Definition
0 Epilepsy is a brain disorder in which clusters of nerve cells, or
neurons, in the brain sometimes signal abno...
Epidemiology
0 More than 2 million people in the United States -- about 1 in 100 --
have experienced an unprovoked seizure...
Aetiology
0 Epilepsy is a disorder with many possible causes. Anything that disturbs
the normal pattern of neuron activity...
Continuation………….
0 Neurotransmitters that plays a role in epilepsy is GABA, or gamma-
aminobutyric acid, which is an inhi...
Continuation…………….
0 The cause is unknown in 70% of cases
0 Brain Trauma (ex. injury, stroke)
0 Brain Lesions (ex. tumors)...
Classification
0 There are many different types of seizures, some that affect the whole
brain (generalised) and some that ...
Tonic-clonic seizures (sometimes called grand mal)
0 The person loses consciousness, goes stiff and falls to the ground.
S...
Absence seizures (sometimes called petit mal)
0 During an absence seizure the person is momentarily unconscious.
0 It may ...
Myoclonic seizures
0 These are sudden jerks.
0 They can affect the whole body, but are usually restricted to one
or both a...
Atonic seizures
0 Atonic seizures cause a sudden loss of muscle tone.
0 Motor symptoms include head drops, loss of posture...
Intractable Seizures
0 Seizures of any kind that do not respond to medications.
0 Twenty percent of people with epilepsy h...
Simple partial seizures
0 The person remains fully conscious, but they are unable to stop or
control the seizure.
0 Exampl...
Complex partial
0 The person is only partly conscious and although it may appear
that they are fully aware of what they ar...
Secondarily generalized
0 The generalized, convulsive phase of these seizures usually lasts no more than a
few minutes, th...
Status Epilepticus
0 Most seizures end after a few minutes. If seizures are prolonged,
or occur in a series,there is an in...
Pathophysiology
0 Nerve impulse propagates in the brain in a synchronous manner and for
that the electrical potential reac...
Continued…..
0 The excessive neuronal disorderly discharge involving in the entire
brain results in loss of consciousness,...
Signs and symptoms
0 "Blackouts" or periods of confused memory
0 Episodes of staring or unexplained periods of unresponsiv...
Diagnosis
0 EEG
0 MRI
0 BLOOD TESTS
7/23/2013 20
Diagnosis
0 An EEG, or electroencephalogram, is a test that can help
diagnose epilepsy
0 During an EEG, the electrical sig...
Continued……
0 CT and MRI scans reveal the structure of the brain, which can be useful
for identifying brain tumors, cysts,...
0 Doctors also are experimenting with brain scans called magnetic
resonance spectroscopy (MRS) that can detect abnormaliti...
Non-pharmacological
treatment
0 First Aid for Generalized Tonic-Clonic Seizures:
0 Stay calm, note time seizure began and ...
Tonic-Clonic Seizure in a Wheelchair:
0 Do not remove from wheelchair unless absolutely necessary
0 Secure wheelchair to p...
Treatment (pharmacologically)
0 Classification:
0 hydantoins : phenytoin
0 Barbiturates: phenobarbitone
0 Iminostilbene: c...
Phenytion
0 Mechanism of action
blocks sodium channels in activated state
blocks high frequency firing
delays recovery of ...
Carbamazepine
0 It’s a tricyclic compound
0 Commonly used as antiepileptic drugs
0 Mechanism of action: similar to phenyti...
Ethosuximide
0 Its an succinimde
0 It raises the seizure threshold
0 Mechanism of action : it reduces the low threshold ca...
Valproic acid
0 It ‘s an salt of sodium valproate
0 Effective in antiepileptic drugs for absence , partial and
generalised...
