Epilepsy is a neurological disorder. This ppt is for knowledge

1. EPILEPSY
Mr. SACHIN
M.Sc. NEUROSCIENCE
GURUGRAM UNIVERSITY

2. Index
01. Introduction 02. Classification
of epilepsy
04.diagnosis
06. Treatment 07. Conclusion
03. Sign and
symptoms

3. INTRODUCTION
• Epilepsy is a widespread and serious brain disease which affects
individuals of all ages.
• It affects more than 50 million individuals globally, with almost 80%
living in low- and middle-income countries (WHO, 2022.).
• Although epilepsy may be successfully treated in most cases, there is a
significant treatment gap, particularly in low- and middle-income countries,
where antiepileptic medications are either unavailable or too expensive
(moshé et al., 2015).
• If properly diagnosed and treated, an estimated 70% of persons with
epilepsy might be seizure-free (WHO, 2022).
• A seizure is caused by an unusual, hypersynchronous discharge of a
population of cortical neurons. An electrographic (or subclinical) seizure is
one in which the discharge is only visible on an electroencephalogram
(EEG) instead of producing subjective symptoms or objective indicators
(clinical epilepsy - an introduction to epilepsy - internet, n.D)

4. i. Seizures that are unprovoked (or reflex) and occur more than once,
ii. One spontaneous (or reflex) seizure 24 hours apart and a chance of more
seizures similar to the previous ones after two unprovoked seizures, there is a
general chance of recurrence (at least 60%) will occur in the next ten years,
and
iii. An epilepsy syndrome has been diagnosed.
Epileptic Seizures and Epilepsy: Definitions Proposed By the International
League Against Epilepsy (ILAE) and the International Bureau for Epilepsy
(IBE).
Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr.
Seizure versus Epilepsy

5. Signs and symptoms
• Signs and symptoms are due to abnormal, excessive or synchronous
neuronal activity in the brain.
• Depending on which areas of the brain are involved, epileptic seizures may
consist of loss of awareness with tremors, confusion and difficulty in
responding; visual or other sensory symptoms; isolated posturing or jerking
of a single limb; or brief loss of awareness.
• Seizure origin, pattern of spread, and brain networks determine the signs
and symptoms of a seizure.

6. Changes in brain structures in
epilepsy
The basic anatomy of epilepsy.

7. CLASSIFICATION
• The most recent classification of seizures and epilepsies was in March 2017 ILAE
• The new classification has four components in general:
1. Seizures (based on their onset)
2. Epilepsies (based on seizure onset)
3. Epilepsy syndromes
4. Epilepsies by etiology

8. Expanded classification of seizure type (Adapted from Ruíz-García et
al., 2022).

9. Seizure type Description Reference
Focal automatisms seizures Automatisms are characterized as an uncoordinated motor activity that occurs in the presence of diminished cognition
and is frequently, but not always, followed by amnesia. Chewing, swallowing, lip-smacking, plucking, and gesticulating
movements are some examples of automatisms.
(Yang et al., 2022)
Focal atonic seizures Sudden loss or reduction of muscular tone affecting the head, trunk, jaw, or limb musculature with no apparent
previous myoclonic or tonic event lasting 1 to 2 seconds.
(Fisher et al., 2017)
Focal clonic seizures It is characterized by decreased muscle tone quickly and lasts a few seconds. They can occur on one side of the body or
in a single limb. Usually, awareness is retained.
(Sarmast et al., 2020).
Focal epileptic spasms Epileptic spasms (ES) have onset in children younger-than-2-year-old. Sudden flexion, extension, or combined
extension flexion of predominantly proximal and truncal muscles characterizes ES.
(Takahashi et al., 2022)
Focal hyperkinetic seizures Seizures are characterized by frequent, uncontrollable muscle movements such as furious kicking, thrashing, and
pedalling.
(Sarmast et al., 2020)
Focal myoclonic seizures It's comparable to clonic seizures, but it's characterized by transient, unstained muscle spasms that quickly last a few
seconds or even less than a second or by an irregular jerking in one portion of the face or body. The majority of people
retain their awareness.
(Sarmast et al., 2020)
Focal tonic seizures A seizure is accompanied by increased muscle contraction lasting seconds to minutes. (Fisher et al., 2017)
Focal behavior arrest These seizures cause the cessation of all activities and unresponsiveness for the seizure duration. (Sarmast et al. n.d.2020)
Focal autonomic seizures A distinguishable change in autonomic nervous system function affects cardiovascular, pupillary, gastrointestinal,
sudomotor, vasomotor, and thermoregulatory functions.
(Fisher et al., 2017)
Focal sensory seizures These seizures are characterized by abnormal sensations such as vision, odour, auditory, gustatory, somatic
hallucination, or vertigo.
(Sarmast et al., 2020)
Focal emotional seizures Seizures are characterized by emotion or the appearance of a feeling, such as fear, spontaneous joy or euphoria,
laughing (gelastic), or crying (dacrystic)
(Fisher et al., 2017)
Focal cognitive seizures Cognitive seizures occur when a patient experiences hallucinations, illusions, Deja vu, or impaired speech during a
seizure event.
(Sarmast et al., 2020)

