Epilepsy is characterized by recurrent seizures and is common, affecting 0.5% of the US population. Seizures can be focal, involving only part of the brain, or generalized, involving both hemispheres. Focal seizures may or may not involve impaired consciousness and can evolve to generalized seizures. Generalized seizures include absence seizures, myoclonic seizures, and tonic-clonic seizures. Epilepsy has many potential etiologies including genetic factors, structural lesions, metabolic disturbances, infections, and unknown causes. Diagnosis involves witnessing recurrent seizures and characteristic EEG changes.
This document presents a case study on seizures. It discusses the anatomy and physiology of the brain as it relates to seizures, noting that seizures result from sudden excessive neuronal discharge that can involve part or all of the brain. It describes different types of focal and generalized seizures. Potential causes of seizures include genetics, infection, age, acute febrile states, toxins, injury, and idiopathic factors. Surgical treatments for seizures aim to remove epileptogenic tissue or disconnect brain regions to reduce seizure activity.
The document discusses seizures and epilepsy, defining a seizure as a paroxysmal event due to abnormal neuronal activity in the brain, while epilepsy is defined as recurrent seizures due to an underlying chronic condition. It describes different types of seizures including partial seizures, which originate in one area of the brain, and generalized seizures, which involve both hemispheres simultaneously. Various causes, classifications, characteristics, evaluations, and treatments of seizures are discussed.
Epilepsy is defined as recurrent unprovoked seizures caused by abnormal neuronal activity in the brain. It has many potential causes including genetic factors, congenital malformations, infections, trauma, and tumors. Seizures are classified as partial or generalized based on where they originate and their effects. Treatment involves initiating anti-seizure medication after two seizures to prevent recurrence, with the medication chosen based on seizure type and potential side effects monitored. Lifestyle advice and emergency plans are also provided to patients.
This document summarizes information about epilepsy and seizures. It defines epilepsy as recurrent seizures and describes different types of seizures including focal-onset, generalized-onset, tonic-clonic, absence, myoclonic, atonic, and tonic seizures. Causes, pathophysiology, diagnosis and treatment options are discussed. Treatment involves antiepileptic medications as first-line treatment, with surgery, neurostimulation or dietary therapies as options for refractory cases. Potential risks and complications of treatments are also summarized.
Epilepsy is a chronic neurological disorder characterized by repeated epileptic seizures caused by abnormal neuronal discharges in the brain. It affects people of all ages worldwide, with over 50 million cases globally. Epilepsy has various causes including brain injury, infection, or genetic predisposition. Seizures can be generalized, affecting the whole brain, or partial, localized to one area. Diagnosis involves a medical history, examination, and tests like EEG or MRI. Treatment includes anti-seizure medications, surgery, dietary therapies, and devices like VNS. Future approaches may include radiosurgery to potentially replace invasive surgery.
The document discusses epilepsy, which is a condition characterized by recurrent seizures. Seizures are classified as either partial or generalized. Partial seizures can be simple, complex, or lead to secondary generalization. Generalized seizures include absence, tonic-clonic, tonic, and myoclonic seizures. Causes of seizures include cerebral anoxia, infections, drugs, tumors, and metabolic disturbances. Management involves airway protection, benzodiazepines, and long-term antiepileptic drugs like carbamazepine, valproate, and phenytoin.
Epilepsy is characterized by recurrent unprovoked seizures caused by abnormal neuronal activity in the brain. Key questions in evaluating epilepsy include determining seizure type, identifying underlying causes or syndromes, selecting appropriate anti-epileptic drug treatment, and determining criteria for stopping treatment or pursuing surgical options. Diagnosis involves a detailed history and examination, as well as EEG and potentially MRI to classify the epilepsy syndrome and guide management.
This document presents a case study on seizures. It discusses the anatomy and physiology of the brain as it relates to seizures, noting that seizures result from sudden excessive neuronal discharge that can involve part or all of the brain. It describes different types of focal and generalized seizures. Potential causes of seizures include genetics, infection, age, acute febrile states, toxins, injury, and idiopathic factors. Surgical treatments for seizures aim to remove epileptogenic tissue or disconnect brain regions to reduce seizure activity.
The document discusses seizures and epilepsy, defining a seizure as a paroxysmal event due to abnormal neuronal activity in the brain, while epilepsy is defined as recurrent seizures due to an underlying chronic condition. It describes different types of seizures including partial seizures, which originate in one area of the brain, and generalized seizures, which involve both hemispheres simultaneously. Various causes, classifications, characteristics, evaluations, and treatments of seizures are discussed.
Epilepsy is defined as recurrent unprovoked seizures caused by abnormal neuronal activity in the brain. It has many potential causes including genetic factors, congenital malformations, infections, trauma, and tumors. Seizures are classified as partial or generalized based on where they originate and their effects. Treatment involves initiating anti-seizure medication after two seizures to prevent recurrence, with the medication chosen based on seizure type and potential side effects monitored. Lifestyle advice and emergency plans are also provided to patients.
This document summarizes information about epilepsy and seizures. It defines epilepsy as recurrent seizures and describes different types of seizures including focal-onset, generalized-onset, tonic-clonic, absence, myoclonic, atonic, and tonic seizures. Causes, pathophysiology, diagnosis and treatment options are discussed. Treatment involves antiepileptic medications as first-line treatment, with surgery, neurostimulation or dietary therapies as options for refractory cases. Potential risks and complications of treatments are also summarized.
Epilepsy is a chronic neurological disorder characterized by repeated epileptic seizures caused by abnormal neuronal discharges in the brain. It affects people of all ages worldwide, with over 50 million cases globally. Epilepsy has various causes including brain injury, infection, or genetic predisposition. Seizures can be generalized, affecting the whole brain, or partial, localized to one area. Diagnosis involves a medical history, examination, and tests like EEG or MRI. Treatment includes anti-seizure medications, surgery, dietary therapies, and devices like VNS. Future approaches may include radiosurgery to potentially replace invasive surgery.