0 Diazepam is a drug of choice in status epilepticus and febrile
convulsions
0 Lorazepam may be used in place of diazepam ...
7/23/2013 32
Epilepsy
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Epilepsy

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Epilepsy

  1. 1. Definition 0 Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. 0 Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. 0 In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness. 7/23/2013 2
  2. 2. Epidemiology 0 More than 2 million people in the United States -- about 1 in 100 -- have experienced an unprovoked seizure or been diagnosed with epilepsy. 0 For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. 0 However, about 25 to 30 percent of people with epilepsy will continue to experience seizures even with the best available treatment. 7/23/2013 3
  3. 3. Aetiology 0 Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures. 0 Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. 0 Researchers believe that some people with epilepsy have an abnormally high level of excitatory neurotransmitters that increase neuronal activity, while others have an abnormally low level of inhibitory neurotransmitters that decrease neuronal activity in the brain. Either situation can result in too much neuronal activity and cause epilepsy. 7/23/2013 Causes 4
  4. 4. Continuation…………. 0 Neurotransmitters that plays a role in epilepsy is GABA, or gamma- aminobutyric acid, which is an inhibitory neurotransmitter. 0 In some cases, the brain's attempts to repair itself after a head injury, stroke, or other problem may inadvertently generate abnormal nerve connections that lead to epilepsy. 0 Abnormalities in brain wiring that occur during brain development also may disturb neuronal activity and lead to epilepsy. 7/23/2013 Causes continuation 5
  5. 5. Continuation……………. 0 The cause is unknown in 70% of cases 0 Brain Trauma (ex. injury, stroke) 0 Brain Lesions (ex. tumors) 0 Poisoning (ex. lead) 0 Infections of the brain (ex. meningitis, encephalitis, measles) 0 Brain injury at birth 0 Genetic causes 0 Abnormal brain development 0 Chronic alcohol/ drug abuse 7/23/2013 Causes continuation 6
  6. 6. Classification 0 There are many different types of seizures, some that affect the whole brain (generalised) and some that affect part of the brain (partial). 0 Common generalised seizures Tonic-clonic seizures (sometimes called grand mal) Absence seizures (sometimes called petit mal) Myoclonic seizures Atonic seziure Intractable seziure 0 Common partial seizures Simple partial seizures Complex partial Secondary generalisation. Status epilepticus. 7/23/2013 7
  7. 7. Tonic-clonic seizures (sometimes called grand mal) 0 The person loses consciousness, goes stiff and falls to the ground. Sometimes they appear to cry out. 0 The skin (particularly around the mouth and under the finger nails) may appear blue in colour. 0 There can be loss of bladder or bowel control. The limbs jerk as the muscles contract and relax in quick succession. 0 The person may bite their tongue and the inside of their cheeks. Slowly they will regain consciousness, but may well be groggy or confused. 0 Very often, the person remains sleepy and may have a headache and aching limbs. 7/23/2013 Tonic-clonic seziure 8
  8. 8. Absence seizures (sometimes called petit mal) 0 During an absence seizure the person is momentarily unconscious. 0 It may appear that they are daydreaming or switching off. However, they are totally unaware of what is happening around them and they cannot be woken up. 0 Absence seizures are most common in childhood. Absence seizures usually begin between ages 4 and 14. The children who get them usually have normal development and intelligence. 0 And nearly 70% of cases, absence seizures stop by age 18. 7/23/2013 Absence seizures 9
  9. 9. Myoclonic seizures 0 These are sudden jerks. 0 They can affect the whole body, but are usually restricted to one or both arms and sometimes the head. 0 The person is not conscious, but the seizure is so brief that the person appears to remain fully conscious. 0 "Myo" means muscle and "clonus" (KLOH-nus) means rapidly alternating contraction and relaxation—jerking or twitching— of a muscle. 7/23/2013 10
  10. 10. Atonic seizures 0 Atonic seizures cause a sudden loss of muscle tone. 0 Motor symptoms include head drops, loss of posture, or sudden collapse. 0 Because they occur without warning, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults. 0 Other names include drop attacks, astatic or akinetic seizures. 7/23/2013 11
  11. 11. Intractable Seizures 0 Seizures of any kind that do not respond to medications. 0 Twenty percent of people with epilepsy have seizures that are resistant to medication, otherwise known as refractory epilepsy. 7/23/2013 12
