Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Epilepsy – A Modern Day Perspective 
Vivek Misra 
B.Tech. (Genetic Engg), M.S. (Neuroscience) 
Research Associate 
The Ins...
Outline 
• Overview of Epilepsy 
• Type of Seizures 
• Diagnosis and Management 
• Psychological Issues 
• Social Perspect...
What is Epilepsy ?
Seizures and Epilepsy 
• A fit or seizure represents a transient abnormal electrical 
discharge in the brain with or witho...
What is Epilepsy? 
• A tendency to have recurring unprovoked seizures 
• Does not include single or occasional seizures or...
How Common Is Epilepsy? 
• Most common serious neurological disorder 
• Affects 1/200 people worldwide 
• Could be as much...
Who Is At Risk? 
• About one half of people affected develop epilepsy 
before 15 years of age 
• Increasing prevalence in ...
What Causes Epilepsy? 
• Causes vary worldwide and with age 
• Unknown in two-thirds of cases overall (idiopathic) 
• Refr...
What Causes Epilepsy ?
Contd…
Genes and Epilepsy 
• Over 200 disorders showing a Mendelian pattern of 
inheritance feature epilepsy as a manifestation 
...
Types Of Seizures
Epileptic Seizures 
• Epileptic seizures are paroxysmal events 
• Symptoms: 
- Generalized convulsive movements, drop atta...
Mechanisms 
• Generalized Seizures: 
– Involve much of the cortex bilaterally from the outset and therefore 
loss of consc...
Simple Partial Seizure 
 Awareness Preserved 
Memory Preserved 
Consciousness Preserved
Contd…
Complex Partial Seizure 
? Awareness Preserved 
? Memory Preserved 
? Consciousness Preserved 
<any one on the above sympt...
Contd…
Generalized Tonic-Clonic Seizures 
(Grand Mal Seizure) 
Grand mal seizures start with loss of consciousness, a cry, 
gener...
Absence Seizures 
(Petit Mal) 
Sudden & brief cessation in activity with rapid return 
to normality, may be frequent, 3Hz ...
Contd… 
• Atypical Absence Seizures 
– Atypical absence seizures differ from typical absence seizures because motor 
sympt...
Contd… 
• Status Epilepticus 
– Usually occurs in a person with history of seizures 
– Repeated seizures lasting 30 minute...
Absence Seizure 
http://youtu.be/fmIkxJs635o
Partial Complex Seizure 
http://youtu.be/Qli6cZdLnG0
Myoclonic Jerks 
http://youtu.be/_QGF9sTx2DI
Generalized Tonic Clonic Seizure 
http://youtu.be/hciaAeYLJSw
Diagnosis and Management
Diagnosis 
• Almost always clinical: a detailed history and an 
eyewitness account are essential 
• Information about: 
- ...
Differential Diagnosis 
• Syncope 
vasovagal, micturition, 
postural, vascular, respiratory, 
cardiac 
• Cardiac Disorders...
Pharmaco-Therapy 
• The management of epilepsy has been transformed, with 
more than 24 agents available for use in the Un...
Newer Anti-Epileptic Drugs
Antiepileptic Drugs Currently Approved by FDA
Contd… 
Much work is needed to answer vital common clinical questions 
regarding AEDs, such as: 
1. Which drug should be u...
Surgical Treatments For Epilepsy 
• Surgical treatment may be an option for individuals whose 