10. Seizure type Description Reference
Generalized tonic-clonic
seizures
Tonic-clonic seizures are characterized by clonic or myoclonic movements that progress to tonic
muscle extension of the limb and trunk muscles, followed by clonic contraction—the tongue biting
and urine incontinence that frequently accompanies these convulsions.
(Hammond, 2016)
Generalized myoclonic-
tonic-clonic seizures
Individuals with juvenile myoclonic epilepsy frequently experience this seizure. Arms jerking, tonic
stiffness, and subsequently clonic rhythmical jerking are its defining features.
(Sarmast et al., n.d.)
Generalized myoclonic-
atonic seizures
Previously known as myoclonic-astatic seizures, this seizure is frequently seen by people with
Doose syndrome. It is distinguished by a momentary jerking of the trunk or limbs, followed by a
limp drop.
(Sarmast et al., n.d.)
Typical absence seizures The absence is characterized by an abrupt and temporary impairment of consciousness, a halt to
current activity, and typically an unresponsive state. A few to twenty seconds into the seizure, it
abruptly ends, and the previous action resumes as if nothing had happened.
(Panayiotopoulos, 1999)
Atypical absence seizures Atypical absences are generalized epileptic seizures that typically affect kids with severe epilepsies,
learning disabilities, and other seizure types. For their diagnosis, video-EEG is crucial.
(Brigo et al., 2019)
Myoclonic absence seizures A myoclonic absence seizure is characterized by rhythmic three-second myoclonic movements that
cause ratcheting abduction of the upper limbs and increasing arm elevation, as well as generalized
spike-wave discharges that occur three times per second. Lasts typically 10 to 60 seconds.
Consciousness impairment may not be immediately apparent. Numerous hereditary disorders, as
well as diseases with no known links, can cause myoclonic absence seizures.
(Elia et al., 1998)
Palpebral myoclonia A generalized epileptic condition clinically characterized by eyelid myoclonia (EM) with or without
absences, eye closure-induced electroencephalography (EEG) paroxysms, and photosensitivity.
Rare tonic-clonic seizures may also take place.
(Striano et al., 2009)

11. Diagnosis
• Epilepsy can be diagnosed based on a patient's medical history, physical and
neurological examination, laboratory testing, electroencephalography results, and
neuroimaging results.
• Neuroimaging studies play an integral role in evaluation of seizures for the
determination of the structural and functional aetiology of seizures.
• Various diagnostic tools are used to identify and classify the seizure type and
aetiology, including Electroencephalogram (EEG), Magnetic Resonance Imaging
(MRI), and Positron Emission Tomography (PET), single photon emission
computed tomography (SPECT), Magneto Encephalogram (MEG), and
neuropsychiatric Testing.
• The EEG often is critical for identifying specific seizure types.
• CT scan may help in assessing newly diagnosed patients, but MRI is preferred.
MRI may locate brain lesions or anatomic defects that are missed by conventional
radiographs or CT scans.

12. treatment
• Medication
Partial/focal seizure with or without secondary generalization, complex partial seizures
or epilepsy syndrome-CBZ, OXC, PHT, VPA, PB
Generalized seizures or epilepsy syndrome-VPA, PHT, PB, CBZ, OXC (for generalized
tonic-clonic seizures) -VPA (for GTCS, myoclonic jerks, absences and generalized
epilepsy syndromes).
• Non pharmacological approaches
Radiofrequency (RF) thermo coagulation
Stereotactic radio-surgery
Vagal nerve stimulation:
• Neuro modulation:
Vagal nerve stimulation:
Deep brain stimulation:
• Diet therapy

13. CONCLUSION
• Epilepsy is common neurological disorder characterised by abnormal excessive
synchronous neuronal activities in the brain.
• It is seen with or without loss of consciousness. The prevalence of epilepsy is 5–8
per 1000 population in high income countries and 10 per 1000 population in low-
income countries and even higher in rural areas.
• Epilepsy is a universal disorder affecting all ages and predisposed by sleep
deprivation, systemic infection, potential external sensory stimuli.
• Epilepsy is characterized by excessive firing of excitatory neurotransmitters and
decrease in function of inhibitory neurotransmitters.
• Benzodiazepines, barbiturates and ion channel modulators are preferred for the
treatment of epilepsy.
• If seizures are not controlled with monotherapy, then polytherapy is recommended.