  12. 12. Simple partial seizures 0 The person remains fully conscious, but they are unable to stop or control the seizure. 0 Examples of symptoms are the movement of a limb; tingling; experiencing a non-existent smell or taste; going pale; sweating; or experiencing a churning feeling in the stomach. 0 Other symptoms can be feelings of fear, panic, sadness or happiness. 0 When seizures occur in the part of the brain responsible for vision, people can see flashing or balls of light, or experience temporary absence of vision. 7/23/2013 13
  13. 13. Complex partial 0 The person is only partly conscious and although it may appear that they are fully aware of what they are doing, this isn’t the case. 0 Examples of symptoms are chewing and swallowing, fumbling with buttons, repeatedly scratching the head or searching for an object. Some people may remove items of clothing. 0 Sometimes the seizures can involve complex body movements, apparently strange behaviour or actions of a sexual nature. 7/23/2013 14
  14. 14. Secondarily generalized 0 The generalized, convulsive phase of these seizures usually lasts no more than a few minutes, the same as primary generalized seizures. 0 The preceding partial seizure is usually not very long. Sometimes this part is so brief that it is hard to detect. 0 These seizures are called "secondarily generalized" because they only become generalized (spread to both sides of the brain) after the initial or "primary" event, a partial seizure, has already begun. 0 They happen when a burst of electrical activity in a limited area (the partial seizure) spreads throughout the brain. Sometimes the person does not recall the first part of the seizure. These seizures occur in more than 30% of people with partial epilepsy. They can affect people of all ages who have partial seizures. 7/23/2013 15
  15. 15. Status Epilepticus 0 Most seizures end after a few minutes. If seizures are prolonged, or occur in a series,there is an increased risk of status epilepticus, a true life threatening emergency. 0 Status epilepticus is usually defined as 30 minutes of uninterrupted seizure activity or repeat seizures without a return to consciousness. 0 The Epilepsy Foundation advises parents and the public to call for emergency assistance 0 when a convulsive seizure lasts for more than five minutes without signs of stopping, or 0 when successive seizures last more than five minutes without a return to consciousness. 7/23/2013 16
  16. 16. Pathophysiology 0 Nerve impulse propagates in the brain in a synchronous manner and for that the electrical potential reaches to zero. Any type of process which damages or cause irritation to the grey matter of the brain may cause activation or inactivation of neurons causes by unknown mechanism. 0 This leads to sudden, excessive, synchronous discharge which results in an electrical potential. If the discharge remains localized it results in partial seizures or it may spread and involve the entire cerebrum causing generalized seizures. 0 Imbalance of excitatory transmitters such as G-amino butyric acid and selective central nervous system, calcium channel blockers may be involved in the seizure disorders. 7/23/2013 17
  17. 17. Continued….. 0 The excessive neuronal disorderly discharge involving in the entire brain results in loss of consciousness, disturbances in sensation and conclusive movements. After peak of seizures there is decrease in frequency of neuronal discharge. It leads to the end of seizures . 0 The seizure may be ending due to loss of cerebral energy reserves, local tissue anoxia, accumulation of toxic metabolites of neuronal metabolism and inhibitory neuronal feed back mechanisms. 7/23/2013 18
  18. 18. Signs and symptoms 0 "Blackouts" or periods of confused memory 0 Episodes of staring or unexplained periods of unresponsiveness 0 Involuntary movement of arms and legs 0 "Fainting spells" with incontinence or followed by excessive fatigue 0 Odd sounds, distorted perceptions, or episodic feelings of fear that cannot be explained. 0 Strange sensations 0 Visual hallucinations 0 Emotional changes 0 Muscle spasms 0 Convulsions 0 Other symptoms, depending on where in the brain the seizures begin. 7/23/2013 Signs and symptoms 19
  19. 19. Diagnosis 0 EEG 0 MRI 0 BLOOD TESTS 7/23/2013 20
  20. 20. Diagnosis 0 An EEG, or electroencephalogram, is a test that can help diagnose epilepsy 0 During an EEG, the electrical signals of the brain are recorded. This electrical activity is detected by electrodes, or sensors, placed on the patient's scalp and transmitted to a machine that records the activity. 0 Electrical signals produced by the brain neurons are picked up by the electrodes and transmitted to a machine, where they produce separate graphs on moving paper recorded in ink or on a computer screen. 7/23/2013 21