seizures are unresponsive t...
Contd…
Contd… 
• Corpus Callosotomy 
– Occasionally, surgical division of this important inter-hemispheric 
connector is helpful ...
Deep Brain Stimulation 
• Deep brain stimulation (DBS) therapy can be used for people 
who have epilepsy that is difficult...
Contd… 
Trials show that for some people their seizures become much 
less frequent, for others it may reduce their seizure...
Psychological Issues
On Diagnosis 
• Grief 
• Fears for Safety 
• Doubts about ability to cope with the situation – no 
control over life. 
• R...
Anxiety 
• Fear of having a seizure 
• Stigmatizing condition 
• Determination to conceal the condition 
Reciprocal Relati...
Depression 
• Reaction to acquiring label of epilepsy 
• Reaction to social/family problems 
• Ability to function effecti...
Aggression 
• Response to constraint by others 
• Loss of freedom/independence
Psychosis 
• Due to lesions in the brain 
• Prolonged high dosage of medication.
Psychological Impact 
• Low Self Esteem 
• Inferiority Complex 
• Isolation
Minimizing Psychological Impact 
• Relaxation Exercise 
• Cognitive Behavior Therapy 
• Family Support 
• Supportive Couns...
Social Perspective
Education 
• Lowered Expectation From Teachers & Parents 
• Attitude To Learning 
• Acceptance Of Failure 
• Actual Loss O...
Employment 
• Restrictions/Options Available 
• Overprotection Of Family – Not Sending ToWork 
• Employer Avoiding Respons...
Marriage 
• Finding understanding partners/family due to social 
stigma – especially for women 
• Unemployment 
• Misconce...
Divorce 
• Concealing the Condition 
• Economic Condition 
• Misconception as mental illness 
• Fear of offspring acquirin...
Marriages and Indian Law 
• Until December 1999, India was the only country in the world 
with "an absurd law on epilepsy ...
Stigma 
• Knowledge, Attitude And Practice Studies 
• Studies done in India reveal that knowledge of epilepsy 
among the I...
Krishnamoorthy ES, Misra V, Sankar S, Anand A 
TS Srinivasan Institute of Neurosciences 
VHS Multi-Specialty Hospital & Re...
Mobility - Driving 
• Dependence on public transport/family members – 
restrictions in driving. 
• Overprotection from fam...
Develop a Management Plan 
Clinical Guidelines for the Management of Epilepsy in Adult with Intellectual 
Disability 2001 ...
Contd… 
• Carers should also be trained in any necessary emergency 
procedures, such as the rectal administration of medic...
Social Issues - Mitigation 
Developing and Designing Information Services on Epilepsy & 
Services 
• Public Education – Re...
What Epilepsy is Not ?
Epilepsy is Not 
• A Curse 
• Witchcraft 
• Contagious 
• Mental Illness 
• Something to be feared or Rejected 
• A supern...
Possession: Jesus Driving out an Unclean Spirit. 1700. Artist Unknown
For more info !! 
http://www.neurokrish.com/epicare 
-- 
http://www.epilepsy.com 
-- 
http://www.epilepsysociety.org.uk
65 
Thank You
Epilepsy – A Modern Day Perspective
Epilepsy – A Modern Day Perspective
Upcoming SlideShare
Loading in …5
×