The document discusses epilepsy, which is a condition characterized by recurrent seizures. Seizures are classified as either partial or generalized. Partial seizures can be simple, complex, or lead to secondary generalization. Generalized seizures include absence, tonic-clonic, tonic, and myoclonic seizures. Causes of seizures include cerebral anoxia, infections, drugs, tumors, and metabolic disturbances. Management involves airway protection, benzodiazepines, and long-term antiepileptic drugs like carbamazepine, valproate, and phenytoin.
Epilepsy is characterized by recurrent unprovoked seizures caused by abnormal neuronal activity in the brain. Key questions in evaluating epilepsy include determining seizure type, identifying underlying causes or syndromes, selecting appropriate anti-epileptic drug treatment, and determining criteria for stopping treatment or pursuing surgical options. Diagnosis involves a detailed history and examination, as well as EEG and potentially MRI to classify the epilepsy syndrome and guide management.
This document provides information on seizures and epilepsy. It defines seizures as abnormal excessive hypersynchronous discharges from the central nervous system. Seizures can be classified as partial or generalized. Partial seizures originate in a specific area of the brain and include simple partial and complex partial seizures. Generalized seizures involve both hemispheres and include absence seizures (petit mal), tonic-clonic seizures (grand mal), tonic, atonic, and myoclonic seizures. The document describes the clinical features and EEG patterns associated with different seizure types.
This document provides information about epilepsy and different types of seizures. It begins with defining the key differences between seizures and epilepsy, noting that epilepsy refers to a tendency for recurrent seizures. Several types of seizures are then described in detail, including generalized seizures (such as absence seizures, tonic-clonic seizures, atonic seizures, and myoclonic seizures) and partial seizures (simple, complex, and those with secondary generalization). Causes of epilepsy are discussed. The document provides an overview of epilepsy and classifications of seizure types.
This document classifies and defines different types of seizures. It discusses the importance of determining the seizure type to identify the cause, select appropriate treatment, and provide a prognosis. Seizures are classified as either focal or generalized. Focal seizures originate in one area of the brain, while generalized seizures involve both hemispheres. Different generalized seizures include tonic-clonic, absence, myoclonic, atonic, and others. Focal seizures can be simple, complex, or start focally and spread. The document provides detailed descriptions and diagrams of the clinical presentations and brain mechanisms of several common seizure types.
The document provides information about epilepsy including:
1. It defines epilepsy as a condition with recurrent seizures due to an underlying chronic process, and classifies seizures as either partial or generalized depending on where they originate in the brain.
2. Common epilepsy syndromes are described such as temporal lobe epilepsy, Lennox-Gastaut syndrome, and West syndrome. Causes of epilepsy include genetic factors, injuries, infections, and tumors.
3. The diagnosis involves evaluating the patient's medical history and performing tests like an EEG to determine the seizure type and localization. Differential diagnoses include syncope, migraines, and psychogenic seizures.
This document describes various seizure semiologies and their associated symptomatogenic zones. It discusses different types of auras including somatosensory, visual, auditory, olfactory, gustatory, autonomic, psychic, and abdominal auras. It also outlines different types of motor seizures including tonic, clonic, tonic-clonic, versive, hypermotor, gelastic, atonic, hypomotor, akinetic, and negative myoclonic seizures. Additional lateralizing signs discussed include dystonic posturing, ictal speech, post-ictal aphasia, Todd's paralysis, post-ictal nose wipe, ictal nystagmus, peri-ictal water
This document summarizes pathology findings related to epilepsy. It discusses classifications of mesial temporal sclerosis and cortical dysplasia, relating histopathological features to surgical outcomes. It defines "dual pathology" in temporal lobe epilepsy as involvement of both the hippocampus and neocortex. Additional lesions commonly associated with epilepsy mentioned include cortical dysplasias, vascular malformations, gliomas, and Rasmussen syndrome.
DEFINITION :
It is defined as abnormal ,paroxysmal, excessive, involuntary neurological discharge from the brain which may be manifested as –
Loss of Conciousness,
Abnormal- Motor
- Sensory ,
- Behavioral disturbance
- and Autonomic dysfunction.
This document defines seizures and epilepsy and describes different types of seizures. It discusses partial and generalized seizures. Partial seizures are further divided into simple and complex seizures. Generalized seizures include absence, tonic, clonic, tonic-clonic, myoclonic and atonic seizures. Various case examples are provided to illustrate the clinical presentation of different seizure types. Risk factors, causes and classification of seizures are also outlined.
This document provides an overview of the ILAE classification of seizures. It begins with definitions of key terms like seizure, epilepsy, aura, etc. It describes the purpose of the ILAE classification system and how it categorizes seizures as either partial or generalized based on clinical manifestations and EEG findings. The classifications include simple and complex partial seizures as well as generalized seizure types like absence seizures, myoclonic seizures, and tonic-clonic seizures. Electrographic characteristics are also discussed for different seizure types. The document concludes with references for further information.
1. The document discusses different types of epileptic seizures including generalized tonic-clonic seizures, absence seizures, myoclonic seizures, simplex partial seizures, and complex partial seizures.
2. It also covers the treatment of epilepsy including common antiepileptic drugs like phenobarbital, carbamazepine, valproic acid, and mechanisms of action like inhibition of sodium and calcium channels or potentiation of GABA.
3. Side effects of antiepileptic drugs are discussed and can include central nervous system effects, allergic reactions, and chronic issues affecting organs or body weight.
Epilepsy is a disorder of the central nervous system characterized by loss of consciousness and convulsions, also known as seizures. Seizures can be frightening and unpredictable, happening at any time. The document provides information on what to do and not do during a seizure, noting it is important to know first aid steps as someone's life could be saved or ended depending on the response. It aims to educate readers so they can potentially provide life saving assistance if they witness a seizure.
Epilepsy: Diagnostics, Medications, Myths and Factsabdul waheed
The document discusses epilepsy, a chronic brain disorder characterized by recurrent seizures. It provides details on the types of seizures, experimental models used to study epilepsy, antiepileptic drugs and their mechanisms of action, diagnostic tools, myths and facts about epilepsy, and references. Epilepsy affects people of all ages worldwide and imbalances in neurotransmitters like glutamate and GABA are believed to underlie seizure mechanisms.