  21. 21. Continued…… 0 CT and MRI scans reveal the structure of the brain, which can be useful for identifying brain tumors, cysts, and other structural abnormalities. An adapted kind of MRI called functional MRI (fMRI) can be used to monitor the brain's activity and detect abnormalities . 0 SPECT (single photon emission computed tomography) is a relatively new kind of brain scan that is sometimes used to locate seizure foci in the brain. 0 Doctors may use an experimental type of brain scan called a magnetoencephalogram, or MEG. 0 MEG detects the magnetic signals generated by neurons to allow doctors to monitor brain activity at different points in the brain over time, revealing different brain functions. 7/23/2013 22
  22. 22. 0 Doctors also are experimenting with brain scans called magnetic resonance spectroscopy (MRS) that can detect abnormalities in the brain's biochemical processes, and with near-infrared spectroscopy, a technique that can detect oxygen levels in brain tissue. 0 These blood samples are often screened for metabolic or genetic disorders that may be associated with the seizures. They also may be used to check for underlying problems such as infections, lead poisoning, anemia, and diabetes that may be causing or triggering the seizures. 7/23/2013 diagnosis 23
  23. 23. Non-pharmacological treatment 0 First Aid for Generalized Tonic-Clonic Seizures: 0 Stay calm, note time seizure began and duration of event 0 Lay person down and turn on left side 0 Place something soft under head 0 Clear objects away from jerking extremities 0 Loosen tight clothing around the neck 0 Protect head and remove glasses 0 Do not restrain 0 Provide privacy if possible 0 Stay with the person until the seizure ends and a full return to consciousness is observed 7/23/2013 24
  24. 24. Tonic-Clonic Seizure in a Wheelchair: 0 Do not remove from wheelchair unless absolutely necessary 0 Secure wheelchair to prevent movement 0 Fasten seatbelt (loosely) to prevent person from falling out of wheelchair 0 Protect and support head 0 Ensure breathing is unobstructed and allow secretions to flow from mouth 0 Pad wheelchair to prevent injuries to limbs 0 Follow relevant seizure first aid protocol 7/23/2013 25
  25. 25. Treatment (pharmacologically) 0 Classification: 0 hydantoins : phenytoin 0 Barbiturates: phenobarbitone 0 Iminostilbene: carbamazepine 0 Succinimide: ethosuximide 0 GABA transaminase inhibitiors: valproic acid 0 Benzodiazepines: diazepam 0 GABA analouges: vigabatrin. 7/23/2013 26
  26. 26. Phenytion 0 Mechanism of action blocks sodium channels in activated state blocks high frequency firing delays recovery of sodium channels from inactivation stabilizes the neuronal membrane inhibits generation of action potentials inhibits spread of seziures 0 Adverse effects epigastric pain ataxia anorexia 0 Drug interactions cimetidine and chlormphenicol inhibit metabolism of phenytoin. 0 Dose 20mg/kg 7/23/2013 27
  27. 27. Carbamazepine 0 It’s a tricyclic compound 0 Commonly used as antiepileptic drugs 0 Mechanism of action: similar to phenytion 0 Useful in treating trigeminal neuralgia and glosso-pharyngeal neuralgia 0 Found to be beneficial in mood disorders and has mild anti diuretic effects 0 Adverse effects : vertigo ,blurring of vision ,dizziness. 0 Dose : 200-400mg TDS 0 Drug interaction : its an enzyme inducer enhance its own metabolism and of other drugs like phenytoin , valproic acid. 7/23/2013 28
  28. 28. Ethosuximide 0 Its an succinimde 0 It raises the seizure threshold 0 Mechanism of action : it reduces the low threshold calcium currents (T-currents) in the thalamic neurons which are responsible for absence seziures. 0 Advrse effects: lethargy ,euphoria ,leukopenia , urticaria . 7/23/2013 29
  29. 29. Valproic acid 0 It ‘s an salt of sodium valproate 0 Effective in antiepileptic drugs for absence , partial and generalised seziures. 0 Mechanism of action : increased synthesis of GABA by increased activity of GABA synthesase enzyme decreasing the metabolism of GABA by inhibiting GABA transaminase enzyme . blocks sodium channels decreases the low threshold calcium( t-currents in the thalamus) 0 Adverse effects: tremors ,rashes, alopecia. 0 Drug interactions : it inhibits the clearance of lamotrigine 7/23/2013 30
  30. 30. 0 Diazepam is a drug of choice in status epilepticus and febrile convulsions 0 Lorazepam may be used in place of diazepam dose : 0.1mg/kg IV 0 Clonazepam is a potent antiepileptic useful in absence and myoclonic seizures 0 Vigabatrine is an GABA analouge which acts by irreversibily inhibiting the enzyme GABA transminase thereby raising brain GABA levels 0 0 Lamotrigine is abroad spectrum antiepileptic activity . Prolongs the activation of sodium channels and also inhibits the release of excitatory amino acids like glutamate dose:50-300mg/day 7/23/2013 31
  31. 31. 7/23/2013 32

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