This is a case presentation on epilepsy by Rangisetty pujitha

1. Case presentation on epilepsy

2. EPILEPSY
DEFINITION:
A neurological disorder marked by sudden recurrent episodes of
sensory disturbances, loss of consciousness, or convulsions, associated
with abnormal electrical activity. This is also defined as having two or
more unprovoked seizures. Abnormalities in the brain, including, brain
tumors or vascular malformations such as arteriovenous malformations
and cavernous malformations can cause epilepsy.
Epidemiology:
Epilepsy affects 50 million people around the world,
according to the world health organization (WHO), and nearly 3.5 million
people in the united states, per the centers for disease control and
prevention (CDC).
Anyone can develop epilepsy, but it most commonly onsets in young
children and older adults. According to research published in 2021, men
develop epilepsy more often than women, possibly because of higher
exposure to risk factors like alcohol use and head trauma.

3. TYPES OF EPILEPSY
Experts now divide epilepsy into four basic types based on the
seizures you’re having :
1. Generalised epilepsy
2.Focal epilepsy
3.Generalised and focal epilepsy
4.Unknown if generalised or focal epilepsy

4. Pathophysiology of epilepsy
Research into the pathophysiology of epilepsy has
been an examination of the balences between
excitation and inhibition.With the development of
the animal models of MTLE, it has become clear that
there are changes on both sides of the balance that
would tilt thw cell towards a hyperexcitable state.
A seizure results when a sudden imbalance occurs
between the excitatory and inhibitory forces within
the network of cortical neurons in favor of a sudden
onset net excitation

5. Symptoms
Epilepsy is caused by abnormal activity in the brain, seizures can
affect any process your brain coordinates. Seizure signs and
symptoms can include:
 Temporary confusion
 A staring spell
 Stiff muscles
 Uncontrollable jerking movements of the arms and legs
 Loss of consciousness or awareness
 Psychological symptoms such as fear, anxiety or dejavu

6. DIAGNOSIS OF EPILEPSY
 AN EEG TEST:
This is the most common test used to diagnose epilepsy. In this test,
electrodes are attached to your scalp with a paste-like substance or cap.
The electrodes record the electrical activity of your brain. Along with
these many tests like CT scans, MRI, PET, and other neuropsychological
tests.
 BLOOD TESTS :
Doctors may take a blood sample to check for signs of infections,
genetic conditions, or other conditions that may be associated with
seizures.
 A NEUROLOGICAL EXAM :
Doctors may test your behavior, motor abilities, mental function, and
other areas to diagnose your condition and determine the type of
epilepsy you may have.

7. DIAGNOSIS
OF EPILEPSY:
PICTURE
PRESENTATION

8. • Some people now are treated as if they have epilepsy after 1 seizure

9. • After two unprovoked seizures, the risk of
a 3rd by 60 months is 73% (59-87%, 95%
confidence intervals.
• So adopt 59 (~ 60%) as the lower end of
the confidence interval for the recurrence
risk we all agree is epilepsy.
• Risk of epilepsy after 2 seizures

10. .
TREATMENT
GENERALLY ,Epilepsy is usually treated by
medication and in some cases by surgery, devices and
dietary changes.
ANTI- EPILEPTIC DRUGS (AEDs) are the most
commonly used treatment for epilepsy. They help
control seizures in around 7 out of 10 of people.AED’s
work by changing the levels of chemicals in your
brain.
These drugs are given with consideration with your
condition, frequency of seizures, your age and other
factors while taking the medication .

11. Medications for epilepsy
 Sodium valproate
 Carbamazepine
 Lamotrigine
 Levitiracetam
 Topiramate
Can be used to control /treat epilepsy
 Surgery to remove a small part of the brain that,s causing
seizure
 A procedure to put a small electrical device inside the body
that can help control seizures .
 Ketogenic diet

12. ROUTE OF ADMINISTRATION
oLEVETIRACETAM: IV/PO oral loading dose 1500 mg maximum and
intravenous upto60mg/kg. have side effects like :
fatigue
Dizziness
Headache
Nausea and vomiting
oPhenytoin: PO/IV oral dose of 20 mg/kg intravenous rate at 18 mg/kg
Have side effects like :
Constipation
Feeling of spinning
Sore or swollen gums
Nervousness

13. Other drugs:
FOSPHENYTOIN: intravenous 18PE/min.maximum rate of 150 PE/min
 Itching, burning, or tingling sensation
 Uncontrollable eye movements
 Loss of coordination
 Agitation
VALPROIC ACID: IV intravenous 30 mg/kg maximum rate of 150 PE/min
 Stomach pain
 Diarrhoea
 Weight gain
 Hair damage

14. Treatment regimen
NON-BENZODIAZEPINE ANTI-EPILEPTIC DRUGS (AEDs)
drug and
route
dose Maximum
Dose
Benefits Disadvantages
phenytoin –
PO/IV
oral dose of
20mg/kg
intravenously
rate at 18mg/kg
400mg/every 2hr
orally,50mg/min
intravenous
Recommended by
ACEP*** guidelines as
first “urgent”or
second line therapy
Hypotension
,arrhythmias and
localized soft tissue
infection
Levetiracetam
PO/IV
Oral loading dose
1500 mg rapid
intravenous upto
60 mg /kg
Upto
3000mg/day
Intravenous over
15 min
New data may show
efficacy in urgent iv
treatment for status
and refractory status
Fatigue, dizziness,
pain at infusion
Valproic acid
– IV
30mg/kg Maximum
dose 60 mg
/kg/day
Recommended for
emergent treatment
of seizures and
refractory status
epilepticus
transient local
irritation at
injection site
Fosphenytoin
IV/IM
Intravenous
18PEkg
Maximum rate of
150 PE /min
Localised soft tissue
infection less likely
fewer adverse effects
vs phenytoin
More expensive
than phenytoin

15. soap analysis
Subjective: A 65-year-old male with a history of epilepsy
diagnosed presents to the hospital. the patient had two seizures
in the past two days. He complains about the loss of memory on
recent things, uncontrollable jerking movements of hands and
legs severe headaches.
OBJECTIVE: EEG, MRI, CT SCAN, PET, blood tests, and other
neurological tests.
ASSESSMENT: AEDs are the most commonly used treatment for
epilepsy. They help seizures in around 7 out of 10 people.AEDs work by
changing the levels of chemicals in your brain
PLANNING: Have adequate sleep, avoid smoking, avoid taking drugs
and alcohol, do meditation.

16. 0ther clinical manifestations
 DRUGS USED:Anti-epileptic drugs
 MOA :established Anti-epileptic drugs (ADEs )
decrease membrane excitability by interacting with
neurotransmitter receptors or ion channels
Uncontrollable jerking movements of the arms
and legs.
 Adverse drug reactions :
Loss of appetite
Skin rashes
Gum hype trophy
Dizziness
Blurred vision

17. OTHER CLINICAL FEATURES
Fainting or fatigue
Rhythmic muscle contractions or muscle spasms
Seizures
Amnesia
Anxiety
Depression
Staring spells

18. Monitoring parameters
Intracranial pressure
Cerebral blood flow
Microdialysis
Brain oxygen probes
Brain tissue hypoxia
Intracerebral metabolic derangements

19. Patient counselling
 Have adequate sleep
 Don’t self-medicate yourself
 Take proper medicines in time.
 Try to take a good ketogenic diet
 Avoid smoking, drinking alcohol, and drugs
 Do some meditation

20. THE END
THANK YOU