Abnormal electrical activity in the brain causes seizures, which appear differently depending on the affected brain region. Seizures are classified by type, such as focal seizures originating in one brain area and spreading, generalized seizures affecting both brain hemispheres simultaneously, or status epilepticus involving continuous seizures. Proper classification is important for treatment selection as some drugs work best for specific seizure types.
Epilepsy is a neurological disorder caused by abnormal electrical activity in the brain that results in seizures. Seizures can be triggered by factors like lack of sleep, flashing lights, or missing medication. There are different types of seizures including tonic-clonic, absence, and atonic seizures. Epilepsy occurs when someone has two or more unprovoked seizures. While there is no cure for epilepsy, treatment options include anti-seizure medications, surgery, or vagus nerve stimulation. Famous people who have lived with epilepsy include Prince, Vincent Van Gogh, and Theodore Roosevelt.
Epilepsy is a chronic condition characterized by recurrent seizures caused by excessive neuronal activity in the brain. Seizures occur when clusters of neurons fire abnormally, driven primarily by glutamate and its NMDA receptor. Some people have genetic mutations affecting the GABA receptor, reducing inhibition of neuronal signals. Seizures can be focal, originating in one brain region, or generalized across both hemispheres. Focal seizures may or may not impair consciousness. Generalized seizures include tonic, clonic, myoclonic, absence and tonic-clonic types. Diagnosis involves tests like MRI, CT and EEG to identify potential causes. Treatment options include anticonvulsant drugs, epilepsy surgery, nerve stimulation, and
Seizures are caused by abnormal electrical activity in the brain. There are many types of seizures that can cause mild to severe symptoms depending on which part of the brain is affected. Seizures are generally managed through medication, emergency response during seizures, ongoing nursing assessment, and diagnostic evaluation by medical providers when needed.
This document discusses psychiatric presentations in epilepsy. It begins by noting the increased prevalence of psychiatric disorders in patients with epilepsy compared to the general population. It then categorizes psychiatric disorders seen in epilepsy into several groups: disorders related to the underlying brain pathology causing epilepsy, disorders related to the seizure occurrence itself (pre-ictal, ictal, post-ictal), and interictal psychiatric disorders not clearly related to seizures. Specific syndromes and disorders are discussed within each category. Ictal phenomena include epileptic auras, automatisms, and non-convulsive status epilepticus, which can resemble psychiatric symptoms but are distinguished by their brief and stereotyped nature.
This document provides an overview of epilepsy, including definitions, types of seizures, causes, diagnosis, and treatment. Some key points:
- Epilepsy is defined as recurrent seizures due to an underlying neurological condition. A seizure is a brief episode caused by abnormal neuronal activity in the brain.
- Seizures are classified as either generalized or partial/focal, depending on where in the brain the abnormal activity originates. Common types include generalized tonic-clonic, absence, myoclonic, atonic, and complex partial seizures.
- Epilepsy has various causes including genetic factors, brain injury, infection, tumors, and metabolic imbalances. Diagnosis involves a neurological exam, medical history
This document provides an overview of seizures in childhood, including definitions, classifications, etiologies, approaches, and complications. It discusses the main types of seizures including focal, generalized tonic-clonic, absence, myoclonic and neonatal seizures. It also covers febrile seizures and status epilepticus. The management of seizures involves stabilizing the child, treating the underlying cause, and using anticonvulsant medications like phenobarbital, phenytoin or benzodiazepines. Outcomes depend mainly on the underlying etiology.
The Shake Down: An In-Depth Look at EpilepsyAmanda Furda
This document provides an overview of epilepsy in dogs and cats. It defines seizures and describes different types including generalized tonic-clonic, focal, and primary generalized seizures. Causes of seizures include structural abnormalities, idiopathic epilepsy which may have a genetic basis, and reactive seizures caused by systemic issues. Testing is recommended to rule out underlying metabolic or structural issues. Treatment involves medications while emergency management focuses on seizure termination and postictal care.
This document provides information on seizures and epilepsy. It defines seizures as abnormal excessive hypersynchronous discharges from the central nervous system. Seizures can be classified as partial or generalized. Partial seizures originate in a specific area of the brain and include simple partial and complex partial seizures. Generalized seizures involve both hemispheres and include absence seizures (petit mal), tonic-clonic seizures (grand mal), tonic, atonic, and myoclonic seizures. The document describes the clinical features and EEG patterns associated with different seizure types.
This document provides information about epilepsy and different types of seizures. It begins with defining the key differences between seizures and epilepsy, noting that epilepsy refers to a tendency for recurrent seizures. Several types of seizures are then described in detail, including generalized seizures (such as absence seizures, tonic-clonic seizures, atonic seizures, and myoclonic seizures) and partial seizures (simple, complex, and those with secondary generalization). Causes of epilepsy are discussed. The document provides an overview of epilepsy and classifications of seizure types.
This document classifies and defines different types of seizures. It discusses the importance of determining the seizure type to identify the cause, select appropriate treatment, and provide a prognosis. Seizures are classified as either focal or generalized. Focal seizures originate in one area of the brain, while generalized seizures involve both hemispheres. Different generalized seizures include tonic-clonic, absence, myoclonic, atonic, and others. Focal seizures can be simple, complex, or start focally and spread. The document provides detailed descriptions and diagrams of the clinical presentations and brain mechanisms of several common seizure types.
The document provides information about epilepsy including:
1. It defines epilepsy as a condition with recurrent seizures due to an underlying chronic process, and classifies seizures as either partial or generalized depending on where they originate in the brain.
2. Common epilepsy syndromes are described such as temporal lobe epilepsy, Lennox-Gastaut syndrome, and West syndrome. Causes of epilepsy include genetic factors, injuries, infections, and tumors.
3. The diagnosis involves evaluating the patient's medical history and performing tests like an EEG to determine the seizure type and localization. Differential diagnoses include syncope, migraines, and psychogenic seizures.