Epilepsy – A Modern Day Perspective

4,994 views

Published on

More than 10 million people suffer from epilepsy in India.Seizures impact the lives of people with epilepsy and their family in many ways including creating barriers to employment and education and facing a sense of discrimination and isolation from their peers who donʼt understand what happens when they see a seizure occur. In India, epilepsy is still thought of as mental illness mainly due to lack of information on the condition among the general public.

This presentation touches every aspect of epilepsy
1. Overview of Epilepsy;
2. Type of Seizures;
3. Diagnosis and Management;
4. Psychological Issues; and
5. Social Perspectives.

Published in: Health & Medicine
  • Be the first to comment

Epilepsy – A Modern Day Perspective

  1. 1. Epilepsy – A Modern Day Perspective Vivek Misra B.Tech. (Genetic Engg), M.S. (Neuroscience) Research Associate The Institute of Neurokrish Neurological Sciences Consulting Pvt. Ltd vivek@uberbrain.net www.UberBrain.net
  2. 2. Outline • Overview of Epilepsy • Type of Seizures • Diagnosis and Management • Psychological Issues • Social Perspectives
  3. 3. What is Epilepsy ?
  4. 4. Seizures and Epilepsy • A fit or seizure represents a transient abnormal electrical discharge in the brain with or without: alteration in consciousness, motor (movement) or sensory (perceptual) symptoms • Seizures represent underlying brain dysfunction • Seizures may represent a focal (ex: Tumor) or generalized (ex: infection) abnormality in electrical brain activity Seizures  Epilepsy
  5. 5. What is Epilepsy? • A tendency to have recurring unprovoked seizures • Does not include single or occasional seizures or those occurring during acute illness (symptomatic seizures) • Unprovoked seizures occurring on two separate occasions are required for epilepsy diagnosis • A cluster of seizures is considered as a single seizure for the purpose of epilepsy diagnosis
  6. 6. How Common Is Epilepsy? • Most common serious neurological disorder • Affects 1/200 people worldwide • Could be as much as 1/100 in developing nations like India due to increased: - poor antenatal care and perinatal injury - infections (tuberculosis & cysticercosis) - road traffic accidents
  7. 7. Who Is At Risk? • About one half of people affected develop epilepsy before 15 years of age • Increasing prevalence in older individuals- probably due to demographic change and the increasing prevalence of degenerative cerebrovascular disease • Slightly higher in males • Slightly higher in lower socio-economic groups
  8. 8. What Causes Epilepsy? • Causes vary worldwide and with age • Unknown in two-thirds of cases overall (idiopathic) • Refractory epilepsy is most often due to - Hippocampal sclerosis, malformations of cortical development, small foreign tissue lesions • Known causes are (secondary) - Cerebrovascular disease (15%) - Cerebral tumor (6%) - Alcohol related (6%) - Post-traumatic (2%) - Neuroinfections (tuberculosis & cysticercosis)
  9. 9. What Causes Epilepsy ?
  10. 10. Contd…
  11. 11. Genes and Epilepsy • Over 200 disorders showing a Mendelian pattern of inheritance feature epilepsy as a manifestation • Single gene disorders where epilepsy is the sole or major manifestation are being discovered but will account only for a small proportion of cases • In most forms of epilepsy the inheritance is probably polygenic (i.e many genes are responsible for the disorder)
  12. 12. Types Of Seizures
  13. 13. Epileptic Seizures • Epileptic seizures are paroxysmal events • Symptoms: - Generalized convulsive movements, drop attacks, transient focal motor or sensory attacks (including facial and eye movements), psychic experiences, episodic phenomena in sleep, prolonged confusional states are all possible • Several well described types of seizure are recognized and are usually stereotyped in an individual
  14. 14. Mechanisms • Generalized Seizures: – Involve much of the cortex bilaterally from the outset and therefore loss of consciousness. – Reciprocal cortico-thalamic interaction • Partial Seizures: – Begin focally in cortex- may become generalized involving entire cortex – Local excitation-inhibition imbalance • Disorder of membrane ion channels: complex changes in brain receptor, membrane and system levels in most cases • Pathological, functional imaging and genetics will probably redefine our understanding and promote rational drug design
  15. 15. Simple Partial Seizure  Awareness Preserved Memory Preserved Consciousness Preserved
  16. 16. Contd…
  17. 17. Complex Partial Seizure ? Awareness Preserved ? Memory Preserved ? Consciousness Preserved <any one on the above symptoms will be affected>
  18. 18. Contd…
  19. 19. Generalized Tonic-Clonic Seizures (Grand Mal Seizure) Grand mal seizures start with loss of consciousness, a cry, generalized tonic muscle contraction, and a fall. Autonomic signs are often present during the tonic phase, including tachycardia, hypertension, cyanosis, salivation, sweating, and incontinence.
  20. 20. Absence Seizures (Petit Mal) Sudden & brief cessation in activity with rapid return to normality, may be frequent, 3Hz spike and wave
