seizure disorder BY SUNIL PAHARI

1. SEIZURE DISORDER
Dr. Sunil Pahari , 3rd year resident
Yangtze university , jingzhou central hospital , hubei , china

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:Aconvulsionisamedicalconditionwherebody
musclescontractandrelaxrapidlyandrepeatedly,resultinginan
uncontrolledshakingofthebody.
Motor manifestation of seizure.
EPILEPSY :
condition to have recurrent seizures.

4. Classifications
According to etiology.
• Primary/ Idiopathic ( etiology not identified)-
85%.
• Secondary (with identified etiology) –15%.
According to type. The chief division of seizure
types on physiological ground is between
• Generalized-. Elcrophysiological abnormalities
involve both hemisphere. (1/3rd)
• Focal/ partial.- one part of cerebrum (2/3rd)
• Unclassified.

7. ETIOLOGY
PERINATAL :
• Cerebral malformation.
• Intra uterine TORCH Infection.
• HIE*.(hypoxic Ischemic encephalopathy)
• Trauma
• Intra ventricular Hemorrhage *
• Maternal drug abuse
• Radiation exposure.
• Perinatal trauma and anoxia
* Common causes of convulsion.

8. • TOXIC CAUSES
• DRUGS- phenothiazide, MAOI,TCA either in overdose or at
therputic level in patient eith lowered seizure threshold.
• rapid withdrawl of antiepileptic and benzodiazepam
• chronic alcohol abuse
• CO, lead , Hg poisoning.

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

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

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

12. Tuberus sclerosis
Sturge weber syndrome
Neurofibromatosis

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

14. OTHERS
1. Trauma.*
2. Febrile convulsion.*
3. Idiopathic.*
4. Tumor.
5. Familial. (mostly absence seizure )
6. Drug withdrawl. 7. Alcohol withdrawl.

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

16. Clinical features
• The diagnosis is primarily a
clinical one. A detailed
history is there fore essential
and usually required
eyewitness reports,
particularly when
consciousness is lost during
the event.
• If an Aura precedes the
attack , patient may be able
to describe this, which help
to localize the focus.

17. Partial seizure
• Partial seizure arise from localized area of cerebral cortex.
• Clinical manifestation depends on where in the cortex the seizure
arise and how fast and far it spread.
• Temporal lobe (M/c) , then frontal lobe.
• subdivided into 1. simple partial-
• - consciousness is not impaired.
• -brief and focal symptoms
•
• 2. complex partial
• - impairment of consciousness, without loss of postural
control ( no fall on ground / blackout).
• - 2- 3 minutes
• - patients are amnesic
• - before attack pts report déjà vu,jamais vu (unreality),
hallucianation of sound , taste, vision, emotional changes .(fear
sexual arousal ) or viseral sensation ( nausea , epigastric discomport
). -

18. In simple partial seizure

19. Types in sps
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.

20. Generalised seizures
• Are characterised by bilateral involvement of the cortex at the onset
of seizure.
• Patient lose consciousness at seizure onset.
• So usually no warning.
•
1. Absence ( petit mal)
2. Tonic clonic. ( Grand mal)
3. Tonic 4. Clonic 5. Myoclonic.
6. Atonic. 7. infantile spasm.
•

21. Absence seizure (petit mal)
• Typical absence seizure have an onset between 4-12yrs.
• Attack may be several times a day, 5- 15 sec.
• Patient suddenly stares vacantly.
• eye blinking ,myoclonic jerks.
• 2 types - typical ( characteristic EEG pattern of threeper –
second generalised spike –and-wave discharge.)
• - atypical - associated with more severe epilepsy
syndrome like Lenox- gastaut syndrome . Less change on
EEG

22. Generalized tonic -clonic seizure
• These seizures typically have no warning.
• Starts with sudden loss of consciousness and fall on the ground .
• This is followed by tonic phase (10 sec)
when the body is stiff, the elbows are flexed ,and the legs extended , upward
rolling of eyeball. Breathing stops and patient may turn cyanosis.
Tonic phase is followed by clonic phase . ( 1-2 minutes)
-voilent generalised rhythemic shaking . .
- tong may be bitten . There is tachycardia.
-bladder and bowel controll may be lost

23. • The frequency of clonic movement gradually decrease and
eventually cease, marking the end of seizure .
following the tonic clonic seizure, patient often cannot be
roused for several minutes and awakes with confusion ( postictal
confusion), headache , myalgia and some retrograde amnesia.
It is not unusual for patient to fall asleep after convulsion, and
this can sometimes be mistaken for unconciousness.

24. SYNDROMEASSOCIATEDWITH EPILEPSY:
GENERALIZED EPILEPSY :
1. WEST SYNDROME:- Infantile Spasm.
2. Lenox- Gastaut SYNDROME:- severe form of epilepsy,
seizure before 4 years.
3. JANJ Syndrome : Juvenile Myoclonic Epilepsy.
4. LANDAU—KLEFFNER Syndrome: aphasia + abnormal
EEG.

25. PARTIAL SEIZURE(40-60%).
OnsetinoneofthecerebralHemisphere.
• SIMPLE PARTIAL SEIZURE ( SPS) :
• Begin in a small group of dysfunctional neuron.
• Conciousness remains intact, may talk during seizure.

26. COMPLEXPARTIALSEIZURE
( 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.

27. • Convulsions.
• Last for 2—3 min.
• EEG—interictal sharp waves or focal or
multifocal spikes (usually originating from
temporal lobe).
• CT/ MRI to detect temporal lobe lesion.

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

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

30. 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.

31. • 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.
• EEG : Diffused or generalized 3hz/ sec.

32. ATYPICAL/ COMPLEXABSENCESEIZURE:
• Myoclonic movement of—
-Face.
- Finger.
- Extremities.
• Occasionally associated with loss of body tone.

33. GENERALIZEDTONICCLONIC
(Grandmal)
• Most frequent type of seizure seen in children.
• It has 4 phase.
• I: Aura.
• II: Tonic phase.
• III : Clonic phase.
• IV : Post ictal phase.

34. PhaseI - Aura:
presenceofauraindicatesthefocusoforigin.
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.

35. IIICLONICPHASE:
• 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 control.

36. TONICSEIZURE:
• 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.

37. MYOCLONIC SEIZURE.
• Quick , brief, paroxysmal often repetative Jerky movement of
limbs , Neck , Trunks.
• Not all myoclonus is result of epilepsy ,it is epileptic if it occur
in the contest of epilepsy , which is cortical origin ( not brain
stem and spinal cord )
• Loss of body tone & falling forward.
• Sustains injury.
• Usually idiopathic (genetic)
• Mental retardation is common.

38. INFANTILESPASM
(Salamseizure)
• 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.

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

40. Seizure management

41. Anticonvulsant drugs

43. Thank you