This document describes various seizure semiologies and their associated symptomatogenic zones. It discusses different types of auras including somatosensory, visual, auditory, olfactory, gustatory, autonomic, psychic, and abdominal auras. It also outlines different types of motor seizures including tonic, clonic, tonic-clonic, versive, hypermotor, gelastic, atonic, hypomotor, akinetic, and negative myoclonic seizures. Additional lateralizing signs discussed include dystonic posturing, ictal speech, post-ictal aphasia, Todd's paralysis, post-ictal nose wipe, ictal nystagmus, peri-ictal water
This document summarizes pathology findings related to epilepsy. It discusses classifications of mesial temporal sclerosis and cortical dysplasia, relating histopathological features to surgical outcomes. It defines "dual pathology" in temporal lobe epilepsy as involvement of both the hippocampus and neocortex. Additional lesions commonly associated with epilepsy mentioned include cortical dysplasias, vascular malformations, gliomas, and Rasmussen syndrome.
DEFINITION :
It is defined as abnormal ,paroxysmal, excessive, involuntary neurological discharge from the brain which may be manifested as –
Loss of Conciousness,
Abnormal- Motor
- Sensory ,
- Behavioral disturbance
- and Autonomic dysfunction.
This document defines seizures and epilepsy and describes different types of seizures. It discusses partial and generalized seizures. Partial seizures are further divided into simple and complex seizures. Generalized seizures include absence, tonic, clonic, tonic-clonic, myoclonic and atonic seizures. Various case examples are provided to illustrate the clinical presentation of different seizure types. Risk factors, causes and classification of seizures are also outlined.
This document provides an overview of the ILAE classification of seizures. It begins with definitions of key terms like seizure, epilepsy, aura, etc. It describes the purpose of the ILAE classification system and how it categorizes seizures as either partial or generalized based on clinical manifestations and EEG findings. The classifications include simple and complex partial seizures as well as generalized seizure types like absence seizures, myoclonic seizures, and tonic-clonic seizures. Electrographic characteristics are also discussed for different seizure types. The document concludes with references for further information.
1. The document discusses different types of epileptic seizures including generalized tonic-clonic seizures, absence seizures, myoclonic seizures, simplex partial seizures, and complex partial seizures.
2. It also covers the treatment of epilepsy including common antiepileptic drugs like phenobarbital, carbamazepine, valproic acid, and mechanisms of action like inhibition of sodium and calcium channels or potentiation of GABA.
3. Side effects of antiepileptic drugs are discussed and can include central nervous system effects, allergic reactions, and chronic issues affecting organs or body weight.
Epilepsy is a disorder of the central nervous system characterized by loss of consciousness and convulsions, also known as seizures. Seizures can be frightening and unpredictable, happening at any time. The document provides information on what to do and not do during a seizure, noting it is important to know first aid steps as someone's life could be saved or ended depending on the response. It aims to educate readers so they can potentially provide life saving assistance if they witness a seizure.
Epilepsy: Diagnostics, Medications, Myths and Factsabdul waheed
The document discusses epilepsy, a chronic brain disorder characterized by recurrent seizures. It provides details on the types of seizures, experimental models used to study epilepsy, antiepileptic drugs and their mechanisms of action, diagnostic tools, myths and facts about epilepsy, and references. Epilepsy affects people of all ages worldwide and imbalances in neurotransmitters like glutamate and GABA are believed to underlie seizure mechanisms.
Abnormal electrical activity in the brain causes seizures, which appear differently depending on the affected brain region. Seizures are classified by type, such as focal seizures originating in one brain area and spreading, generalized seizures affecting both brain hemispheres simultaneously, or status epilepticus involving continuous seizures. Proper classification is important for treatment selection as some drugs work best for specific seizure types.
Epilepsy is a neurological disorder caused by abnormal electrical activity in the brain that results in seizures. Seizures can be triggered by factors like lack of sleep, flashing lights, or missing medication. There are different types of seizures including tonic-clonic, absence, and atonic seizures. Epilepsy occurs when someone has two or more unprovoked seizures. While there is no cure for epilepsy, treatment options include anti-seizure medications, surgery, or vagus nerve stimulation. Famous people who have lived with epilepsy include Prince, Vincent Van Gogh, and Theodore Roosevelt.
Epilepsy is a chronic condition characterized by recurrent seizures caused by excessive neuronal activity in the brain. Seizures occur when clusters of neurons fire abnormally, driven primarily by glutamate and its NMDA receptor. Some people have genetic mutations affecting the GABA receptor, reducing inhibition of neuronal signals. Seizures can be focal, originating in one brain region, or generalized across both hemispheres. Focal seizures may or may not impair consciousness. Generalized seizures include tonic, clonic, myoclonic, absence and tonic-clonic types. Diagnosis involves tests like MRI, CT and EEG to identify potential causes. Treatment options include anticonvulsant drugs, epilepsy surgery, nerve stimulation, and
Seizures are caused by abnormal electrical activity in the brain. There are many types of seizures that can cause mild to severe symptoms depending on which part of the brain is affected. Seizures are generally managed through medication, emergency response during seizures, ongoing nursing assessment, and diagnostic evaluation by medical providers when needed.
This document discusses psychiatric presentations in epilepsy. It begins by noting the increased prevalence of psychiatric disorders in patients with epilepsy compared to the general population. It then categorizes psychiatric disorders seen in epilepsy into several groups: disorders related to the underlying brain pathology causing epilepsy, disorders related to the seizure occurrence itself (pre-ictal, ictal, post-ictal), and interictal psychiatric disorders not clearly related to seizures. Specific syndromes and disorders are discussed within each category. Ictal phenomena include epileptic auras, automatisms, and non-convulsive status epilepticus, which can resemble psychiatric symptoms but are distinguished by their brief and stereotyped nature.
This document provides an overview of epilepsy, including definitions, types of seizures, causes, diagnosis, and treatment. Some key points:
- Epilepsy is defined as recurrent seizures due to an underlying neurological condition. A seizure is a brief episode caused by abnormal neuronal activity in the brain.
- Seizures are classified as either generalized or partial/focal, depending on where in the brain the abnormal activity originates. Common types include generalized tonic-clonic, absence, myoclonic, atonic, and complex partial seizures.
