DOSE : 2mg/kg stat , 5—15mg/kg/day B.D.
  • 27. TOPIRAMATE (Topamax ) • DOSE : - 1—9mg/kg/day BD. • SIDE EFFECT : - Drowsiness. - Weight loss. • VIGABATRINE (Sabril ) • DOSE : 50—150mg/kg/day. OD , BD. • SIDE EFFECT : Sedation , Restiction of visual field.
  • 28. CLONAZEPAM (Klonopin) DOSE : - 0.01 –0.02mg/kg/day. B.D. SIDE EFFECTS : - Sedation.