Epilepsy is characterized by recurrent seizures caused by abnormal neuronal activity in the brain. Seizures can be classified as partial or generalized depending on whether the abnormal activity is localized or bilateral. Common seizure types include tonic-clonic, absence, myoclonic, and simple or complex partial seizures. Symptoms vary depending on the seizure type and location of abnormal brain activity. Diagnosis involves patient history, witness accounts, and EEG testing. Treatment options include anti-seizure medications, diet changes, surgery, and vagus nerve stimulation.

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