Epilepsy 1

1. Epilepsy

2. Epilepsy:
recurrent
seizures
Atonic/
tonic
Simple Complex
Partial
Myo-
clonic
Generalized
Classification - Epidemiology - Symptoms - Diagnosis - Treatment
Absence
Jacksonian/spreading
Tonic
clonic:
Most
dangerous
bc/o status
epilepticus

3. Classification - Epidemiology - Symptoms - Diagnosis - Treatment

4. 5%0,7% 20%3%
Prevalence
Classification - Epidemiology - Symptoms - Diagnosis - Treatment
Lifetime risk
for epilepsy
Lifetime risk
for seizure
of epilepsies are
Primary
generalized

5. Classification - Epidemiology - Symptoms - Diagnosis - Treatment
5-10 seconds impaired consciousness
Stop of activity
Dazed look
Sometimes:
Involuntary contraction
Rhythmic myoclonic twitches eyelids or mouth
Absence seizures

6. Classification - Epidemiology - Symptoms - Diagnosis - Treatment
Witness account
EEG
2: tonic
3: clonic
4: coma
Spike
and wave
F: Frontal
T: Temporal
O: Occipital

7. Classification - Epidemiology - Symptoms - Misdiagnosis - Treatment
Story of Justin
Don't confuse absence seizures with autism or ADHD

8. Classification - Epidemiology - Symptoms - Misdiagnosis - Treatment
For absence seizures: ethosuximide first-line,
valproic acid as second line
Status epilepticus: lorazepam 0,1mg/kg iv
or check pockets for Stesolyd (rectal diazepam)
- ensure airway and prevent trauma
- dont put your hand in the mouth
but push cheeks between teeth as with cpr
Prevent an attack = prevent excitotoxicity

9. Status epilepticus at the EMD

10. Classification - Epidemiology - Symptoms - Misdiagnosis - Treatment
Moderate ketogenic diet
Electric vagus nerve stimulator
Lobectomy (rare)
0%
12,5%
25%
37,5%
50%
Carbohydrate Fat Protein
45%45%
10%

11. Sources
Kuks
Mumenthaler
Guyton
Rang&Dale
Kumar&Clarke

12. Definition
■Epileptic seizure: ‘the result of abnormal
function of voltage-gated and transmitter-
gated ion channels, which can cause
neurons to be overstimulated’ (Kuks)

13. (International) classification
■Partial seizures (localized)
– Simple partial
– Complex partial
– Partial progressing to generalized
■Generalized seizures (bilateral)
– Clonic, tonic, or tonic-clonic
– Absence seizures
– Myoclonic seizures (without loss of consciousness
– Atonic or drop attacks
■Non-classified seizures (organic)

14. (Generalized) tonic-clonic
■Mild feelings of unease (hours-days)
■Aura > strange feeling of discomfort,
epigastric rising sensation, sensory
phenomena or emotional changes
■Loss of consciousness, tonic contractions
> clonic convulsions
■Postictal coma > disoriented

15. Other symptoms during seizure
■Red face > blue face (stop breathing)
■Unnatural cry > forced expiration
■Eye balls roll upwards (open eyes)
■Dilated pupils, non-reactive to light
■Tongue biting
■Saliva secretion
■Urine incontinence

16. Absence seizures
■5-10 seconds impaired consciousness
■Childhood (4-12yr)
■Stop of activity
■Dazed look or eyes roll up
■Rhythmic myoclonic twitches eyelids or
mouth
– Involuntary contraction

17. Myoclonic seizures
■Sudden appearance of one or more
‘violent muscular contractions’
■Mainly in the arms > drop things
■Juvenile myoclonic epilepsy
– Generalized tonic-clonic seizures

18. Simple partial seizures
■Consciousness remains normal
■Symptoms depend on place
■Motor seizures > thumb, mouth
– Short, after temporarily paralysed
■Frontal cortex > automatism lower
extremities (cycling)
■Behind central sulcus > sensory
perceptions

19. Complex partial seizures
■Partially impaired consciousness
■Gesticulations, chewing, smacking,
simple routine actions (go wrong)
■Sometimes patient can prevent spread
■Often also have generalized seizures
■Postictal confusion

20. Drop attacks
■Sudden loss of muscle tone in legs
– Patient falls forward
■No loss of consciousness
■No other symptoms
■Mainly women >50

21. References
■Mumenthaler, fundamentals of neurology
> Epilepsy and its differential diagnosis
– Chapter 9
■Kuks neurology > Epilepsy and other
paroxysmal disorders
– Chapter 18