classification of epilepsy and treatment,treatment of epilepsy

1. Dr Ganta.Raja Sekhar
DM(Neurology)
NIMS,HYDERABAD
Asst Professor
Dept Of Neurology
SV Medical College
TIRUPATI

2. •Seizure (Latin sacire to take possession of)
• A paroxysmal event due to abnormal,
excessivehypersynchronous dischargesfrom
anaggregate of central nervoussystem

3. Eminent BritishNeurologist.
Epilepsy
defined asan intermittentderangement of
nervous system due to an excessive and
disorderly discharge of cerebral nervous tissue
onmuscles.

4. • An intense paroxysm of involuntary repetitive
muscular contractions.
Seizure(is agenericterm)
• Convulsive seizure or motorseizure.
Non convulsive seizure
• sensory seizure.
• Psychic seizure.
• Autonomic seizure.
• All seizuresarenot convulsions.
• Notall seizures are convulsions.

5. Classification of seizures
(Adopted by
The International League Against Epilepsy -1981 )
• Partial seizures
• Simple partialseizures
(with motor, sensory,psychic or autonomic signs.)
• Complex partial seizures.
• Partial seizures withsecondary
generalization.

6. Absence (petit mal)
Tonic-clonic (grand-mal)
Tonic.
Atonic.
Myoclonic.

7. Neonatalseizures.
Infantile spasms.

8. CLASSIFICATION OF EPILEPSY
Seizuretype
Simple Partial
ComplexPartial
Absence
Tonic clonic
Tonic
Atonic
Myoclinic

9. Focal spikes /sharpwaves
Generalised spike andwave

10. Cortex
Temporal
Frontal
Parietal
Occipital
Generalised (diencephalon)
Multifocal

11. PARTIAL SEIZURES
(FOCAL SEIZURES)
Occur within discrete regions of the brain.
Causemotor, sensory, autonomic or psychic
symptoms.
Consciousnessisfully preserved during the
seizure.

12. • Genetic
• Developmental
• Tumors
• Trauma
• Vascular
• Infections
• Inflammation
• Metabolic
• Drugs, alcohol andtoxins
• Degenerative

13. Partial Motor Seizures.
Dueto seizureactivity in the precentral gyrus.
Motor seizuresaffect the contralateral face,
arm, trunk orleg.
Movements typically clonic at afrequency of
around 2-3Hz.
Pure tonic posturing may alsobe seen.
Seizuremay remain localised to one part or
may spreadto involve the whole side.

14. seizures.
1.
Motor seizure begins in arestricted region suchas
the fingers and gradually progresses over seconds
to minutes to include alarger portion of the
extremity.
JACKONSANIAN SEIZURES

15. 2. TODDS PARALYSIS.
Patients may experience paresis of the
involved limb for minutes to many hours
following theseizure.

16. 3. EPILEPSIA PARTIALIS
CONTINUA.
Rarelythe seizure may continue for hours to days
when it is called epilepsia partialiscontinua.
Often refractory to treatment.

17. 4. VERSIVE SEIZURES
A frontal epileptic focus may involve the frontal
eyefield causingforced deviation of the eyesand
sometimes turning of the head to the opposite
side.
Suchseizuresoften becomegeneralised to atonic
clonic seizure.

18. PARTIAL SENSO
RY SEIZURES
Somatosensory seizures.
Special sensoryseizures.

19. Somatosensory seizures
Focusin the contralateral post rolandic
convolution.
Sensory seizures describedas
Numbness
Tingling
Pins and needlesfeeling
Sensation of crawling(formication)
Electric sensation,
Sensation of movement of the part.
Painand thermal sensations occuroccasionally.

20. Special sensory seizures
Visualseizures.(Rare.)
Occurassensation of darknessor flashesof light which
may bestationary or moving.
May appear colourless orcoloured.
There may be twinkling or pulsating lights.
Visualhallucinations may occur with involvement
ofoccipito-temporal or antero-medial temporal areas.

21. Rare.
There may be sensation of buzzing or roaring in
the ears or sensation of human voice repeating
unrecognisable words.
Vertiginous sensations.
occur with supero posterior temporal region or
parieto temporal regioninvolvement.

22. Assocwith lesions of inferior and medial parts of
temporal lobe usually in the region of parahippocampal
convolution or uncusand hence the termuncinate
seizures.
patient perceives afoulsmell

23. In temporal lobedisease.
salivation and sensation of thirst is present.
Vague and often indefinable visceral sensations
arising in the thorax, epigastrium and abdomen
may occur with temporal lobe focus.

24. Simple p a r t i a l seizures
EEG—ictal EEGmay show abnormal
discharges over the appropriate areaof
cortex.

25. PSYCHOMOTORSEIZURES
TEMPORALLOBESEIZURES.
These patientshave
Aura- in the form of asimple focal seizure or a
hallucination or illusion suggestive of atemporal
lobe origin.
haveaperiod of altered behavior, altered
consciousnessand amnesiato the event.

26. partial seizures.
1. Sensory illusions anddistortions
Micropsia and macropsia- objects and personsin
the environment appear to shrink or recede into
distance or mayenlarge

27. visual and auditorycommon.
Olfactory and gustatoryrare.