- Epilepsy has various causes including genetic factors, brain injury, infection, tumors, and metabolic imbalances. Diagnosis involves a neurological exam, medical history
This document provides an overview of seizures in childhood, including definitions, classifications, etiologies, approaches, and complications. It discusses the main types of seizures including focal, generalized tonic-clonic, absence, myoclonic and neonatal seizures. It also covers febrile seizures and status epilepticus. The management of seizures involves stabilizing the child, treating the underlying cause, and using anticonvulsant medications like phenobarbital, phenytoin or benzodiazepines. Outcomes depend mainly on the underlying etiology.
The Shake Down: An In-Depth Look at EpilepsyAmanda Furda
This document provides an overview of epilepsy in dogs and cats. It defines seizures and describes different types including generalized tonic-clonic, focal, and primary generalized seizures. Causes of seizures include structural abnormalities, idiopathic epilepsy which may have a genetic basis, and reactive seizures caused by systemic issues. Testing is recommended to rule out underlying metabolic or structural issues. Treatment involves medications while emergency management focuses on seizure termination and postictal care.
The shake down: An in depth look at epilepsyupstatevet
This document provides an in-depth overview of epilepsy in dogs and cats. It defines seizures, describes different seizure types including focal and generalized seizures. It discusses causes of seizures including idiopathic epilepsy which has a genetic basis in some breeds, structural epilepsy caused by brain abnormalities, and reactive seizures triggered by systemic issues. The document outlines testing, treatment including common anti-seizure medications like phenobarbital, and conditions that can mimic seizures.
This document provides an overview of approaches to seizure and epilepsy diagnosis and classification. It discusses the differential diagnosis of seizures and conditions that can mimic seizures like syncope. It describes focal seizures which originate in one hemisphere and can involve motor, sensory or cognitive symptoms. Generalized seizures rapidly engage both hemispheres and include absence seizures, tonic-clonic seizures and atonic seizures. Seizures are classified based on their origin and symptoms. The EEG findings for different seizure types are also outlined.
This presentation summarizes key information about epilepsy, including its definition, types of seizures, and treatment options. Epilepsy is characterized by excessive and synchronous neuronal discharge that can cause loss of consciousness or abnormal movements. Seizures are classified as partial or generalized. Partial seizures are limited to one part of the brain while generalized seizures affect both hemispheres. Common generalized seizure types include tonic-clonic, myoclonic, atonic, and absence seizures. New anti-seizure drugs discussed include vigabatrin, zonisamide, and topiramate. The presentation stresses the importance of planning and prenatal vitamin intake for women with epilepsy who are considering pregnancy.
Epilepsy is characterized by recurrent seizures that result from abnormal neuronal activity in the brain. Seizures can be generalized, originating simultaneously across both hemispheres of the brain, or partial, originating in a localized region of the brain. Generalized seizures include absence seizures, tonic-clonic seizures, atonic seizures, and myoclonic seizures. Partial seizures can be simple, with motor, sensory or other symptoms but no change in consciousness, or complex, with impaired consciousness. Seizures can have various causes including genetic factors, head injuries, infections, or other acquired brain abnormalities. Evaluation and treatment involve diagnostic testing, medication, and management of any underlying conditions.
The document discusses seizure disorders and epilepsy. It defines epilepsy as a brain disorder causing seizures from abnormal electrical activity in the brain. Seizures are classified as partial or generalized depending on where they originate and spread in the brain. Common causes of epilepsy include genetic factors, brain injuries, infections, and metabolic imbalances. Diagnosis involves a medical history, neurological exam, EEG, and brain imaging. Treatment focuses on medications to control seizures and sometimes surgery for refractory cases. Nursing care includes safety measures during seizures and education on epilepsy management.
The document provides guidelines for the management of childhood epilepsy. It discusses the classification of seizures and epilepsy syndromes. Some key seizure types include partial seizures, generalized seizures like absence seizures, myoclonic seizures, atonic seizures, and tonic-clonic seizures. It also discusses approaches to diagnosing and treating common idiopathic or genetic epilepsy syndromes in children like benign childhood epilepsy with centrotemporal spikes and childhood absence epilepsy. Treatment involves antiepileptic drugs and considering neuroimaging in some cases.
This document defines pediatric seizures and epilepsy, describes the different types of seizures including partial, generalized, absence, myoclonic, atonic, and tonic-clonic seizures. It discusses the epidemiology, pathophysiology, classification, and etiologies of seizures in children. Seizures are common in children, especially those under 3 years old, and have different characteristics compared to seizures in adults due to the immature nervous system in children. Febrile seizures occur in 3% of children. Genetic factors account for 20% of childhood epilepsy cases.
Epilepsy is defined as recurrent seizures caused by excessive electrical discharges in the brain. It affects people of all ages worldwide. The causes of epilepsy can include genetic factors, structural abnormalities, metabolic disorders, infections, or unknown causes. Seizures occur due to an imbalance between excitatory and inhibitory signals in the brain. Epilepsy is diagnosed based on having two or more unprovoked seizures or one seizure with a high risk of future seizures. Seizures can vary in their clinical presentation depending on the area of brain involved.
- Seizures are caused by abnormal excessive neuronal activity in the brain and can be classified as either partial or generalized seizures. Partial seizures originate in a localized region of the brain while generalized seizures involve both hemispheres.
- Common types of generalized seizures include absence seizures, characterized by brief lapses of consciousness, and tonic-clonic seizures which involve tonic muscle contraction followed by clonic movements.
- Complex partial seizures originate in the temporal lobe and involve psychic experiences such as hallucinations followed by automatisms like lip smacking and confusion after the seizure.
This document discusses the classification and diagnosis of seizures and epilepsy. It defines key terms like seizure, epilepsy, and types of seizures. Seizures are classified as partial or generalized. Partial seizures are further divided into simple and complex, based on effects on consciousness. Generalized seizures include absence, tonic-clonic, myoclonic, tonic, clonic, and atonic. The document also discusses evaluation methods, differential diagnosis, comorbidities, mortality risks, and treatment approaches including anti-epileptic drugs.
