epilepsy, its type, causes,diagnosis, management,prevention, first aid care

2. • Epilepsy is a condition in which
there is nerve cell in the brain
fire electrical impulses at a rate
up to four times higher than
normal.
(Medicinet, 2019)
DEFINITION

3. • The electrical signal travel in & out of the cell
which is control through the neurotransmitter.
• Excitatory neurotransmitter open the ion
channel to transmit the nerve impulse
• Inhibitory nerve transmitter close the channel
& stop relay impulse.
• During seizure cluster of brain cell temporarily
impaired & send excitatory signals over & over
which is known as paroxysmal
PATHOPHYSIOLOGY

4. • In this period there may be too much excitation
& too little inhibition.
• The main excitatory neurotransmitter are
glutamate & NMDA(N-methyl-D-aspartate
receptor) is the glutamate receptors which open
the ion channel allow calcium+ ion which cause
fasting long lasting activation of neurone
• On the other side inhibitory neurotransmitter is
GABA(Gamma aminobutyric acid) which bind by
GABA receptors which inhibit the signal by
opening calcium- ion.& control seizure.
Cont...

8. 1. Head trauma and brain injury -
2. Medical illnesses - Several medical conditions
such as:-
• Brain tumors
• Stroke
• Hemorrhage -
• Encephalitis/Brain abscess -
• Meningitis -
• Metabolic problems
• Fevers
3. Alcohol withdrawal
4. Use of illicit drugs
5. Drug withdrawal
CAUSES OF SEIZURES

9. • It is divided in to two types, those are:-
1. Focal seizures
• Focal seizures result from abnormal electrical activity
in one area of brain. Focal seizures can occur with or
without loss of consciousness:
A. Simple partial seizure. :- Only one part of the brain affected.
Patient is having abnormal feeling at that time like
abnormal teast, vision etc. Here there is no loss of
consciousness.
• Ex- At the talking someone having vision problem like
looking bright colours in front which are not actually.
B. Complex partial seizure. It affect large portion of the brain.
Here the patient do not have any idea about surrounding &
forget about the seizure activity. Here the person do
repeated action like chewing, nose touching, replacing same
object repeatedly
• Ex- At the time of playing someone stop & touching nose or
rubbing dress.
TYPES OF SEIZURE:-

12. 2. Generalized seizures
Seizures that appear to involve all areas of
the brain are called generalized seizures. Different
types of generalized seizures include:
A.Absence seizures:-Absence seizures characterized by
staring into space or by subtle body movements,
such as eye blinking or lip smacking. These seizures
may occur in clusters and cause a brief loss of
awareness.
B. Tonic seizures:- Tonic seizures cause stiffening of
muscles. These seizures usually affect muscles in
back, arms and legs and may cause to fall to the
ground.
C. Atonic seizures:- Atonic seizures, also known as drop
seizures, cause a loss of muscle control, which may
cause to suddenly collapse or fall down.

13. ABSENCE SEIZURE

15. Myoclonic seizures

16. • Clonic seizures:- Clonic seizures are associated
with repeated or rhythmic, jerking muscle
movements. These seizures usually affect the
neck, face and arms.
• Myoclonic seizures:- Myoclonic seizures
usually appear as sudden brief jerks or
twitches of arms and legs.
• Tonic-clonic seizures:- Tonic-clonic seizures,
previously known as grand mal seizures. It can
cause an abrupt loss of consciousness, body
stiffening and shaking, and sometimes loss of
bladder control or biting of tongue.

17. • A neurological exam:- Examination of behaviour,
motor abilities, mental function and other areas
to diagnose condition and determine the type of
epilepsy.
• Blood tests:- To check for signs of infections,
genetic conditions
• Electroencephalogram (EEG):- In this test,
electrodes are attached to scalp to record the
electrical activity of brain.
DIAGNOSIS

20. • Magnetic resonance imaging (MRI):- An MRI uses powerful
magnets and radio waves to create a detailed view of brain
to detect lesions or abnormalities in brain
• Functional MRI (fMRI):- A functional MRI measures the
changes in blood flow that occur when specific parts of
brain are working. It is used as an fMRI before surgery to
identify the exact locations of critical functions so that
surgeons can avoid injuring those places while operating.
• Positron emission tomography (PET):- PET scans use a small
amount of low-dose radioactive material that's injected into
a vein to help visualize active areas of the brain and detect
abnormalities.
• Single-photon emission computerized tomography
(SPECT). This test uses a small amount of low-dose
radioactive material that's injected into a vein to create a
detailed, 3-D map of the blood flow activity in brain during
seizures.