28. Dejavu- feelings ofincreased familiarity.
Jamaisvu- feelings of strangenessor
unfamiliarity.
Feeling of depersonalisation.
Sudden interruption inmemory.
Fragments of old memories and scenesappearin
patients mind and recur with striking clarity.

29. Lesscommonly observed.
sadness,loneliness,anger,happiness,sexual
excitement.
Fear and anxiety-mostcommon affective
experiences.
Senseof rage and intense anger.

30. AUTOMATISMS-
Lipsmacking
Chewing
Swallowing
Fumbling ofhands
Shuffling offeet
Inappropriate acts.

31. Gelastic epilepsy —laughter may be the most
striking feature of anautomatism.
Volvular epilepsy—patient may walk repititively in
small circles.
Epilepsia procursiva—runsrepititively.
Poriomania—wanders aimlessly asan ictalor
postictal phenomenon.

32. During the episode, patient is not in contact
with hissurroundings.
Patient is typically confused following the
seizure.
May take secondsto anhour for full recovery
of consciousness.
Postictally patient may show anterograde
amnesiaor aphasia(if dominant hemisphere)

33. Interictal EEGis often normal or may show
brief epileptiform spikesor sharo waves.
SinceCPseizurescanarise from the medial
temporal lobe or inferior lobe which are
distant from the scalp, EEGduring seizure
may be non localising but detected using
sphenoidal or surgically placed intracranial
electrodes.

34. CPseizures can occur at anyage.
Usually seeninadolescence and adults.
H/o febrile seizuresin childhood is often
present.
2/3rds of CPseizure ptshave GTCseizures.

35. Depressiveillness
Psychotic symptoms
Paranoid delusional stateand
Abnormalities ofbehaviour and
Personality during interictalperiod.

36. generalisation.
Partial seizurescanspread to both
hemispheres and produce GTCseizures.
Isoften difficult to distinguish from primary
GTCseizure.

37. Arise from both cerebral hemispheres without any
focal onset.
Absence seizures (petitmal).
characterised by suddenLOCwithout lossof
posturalcontrol.
seizure typically lasts for only seconds.
consciousnessreturns assuddenly asit waslost.
no postictalconfusion.

38. ABSENCE SEIZURES
Absence seizures may be accompanied by
rapid blinking movements, chewing, or clonic
movements of thehands.
Begin in childhood (4-8 yrs age)or early
adolescence.
Main seizuretype in 15-20%of children with
epilepsy.
May occur 100times aday (pykno epilepsy)

39. May manifest asunexplained daydreaming
or poorperformance.
EEG-typically reveals characteristic
generalised 3-Hz/sec spike and wave
discharges.
Respond well totreatment.
About 60—70%usually have aspontaneous
remission duringadolesence.
May be associated withGTCseizures.

40. ATYPICAL ABSENCE SEIZURES
LOCmay belonger.
Focalmotor signsmay be present.
EEG not characteristic and may show
generalised slow spike and wave pattern
with afrequency of about 2.5Hz/sec.
Often associated with diffuse structural
abnormalities of the brain and patients may
have neurologic dysfunction like mental
retardation.
Lessresponsive to treatment.

41. SEIZURES
(GRANDMALSEIZURES).
Most common seizure type due to metabolic
derangements.
10%of all patients with epilepsy haveGTC
seizures.
GTCseizures are characterisedby
premonitory phase.
Ictal phase.
post –ictalphase.

42. PREMONITORYPHASE
vague premonitory symptoms may be
present and patients feel that the
seizure isimminent.

43. May begin abruptly without warning.
Tonic phase
characterised by tonic contraction of muscles
throughout the body .There is extension of the
back and neck,foll by arms and legs. This is
accompanied by LOC, upward eye deviation and
pupillary dilatation.

44. tonic contraction of muscles of expiration and of
larynx at the onset will produce aloud moan called
ictal cry asair is forcibly emitted through closed
vocal cords. Respirations are impaired, secretions
pool in the oropharynx and cyanosisdevelops.
Tonguebite
contraction of the jaw musclescausesbiting of the
tongue.

45. in heart rate, BPandpupil size.
Tonic phase lasts upto10—30secsand is
followed by clonic phase.
Clonicphase
during this phase, there are convulsive
movements of all the 4 limbs. jaw and facial
muscles.Breathing may bestertorous and saliva
may froth from the mouth.
Theictal phaseusually lasts no more than 1min.

46. Characterised by unresponsiveness,flaccidity,
hypersalivation.
Bladder or bowel incontinence may occur.
Consciousnessis gradually regained over minutes
to hours followed by post ictal confusion.
Subsequentlypatients complain of headache,
fatigue ormuscle ache.

47. • Suddenlossofmuscletonelasting1—2secs
• Brief impairment ofconsciousness.
• Nopost ictalconfusion.
• EEGrevealsbrief generalisedspikeandwave discharges
followedimmediatelybydiffuseslow wavesthat
correlatewithlossofmuscletone.
• Usuallyseeninassociationwithknownepileptic
syndromes.

48. Suddenand brief muscle contraction involving one part of
the body or the entire body.
Seen physiologically whileasleep.
Pathologic myoclonus seenin association with metabolic
disorders, degenerative CNSdiseases, or anoxic braininjury.

49. Seenin neonatesand infants due to differences in
neuronal function and connectivity in the
immature versus matureCNS.

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