This document provides an overview of epilepsy and psychiatric aspects of epilepsy. It defines key terms like seizure, epilepsy, and status epilepticus. It describes different types of seizures including partial seizures, generalized seizures, tonic seizures, atonic seizures, myoclonic seizures, and absence seizures. Causes of epilepsy like genetic predisposition, trauma, poisoning, and tumors are discussed. The document also covers management of psychiatric patients with epilepsy and first aid for pre-ictal, ictal, and post-ictal phases of seizures.
This document discusses seizures and epilepsy. It defines a seizure as abnormal excessive neuronal activity in the brain and epilepsy as a predisposition to recurrent seizures. Seizures are classified as acute symptomatic, occurring within a week of an injury or illness, or unprovoked. Epilepsy is diagnosed if there are two unprovoked seizures or one seizure and high risk of recurrence. Causes include genetic, structural, metabolic, immune and infectious factors. Seizures are also classified as focal or generalized. Treatment involves controlling seizures with antiseizure medication while minimizing side effects and maintaining quality of life. Goals are seizure freedom, monitoring for side effects, and considering medication withdrawal after being seizure-free for two years.
This document provides information about epilepsy and emergency medication management. It defines epilepsy and seizures, describes different types of seizures and their classification. It discusses general seizure management, status epilepticus, sudden unexpected death in epilepsy, risks and reducing risks. The document outlines anti-epileptic medications including diazepam and midazolam. It stresses the importance of individual seizure management plans and keeping a seizure diary.
Seizures are caused by abnormal electrical activity in the brain and can be classified as generalized or partial based on where they originate. Common types include generalized tonic-clonic, absence, myoclonic, and complex partial seizures. Seizures have various causes like genetics, head trauma, infections, and developmental disorders. Diagnosis involves a medical history, neurological exam, EEG, and imaging tests. Treatment primarily consists of anti-seizure medications to control seizures, while management focuses on preventing complications and improving quality of life.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
2. Essentials of Diagnosis
• Recurrent seizures.
• Characteristic
electroencephalographic
changes accompany seizures.
• Mental status abnormalities or
focal neurologic symptoms may
persist for hours postictally.
3. General Considerations
The term "epilepsy" denotes any
disorder characterized by recurrent
unprovoked seizures.
A seizure is a transient disturbance
of cerebral function due to an
abnormal paroxysmal neuronal
discharge in the brain.
Epilepsy is common, affecting
approximately 0.5% of the population
in the United States
4. Etiology
Genetic Epilepsy
This category encompasses a broad
range of disorders, for which the age at
onset ranges from the neonatal period
to adolescence or even later in life.
Monogenic disorders tend to exhibit an
autosomal dominant pattern of
inheritance, and where the mutation is
known, the responsible gene often
encodes a neuronal ion channel.
5. Structural/Metabolic Epilepsy
There are many causes for recurrent
seizures
Metabolic disorders
Withdrawal from alcohol or drugs.
Uremia and
Hypoglycemia or hyperglycemia
Since these seizures are provoked by a
readily reversible cause, this would not
be considered epilepsy
6. Trauma
An important cause of seizures at any age especially in
young adults.
Posttraumatic epilepsy is more likely to develop if the
dura mater was penetrated and generally becomes
manifest within 2 years following the injury.
However, seizures developing in the first week after
head injury do not necessarily imply that future attacks
will occur.
There is no clear evidence that prophylactic
anticonvulsant drug treatment reduces the incidence of
posttraumatic epilepsy.
7. Tumors and other space-occupying lesions
Neoplasms may lead to seizures at any age
Especially important cause of seizures in middle and
later life
Seizures are commonly the initial symptoms of the
tumor
often are focal in character.
They are most likely to occur with structural lesions
involving the frontal, parietal, or temporal regions.
Tumors must be excluded by imaging studies (MRI
preferred over CT) in all patients with onset of seizures
after 30 years of age, focal seizures or signs, or a
progressive seizure disorder.
8. Vascular diseases
Become increasingly frequent causes of
seizures with advancing age
Are the most common cause of seizures with
onset at age 60 years or older
10. Infectious diseases
Must be considered in all age groups
potentially reversible causes of seizures.
Seizures may occur with an acute infective or inflammatory
illness
Bacterial meningitis or herpes encephalitis
or in patients with more longstanding or chronic disorders,
such as neurosyphilis or cerebral cysticercosis.
In patients with AIDS, they may result from central nervous
system toxoplasmosis, cryptococcal meningitis, secondary viral
encephalitis, or other infective complications.
Seizures are a common sequela of supratentorial brain
abscess, developing most frequently in the first year after
treatment.
13. Classification of Seizures
The International League Against Epilepsy
distinguishes seizures affecting only part of the
brain (focal seizures) from those that are
generalized.
14. Seizure classification.
Seizure Type
Key Features
Focal seizures
Other Associated Features
Involvement of only a restricted
part of brain; may evolve to a
bilateral, convulsive seizure
Without
Observable focal motor or autonomic
impairment of
symptoms, or subjective sensory or
consciousness
psychic symptoms may occur
With impairment
Above symptoms may precede,
of consciousness
accompany, or follow the period of
altered responsiveness
Generalized
Diffuse involvement of brain at
seizures
onset
Absence (petit
mal)
Consciousness impaired briefly;
May have clonic, tonic, or atonic (ie,
patient often unaware of attacks
loss of postural tone) components;
autonomic components (eg, enuresis);
or accompanying automatisms
Almost always begin in childhood and
frequently cease by age 20
Atypical absences
May be more gradual in onset
More marked changes in tone may
and termination than typical
occur
absence
Myoclonic
Single or multiple myoclonic
jerks
Tonic-clonic
Tonic phase: Sudden loss of
May be accompanied by tongue biting,
consciousness, with rigidity and
incontinence, or aspiration; commonly
arrest of respiration, lasting < 1
followed by postictal confusion
minute
(grand mal)
variable in duration
Clonic phase: Jerking occurs,
usually for < 2–3 minutes
Flaccid coma: Variable duration
Status epilepticus
Repeated seizures without
recovery between them; a fixed
and enduring epileptic condition
lasting ≥ 30 minutes
15. Focal Seizures
The initial clinical and EEG manifestations of
partial seizures indicate that only a restricted part
of one cerebral hemisphere has been activated.