22. FMRI

23. PET

24. SPECT

25. • Neuropsychological tests. In these tests, there is
assessment of thinking, memory and speech skills. The
test results helps to determine which areas of brain are
affected.
• Statistical parametric mapping (SPM). SPM is a
method of comparing areas of the brain that have
increased metabolism during seizures to normal brains,
which can give doctors an idea of where seizures begin.
• Magneto encephalography (MEG). MEG measures the
magnetic fields produced by brain activity to identify
potential areas of seizure onset.
• Computerized tomography (CT) scan. A CT scan uses X-
rays to obtain cross-sectional images of brain. CT scans
can reveal abnormalities in brain that might be causing
seizures, such as tumors, bleeding and cysts

26. • MEDICAL MANAGEMENT:-
• Anti-epileptic drugs (AEDs)
• It works by changing the levels of chemicals in brain.
They don't cure epilepsy, but can stop seizures
happening.
• AEDs are available in a number of different
forms, including tablets, capsules, liquids and syrups
• Common types include:
• sodium valproate, carbamazepine, lamotrigine,
levetiracetam, oxcarbazepine, ethosuximide
• side effects:-
• Fatigue, Dizziness, Weight gain, Loss of bone density,
Skin rashes, Loss of coordination, Speech problems,
Memory and thinking problems
TREATMENT:-

27. • 1. Lesionectomy
A lesion such as blood vessel abnormality and tumors — are
prone to cause seizures. When the pre-operative testing indicates
that these lesions are the cause of the epilepsy, they can be
removed surgically.
• 2. Lobectomy
Each hemisphere, or half, of the brain is divided into four
main lobes — the frontal, temporal, parietal and occipital.
Seizures may arise within any of the lobes. A lobectomy is an
operation to remove a lobe of the brain. Removal of one of the
temporal lobes — called a temporal lobectomy — is the most
common type of epilepsy surgery performed.
• 3. Multilobar resection
A Multilobar resection involves removal of parts or all
of two or more lobes of the brain. It is reserved for more
widespread abnormalities causing seizures, providing that no
vital functions are in those regions.
SURGICAL MANAGEMENT

28. • . Hemispherectomy
Surgery to remove or disconnect a hemisphere.
• There are many subtypes of this surgery, the two
main divisions being anatomic and functional
hemispherectomy.
• Anatomic hemispherectomy involves removing the
entire half of the brain that is injured and is
generating the debilitating seizures. This includes the
four lobes of the hemisphere — frontal, temporal,
parietal and occipital.
• Functional hemispherectomy involves separating the
abnormal hemisphere from the normal one by
disconnecting fibers that communicate between the
two. Often, some portions of the abnormal brain are
surgically removed in order to perform this
disconnection.

29. • . Corpus callosotomy
The corpus callosum is one of the
main fiber bundles that connect the two
hemispheres. When debilitating generalized seizures
or falling-type seizures start on one side of the brain
and quickly spread to the other, patients may be
candidates for this procedure. A large part of this
fiber bundle may be cut to reduce the risk of spread
of seizure. The procedure is palliative, meaning that
although seizures may improve, they usually do not
disappear.
• 7. Stereotactic radiosurgery
Stereotactic radiosurgery involves the delivery of a
focused beam of radiation to a specific target area.
Gamma Knife radiosurgery, one of the most common
forms of radiosurgery, uses gamma rays to target the
area to be treated

30. CORPUS CALLOSUM

31. • Apart from medications and surgery, these potential therapies
offer an alternative for treating epilepsy:
• Vagus nerve stimulation. In vagus nerve stimulation, there is
implantation of a device called a vagus nerve stimulator
underneath the skin of the patient chest, similar to a heart
pacemaker. Wires from the stimulator are connected to the
vagus nerve in neck.
• The battery-powered device sends bursts of electrical energy
through the vagus nerve and to the brain. Device can usually
reduce seizures by 20 to 40 percent.
• Ketogenic diet. Some children with epilepsy have been able to
reduce their seizures by following a strict diet that's high in fats
and low in carbohydrates.
• In this diet, called a ketogenic diet, the body breaks down fats
instead of carbohydrates for energy. After a few years, some
children may be able to stop the ketogenic diet — under close
supervision of their doctors — and remain seizure-free.
Therapies

33. • Always Stay With the Person Until the Seizure Is
Over
• Pay Attention to the Length of the Seizure
• Prevent Injury by Moving Nearby Objects Out of
the Way
• Make the Person as Comfortable as Possible
• Keep Onlookers Away
• Do Not Forcibly Hold the Person Down
• Do Not Put Anything in the Person's Mouth!
GENERAL FIRST AID FOR ALL SEIZURE
TYPES:-

34. • Make Sure Their Breathing is Okay
• Do not Give Water, Pills or Food by Mouth
Unless the Person is Fully Alert
• Call for Emergency Medical Help
• Be Sensitive and Supportive, and Ask Others
to Do the Same

35. • Epilepsy can be prevented by following way:-
• Prevent traumatic brain injuries by using Use safety
belts, child passenger seats, airbags, bicycle helmets,
and motorcycle helmets to reduce motor vehicle and
traffic injuries.
• Regular health checkups for patient and family may
help prevent and find diseases.
• Lower the chances of stroke and heart disease by
eating well, exercising, and not smoking.
• Get vaccinated:- Immunizations lower chances of
infection that can sometimes lead to epilepsy.
• Wash hands and prepare food safely
• Stay healthy during pregnancy:- Some problems
during pregnancy and childbirth can lead to epilepsy.
SEIZURE PREVENTION TIPS