  21. 21. Contd… • Atypical Absence Seizures – Atypical absence seizures differ from typical absence seizures because motor symptoms are more prominent and sometimes have a focal preponderance. – Children with atypical absence seizures tend to have multifocal or generalized cerebral pathology, clinically associated with a lag in attaining normal developmental milestones. • Myoclonic Seizures • Myoclonus is also a nonspecific term that describes brief nonepileptic muscle jerks. They may involve a body segment or be generalized, may be single or repetitive, and may be spontaneous or provoked by sensory stimulation (reflex) or limb action. • Myoclonic seizures also may occur in children with a variety of epileptic syndromes such as the Lennox–Gastaut syndrome, infantile spasms (West syndrome), and early myoclonic encephalopathy. Myoclonus also may be a part of CNS storage diseases. In the adult population, it is classic finding for spongiform encephalopathy (Creutzfeldt–Jakob disease).
  22. 22. Contd… • Status Epilepticus – Usually occurs in a person with history of seizures – Repeated seizures lasting 30 minutes or longer without recovery of consciousness – Usually due to AED withdrawal (non-compliance), acute infections or metabolic states – GTC status is a medical emergency – Complex partial and absence status present with impaired awareness • Automatisms: – Semi-purposeful or release phenomena, occur in both absences and complex partial; – lip smacking, swallowing, fidgeting with hands, complex behaviors
  23. 23. Absence Seizure http://youtu.be/fmIkxJs635o
  24. 24. Partial Complex Seizure http://youtu.be/Qli6cZdLnG0
  25. 25. Myoclonic Jerks http://youtu.be/_QGF9sTx2DI
  26. 26. Generalized Tonic Clonic Seizure http://youtu.be/hciaAeYLJSw
  27. 27. Diagnosis and Management
  28. 28. Diagnosis • Almost always clinical: a detailed history and an eyewitness account are essential • Information about: - The circumstances of the episode - Patterns of occurrence - Preceding symptoms- localizing or diagnostic - Timing, pattern, tempo and evolution of symptoms - Reported behaviors- before, during and after - Investigations are seldom necessary for making diagnosis: but are helpful in terms of management
  29. 29. Differential Diagnosis • Syncope vasovagal, micturition, postural, vascular, respiratory, cardiac • Cardiac Disorders arrhythmias, aortic or mitral stenosis, cardio-myopathies, myxoma.. • Metabolic/ Endocrine hypoglycemia, phaeochromocytoma, porphyria, carcinoid syndrome • Neurological TIA, cataplexy-narcolepsy, basilar migraine, III ventricle cyst, Meniere’s disease, episodic ataxias, movement and sleep disorders • Psychogenic hyperventilation, panic attacks, non-epileptic attack disorder, episodic dyscontrol syndrome, malingering, Munchausen
  30. 30. Pharmaco-Therapy • The management of epilepsy has been transformed, with more than 24 agents available for use in the United States and even more options elsewhere in the world. • Although there are a considerable number of choices of AEDs for the management of both the first seizure and chronic epilepsy, there is a paucity of comparative effectiveness data to offer evidence-based recommendations of which drug should be best used in a given clinical scenario.
  31. 31. Newer Anti-Epileptic Drugs
  32. 32. Antiepileptic Drugs Currently Approved by FDA
  33. 33. Contd… Much work is needed to answer vital common clinical questions regarding AEDs, such as: 1. Which drug should be used (first-generation or a new agent)? 2. Are there certain agents that should be tried before surgery? 3. Can a certain combination of medications yield better seizure control than a single agent? 4. Are the trial designs used to approve new AEDs clinically meaningful? Joseph et.al, Mayo Clin Proc. 2012
  34. 34. Surgical Treatments For Epilepsy • Surgical treatment may be an option for individuals whose seizures are unresponsive to medical therapy or those who cannot take medications because of significant adverse effects or quality-of-life issues. • In a randomized controlled study of patients with refractory temporal lobe epilepsy, patients that underwent temporal lobectomy were more likely to be seizure free than the patients randomized to AED therapy. • Many aspects of cortical mapping and function were derived from work related to surgery for epileptic activity.
  35. 35. Contd…
  36. 36. Contd… • Corpus Callosotomy – Occasionally, surgical division of this important inter-hemispheric connector is helpful for controlling seizures that spread quickly from one side to the other. • Functional Hemispherectomy • Functional isolation of specific cerebral regions within each hemisphere is possible by dividing the fiber connections between frontal, temporal, and parietal lobes while avoiding large resection of cortex and sparing the deeper nuclei and structures such as the basal ganglia.