The ictal manifestations depend on the area of
the brain involved
Focal seizures sometimes involve impairment of
consciousness and may evolve to convulsive
seizures, in a process previously called secondary
generalization.
16. Without impairment of consciousness
Seizures may be manifested by focal motor symptoms
(convulsive jerking)
Somatosensory symptoms (eg, paresthesias or tingling) that
spread (or “march”) to different parts of the limb or body
depending on their cortical representation
Were previously described as “simple partial” seizures
In other instances, special sensory symptoms (eg, light
flashes or buzzing) indicate involvement of visual, auditory,
olfactory, or gustatory regions of the brain
There may be autonomic symptoms or signs (eg, abnormal
epigastric sensations, sweating, flushing, pupillary dilation).
The sole manifestations of some seizures are phenomena
such as dysphasia, dysmnesic symptoms (eg, déjà vu, jamais
vu), affective disturbances, illusions, or structured
hallucinations, but such symptoms are usually accompanied
by impairment of consciousness.
17. With impairment of consciousness
Impaired consciousness or responsiveness
may be preceded, accompanied, or followed
by the various symptoms mentioned above
Automatisms may occur.
Such dyscognitive seizures were previously
called "complex partial" seizures.
18. Generalized Seizures
There are several different varieties of
generalized seizures
In some circumstances, seizures cannot
be classified because of incomplete
information or because they do not fit
into any category.
19. Absence seizures
These are characterized by impairment of consciousness, sometimes
with mild clonic, tonic, or atonic components (ie, reduction or loss of
postural tone), autonomic components (eg, enuresis)
Or accompanying automatisms
Onset and termination of attacks are abrupt
If attacks occur during conversation, the patient may miss a few words
or may break off in midsentence for a few seconds
The impairment of external awareness is so brief that the patient is
unaware of it
Absence ("petit mal") seizures almost always begin in childhood and
frequently cease by the age of 20 years or are then replaced by other
forms of generalized seizure
Electroencephalographically, such attacks are associated with bursts of
bilaterally synchronous and symmetric 3-Hz spike-and-wave activity
A normal background in the electroencephalogram and normal or
above-normal intelligence imply a good prognosis for the ultimate
cessation of these seizures.
20. Atypical absence seizures
There may be more marked changes in tone, or attacks may
have a more gradual onset and termination than in typical
absence seizures.
They commonly occur in patients with multiple seizure types
May be accompanied by developmental delay or mental
retardation
Are associated with slower spike-wave discharges than those in
typical absence attacks.
21. Myoclonic seizures
Myoclonic seizures consist of single or multiple myoclonic jerks.
Tonic-clonic ("grand mal") seizures
In these seizures, which are characterized by sudden loss of consciousness
the patient becomes rigid and falls to the ground
respiration is arrested.
This tonic phase, which usually lasts for < 1 minute, is followed by a clonic phase in which
there is jerking of the body musculature that may last for 2 or 3 minutes
followed by a stage of flaccid coma
During the seizure, the tongue or lips may be bitten, urinary or fecal incontinence may occur
the patient may be injured.
Immediately after the seizure, the patient may recover consciousness, drift into sleep, have a
further convulsion without recovery of consciousness between the attacks (status
epilepticus),
or after recovering consciousness have a further convulsion (serial seizures).
In other cases, patients will behave in an abnormal fashion in the immediate postictal period,
without subsequent awareness or memory of events (postepileptic automatism).
Headache, disorientation, confusion, drowsiness, nausea, soreness of the muscles, or some
combination of these symptoms commonly occurs postictally.
Tonic, clonic, or atonic seizures
Loss of consciousness may occur with either the tonic or clonic accompaniments
described above, especially in children.
Atonic seizures (epileptic drop attacks) have also been described.
22. Clinical Findings
Symptoms and Signs
Nonspecific changes such as headache, mood alterations, lethargy, and myoclonic jerking alert
some patients to an impending seizure hours before it occurs.
These prodromal symptoms are distinct from the aura; the aura that may precede a generalized
seizure by a few seconds or minutes is itself a part of the attack and it arises locally from a
restricted part of the brain
In most patients, seizures occur unpredictably at any time and without any relationship to posture
or ongoing activities
Occasionally, however, they occur at a particular time (eg, during sleep) or in relation to external
precipitants such as lack of sleep, missed meals, emotional stress, menstruation, alcohol ingestion
(or alcohol withdrawalbelow), or use of certain drugs
Fever and nonspecific infections may also precipitate seizures in epileptic patients.
In a few patients, seizures are provoked by specific stimuli such as flashing lights or a flickering
television set (photosensitive epilepsy), music, or reading.
Clinical examination
No abnormality between seizures in patients with idiopathic epilepsy
In the immediate postictal period, extensor plantar responses may be seen
The presence of lateralized or focal signs postictally suggests that seizures may have a focal origin
In patients with symptomatic epilepsy, the findings on examination will reflect the underlying
cause.
23. Imaging
MRI is indicated for patients with focal neurologic symptoms or signs,
focal seizures, or electroencephalographic findings of a focal disturbance
some clinicians routinely order MRI for all patients with new-onset
seizure disorders.
CT is generally less sensitive than MRI to small structural brain
abnormalities but may be used when MRI is contraindicated (eg, in a
patient with a metallic implant).
Such studies should be performed in patients with clinical evidence of a
progressive disorder and in those with new onset of seizures after the
age of 20 years because of the possibility of an underlying neoplasm.
24. Laboratory and Other Studies
Initial investigations should include complete blood count
serum glucose, electrolytes, creatinine, calcium, magnesium
liver function tests to exclude various causes of seizures and to
provide a baseline for subsequent monitoring of long-term effects of
treatment
A lumbar puncture may be necessary when any sign of infection is
present or in the evaluation of new-onset seizures in the acute setting
Electroencephalography may support the clinical diagnosis of epilepsy
(by demonstrating paroxysmal abnormalities containing spikes or
sharp waves), provide a guide to prognosis, and help classify the
seizure disorder.
Classification of the disorder is important for determining the most
appropriate anticonvulsant drug with which to start treatment
For example, absence and focal seizures with impairment of
consciousness may be difficult to distinguish clinically, but the
electroencephalographic findings and treatment of choice differ in
these two conditions.
Finally, by localizing the epileptogenic source, the
electroencephalographic findings are important in evaluating
candidates for surgical treatment.
25. Differential Diagnosis
The distinction between the various disorders
likely to be confused with generalized seizures is
usually made on the basis of the history.
The importance of obtaining an eyewitness
account of the attacks cannot be
overemphasized.
26. Differential Diagnosis of Focal Seizures
Transient ischemic attacks
These attacks are distinguished from seizures by their longer
duration, lack of spread, and symptoms
Level of consciousness, which is unaltered, does not distinguish
them
There is a loss of motor or sensory function (eg, weakness or
numbness) with transient ischemic attacks, whereas positive
symptoms (eg, convulsive jerking or paresthesias) characterizes
seizures.
27. Rage attacks
Rage attacks are usually situational
lead to goal-directed aggressive
behavior
28. Panic attacks
These may be hard to distinguish from focal
seizures unless there is evidence of an
anxiety disorder between attacks
attacks have a clear relationship to external
circumstances.
29. Differential Diagnosis of Generalized Seizures
Syncope
Syncopal episodes usually occur in relation to postural change,
emotional stress, instrumentation, pain, or straining
They are typically preceded by pallor, sweating, nausea, and
malaise and lead to loss of consciousness accompanied by
flaccidity; recovery occurs rapidly with recumbency, and there is
no postictal headache or confusion
In some instances, however, motor accompaniments and urinary
incontinence may simulate a seizure.
30. Cardiac disease
Cerebral hypoperfusion due to a disturbance of cardiac
rhythm should be suspected in patients with known
cardiac or vascular disease or in elderly patients who
present with episodic loss of consciousness
Prodromal symptoms are typically absent
Repeated Holter monitoring may be necessary to
establish the diagnosis
Monitoring initiated by the patient ("event monitor")
may be valuable if the disturbances of consciousness
are rare
A relationship of attacks to physical activity and the
finding of a systolic murmur are suggestive of aortic
stenosis
31. Brainstem ischemia
Loss of consciousness is preceded or accompanied
by other brainstem signs
Basilar artery migraine and vertebrobasilar vascular
disease are discussed elsewhere in this chapter
32. Psychogenic nonepileptic seizure (PNES)
Simulates an epileptic seizure
PNES may occur due to a conversion disorder or malingering
Many patients also have true seizures or a family history of epilepsy.
Although a PNES tends to occur at times of emotional stress, this may also be the case
with true seizures.
Clinically, the attacks superficially resemble tonic-clonic seizures, but there may be
obvious preparation before a PNES.
Moreover, there is usually no tonic phase; instead, there may be an asynchronous
thrashing of the limbs, which increases if restraints are imposed and rarely leads to injury.
Consciousness may be normal or “lost,” but in the latter context the occurrence of goaldirected behavior or of shouting, swearing, etc, indicates that it is feigned. Postictally,
there are no changes in behavior or neurologic findings.
Often, clinical observation is insufficient to discriminate epileptic from nonepileptic
seizures. Video electroencephalographic monitoring may be helpful: epileptic seizures,
especially those involving altered consciousness, commonly involve scalp
electroencephalographic signs that coincide with a behavioral spell, whereas a PNES does
not
The serum level of prolactin has been found to increase dramatically between 15 and 30
minutes after a tonic-clonic convulsion in most patients, whereas it is unchanged after a
PNES. Serum creatine kinase levels also increase after a convulsion but not a PNES.
33. Treatment
General Measures
For patients with epilepsy, drug treatment is prescribed
with the goal of preventing further attacks and is usually
continued until there have been no seizures for at least 2
years
Epileptic patients should be advised to avoid situations
that could be dangerous or life-threatening if further
seizures should occur.
Legislation may require clinicians to report to the state
authorities any patients with seizures or other episodic
disturbances of consciousness; driving cessation for 6
months or as legislated is appropriate following an
unprovoked seizure.
34. Choice of medication
Drug selection depends on seizure type
The dose of the selected drug is gradually increased until seizures are controlled or side
effects prevent further increases
If seizures continue despite treatment at the maximal tolerated dose, a second drug is added
and the dose increased depending on tolerance; the first drug is then gradually withdrawn
In treatment of focal seizures, the success rate is higher with carbamazepine, phenytoin, or
valproic acid than with phenobarbital or primidone. Gabapentin, topiramate, lamotrigine,
oxcarbazepine, levetiracetam, zonisamide, lacosamide, ezogabine, vigabatrin, and tiagabine
are newer antiepileptic drugs used to treat focal seizures. Felbamate is also effective for such
seizures but, because it may cause aplastic anemia or fulminant hepatic failure, should be
used only in selected patients unresponsive to other measures. Rufinamide is currently
approved only for seizures in patients with Lennox-Gastaut syndrome, but it may be effective
against seizures in a broader range of refractory patients. For generalized or unclassified
seizures, valproate is better tolerated than topiramate and more efficacious than lamotrigine
and is thus preferred for many patients; however, the teratogenic potential of valproate
makes its use undesirable in women of childbearing age. All antiepileptics are potentially
teratogenic, although the teratogenicity of the newer antiseizure medications is less clear.
Nevertheless, antiepileptic medication must be given to pregnant women with epilepsy to
prevent seizures, which can pose serious risk to the fetus from trauma, hypoxia, or other
factors. In most patients with seizures of a single type, satisfactory control can be achieved
with a single anticonvulsant drug. Treatment with two drugs may further reduce seizure
frequency or severity but usually only at the cost of greater toxicity. Treatment with more
than two drugs is almost always unhelpful unless the patient is having seizures of different