  37. 37. Deep Brain Stimulation • Deep brain stimulation (DBS) therapy can be used for people who have epilepsy that is difficult to treat, or who cannot have surgery to separate or remove the part of the brain that causes seizures to happen. It involves implanting electrodes into specific areas of the brain • The electrodes are connected to a neuro-stimulator, a battery powered device that sends electrical impulses to the brain. • DBS therapy aims to control excess electrical activity in the brain using regular electrical impulses to reduce the frequency and severity of seizures.
  38. 38. Contd… Trials show that for some people their seizures become much less frequent, for others it may reduce their seizures a little, and for others it has no effect.
  39. 39. Psychological Issues
  40. 40. On Diagnosis • Grief • Fears for Safety • Doubts about ability to cope with the situation – no control over life. • Resentment from family – disruption to their own lives • Guilt – is it their fault? • Isolation • Insecurity in patients affecting self worth & confidence.
  41. 41. Anxiety • Fear of having a seizure • Stigmatizing condition • Determination to conceal the condition Reciprocal Relationship Higher the Anxiety - Higher the Seizure - Higher the Anxiety.
  42. 42. Depression • Reaction to acquiring label of epilepsy • Reaction to social/family problems • Ability to function effectively in work place as well as a family supporter. • Prodromal/ictal experience
  43. 43. Aggression • Response to constraint by others • Loss of freedom/independence
  44. 44. Psychosis • Due to lesions in the brain • Prolonged high dosage of medication.
  45. 45. Psychological Impact • Low Self Esteem • Inferiority Complex • Isolation
  46. 46. Minimizing Psychological Impact • Relaxation Exercise • Cognitive Behavior Therapy • Family Support • Supportive Counseling - Reassurance
  47. 47. Social Perspective
  48. 48. Education • Lowered Expectation From Teachers & Parents • Attitude To Learning • Acceptance Of Failure • Actual Loss Of Schooling/Classes • School/Teacher Avoiding Responsibility
  49. 49. Employment • Restrictions/Options Available • Overprotection Of Family – Not Sending ToWork • Employer Avoiding Responsibility
  50. 50. Marriage • Finding understanding partners/family due to social stigma – especially for women • Unemployment • Misconception as mental illness
  51. 51. Divorce • Concealing the Condition • Economic Condition • Misconception as mental illness • Fear of offspring acquiring seizures
  52. 52. Marriages and Indian Law • Until December 1999, India was the only country in the world with "an absurd law on epilepsy and marriage." • Marriages under the above mentioned acts could be solemnized "if at the time of marriage neither party suffers from recurrent attacks of insanity or epilepsy.“ • It took a struggle of 12 years for the Indian Epilepsy Association to have the word ‘epilepsy’ deleted from this law. • Seizure no longer a condition to claim for divorce.
  53. 53. Stigma • Knowledge, Attitude And Practice Studies • Studies done in India reveal that knowledge of epilepsy among the Indian population is high or comparable to western countries. • However, attitudes towards epilepsy are more negative. These attitudes have a significant correlation with level of education and occupation, i.e. lower education is associated with higher discrimination.
  54. 54. Krishnamoorthy ES, Misra V, Sankar S, Anand A TS Srinivasan Institute of Neurosciences VHS Multi-Specialty Hospital & Research Institute ILAE Annual Congress 2013, Montreal, CA
  55. 55. Mobility - Driving • Dependence on public transport/family members – restrictions in driving. • Overprotection from family • Restriction in employment
  56. 56. Develop a Management Plan Clinical Guidelines for the Management of Epilepsy in Adult with Intellectual Disability 2001 • Both the medical and psychological impact of epilepsy are assessed adequately, and reviewed; • Carers and staff working with Individual should receive training in epilepsy and its management, and on the impact it has on peoples live; • Training should also be provided on methods of behavioral observation and seizure reporting;
  57. 57. Contd… • Carers should also be trained in any necessary emergency procedures, such as the rectal administration of medication and resuscitation, and clear policies should be provided for these on an individual basis; • Care plans should be ensure consistency in the support offered to people with intellectual disability and epilepsy. For example, the same individual should accompany the person with epilepsy to clinic appointment • Accurate records should be kept, using diaries or equivalent and those working with the person with epilepsy should be familiar with use.
  58. 58. Social Issues - Mitigation Developing and Designing Information Services on Epilepsy & Services • Public Education – Remove Misconceptions • Societal Support • Self Help Groups • Government Support for Networking
  59. 59. What Epilepsy is Not ?
  60. 60. Epilepsy is Not • A Curse • Witchcraft • Contagious • Mental Illness • Something to be feared or Rejected • A supernatural gift or blessing
  61. 61. Possession: Jesus Driving out an Unclean Spirit. 1700. Artist Unknown
  62. 62. For more info !! http://www.neurokrish.com/epicare -- http://www.epilepsy.com -- http://www.epilepsysociety.org.uk
  63. 63. 65 Thank You

×