This document provides an overview of epilepsy. It defines a seizure as abnormal electrical activity in the brain resulting in abnormal motor, sensory, or psychomotor experiences. Not all such experiences constitute epilepsy. There are several types of seizures including motor seizures that cause body stiffening or jerking and absence seizures. Epilepsy can be partial, generalized, or uncategorized. Causes may be idiopathic, symptomatic of an underlying brain lesion, genetic, or due to infections, tumors, or injuries. Treatment involves first identifying the seizure type and then using anti-seizure medications like carbamazepine or valproic acid to control seizures. Status epilepticus is a medical emergency treated aggressively with benzodiaz

1. Epilepsy
Overview of
Geewan Kamal Udawattage
Group 1
4th year
Epilepsy center

2. Seizure
• Abnormal electrical activity in brain/cns resulting in
abnormal motor,sensory or psychomotor experiences.
• But everyday people might have abnormal electrical
activity so inorder to diagnose it as a seizure this
abnormal electrical activity must be followed by
abnormal motor,sensory or psychomotor experience.
• Every seizure is not epilepsy
• Under or overdiagnosing epilepsy causes complications.

3. Abnormal motor experiences(motor seizures)
a. Tonic –agonist and antagonist muscles fire
simultaneously.whole body becomes rigid and stiffens.Even
respiratory mucles may get rigid so that cyanosis could occur.
b. Clonic-agonist and antagonist muscles fire alternatively.Body
jerks.
c. Tonic-clonic
d. Atonic-loses tone
e. Myoclonic-sudden movement of some part of the body.only
one jerk
Abnormal sensory experiences
a) Somatic
b) Special
c) Visceral-abnormal abdominal cramps,nausea(seizure in insula-
concern with visceral sensation)

4. Abnormal psycomotor
experiences
• Specially in temporal lobe
epilepsy.
• temporal lobe is concern
with limbic system and other
primitive functions like
olfaction,taste,emotions and
sexual behaviour. helps to
diffrenciate between fantasy
and reality.familiarity and
unfamiliarity also produced
by this lobe.
• so seizures in temporal lobe
cause
a) Taste and olfactions
followed by psychomotor
disturbance
b) Dejavu-overfamiliarity
c) Jamaisvu-underfamiliarity

5. Scenario
An epileptic patient comes to you and how can you
manage him
1. Is it a true seizure or pseudo seizure??
2. If it is epilepsy what type is it??
3. If it is partial epilepsy is it simple or complex?is it a
motor,sensory or psychomotor seizure??
4. Any evidence for disturbed electrophysiology??
5. Anatomically localized the lesion??
6. Look for the cause
7. Most appropiate first line drug???
8. How to manage the cause.

6. 1) Is it a true seizure or pseudo seizure??
Pseudoseizures
o psychological reasons leading to seizure like conditions.(most of them
70% have a history of sexual abuse in their childhood-mainly girls).
o Not occurs during sleep
o EEG shows no abnormal waves during attacks
Q.during an attack ,
a) Urinary incontinance
b) Bitting of the side of the tongue
c) Limb flaring
d) Arching of the back
e) Resistance to eye opening or eyes rolling up when opened

7. 2) If it is epilepsy what type is it??

8. Epidemiology
• So epilepsy is
abnormal,spontaneous and
recurrent electrical activity in cns
which may clinically manifest as
abnormal motor,sensory and
psychomotor experiences,
• Around 50 million people
worldwide have epilepsy.
• Epilepsy responds to treatment
about 70% of the time, yet about
three fourths of affected people in
developing countries do not get the
treatment they need.
• People with epilepsy and their
families can suffer from stigma and
discrimination in many parts of the
world.

9. Epilepsy
Types of epilepsy
1. Partial epilepsy
2. Partial epilepsy
becoming
generalized epilepsy
3. Generalised epilepsy
4. Uncatagorized
Seizures
Partial Generalized
Simple Partial
Complex Partial
Secondarily
Generalized
Absence
Myoclonic
Atonic
Tonic
Tonic-Clonic

10. Partial epilepsy
• Is a type of epilepsy in which onset of the seizure is
referrable to one cerebral hemisphere.
• Average duration 1-3 minutes
• Typically frontal or temporal lobe onset
• Reticular formation+intralaminar nuclei of thalami involves
in activating the cortex.thalami are parts of diencephalon.
• If an epileptic patient during an attack losses consiousness
that seizure involves diencephalon.
• Partial epilepsy+have consiousness during attack-simple
epilepsy
• Partial epilepsy+loss consiousness during attack-complex
epilepsy

11. 3)If it is partial epilepsy is it simple or complex?is
it a motor,sensory or psychomotor seizure??

12. Partial epilepsy
 Simple
• Motor –tonic,clonic,tonic-
clonic,atony
• Sensory
• Psychomotor
 Complex
• Motor
• Sensory
• psychomotor
Seizures
Partial Generalized
Simple Partial
Complex Partial
Secondarily Generalized

13. Generalized epilepsy
• Absence seizures
• Tonic-clonic seizures
• Tonic seizures
• Clonic seizures
• Myclonic seizures
• Atonic seizures

14. Absence epilepsy
• Starts in childhood.
• Brief episodes of epilepsy in which person
becomes mentally absent.but the person doesn’t
fall down eventhough losses consiouness.
• Can have about 100 attacks per day
• As the child grows up they may recover but
unfortunately some develop into tonic-clonic
epilepsy.
• Very characteristic EEG pattern.spikes and waves
with a frequency of 3 per sec.

15. Tonic-clonic epilepsy
1. Prodrome-occurs before seizure.patient is not aware but
others are aware because of the behavioural changes.
2. Aura-part of seisure.only perceived by the patient.strange
gut feelings,smells,taste,fear
3. Tonic-body stiffens,cyanosis,crying
4. Clonic-body jerking,tongue bitting,urinary incontinence
5. Postictal-patient becomes drowsy,relaxed and irritable
• Duration 30-120 seconds

16. Jacksonian epilepsy
• features of epilepsy travelling in some part of
the body(along the arm upwards)-jacksonian
march.in cerebral cortex electrical activity is
slowly marching.
• After jacksonian epilepsy that part of the body
becomes weakens for a while it is called todds
paralysis.
• Motor and sensory jacksonian epilepsy can be
present.

17. 4)Any evidence for disturbed electrophysiology??
• Normal EEG in between attacks donot rule out epilepsy and
also abnormal EEG in between attacks also donot confirm
there was epilepsy because even normal people can have
it.so interictal EEG is not very useful.
• Interictal generalized polyspike-wave complex consistent
with a diaganosis of idiopathic generalized epilepsy
Tonic clonic
seizure

18. Typical absence
seizure
Partial Right frontal
seizure

19. 5)Anatomically localized the lesion??
• MRI
• CT
• XRAY
• Tests for metabolic and infectious conditions
• Hepatic functioning tests
• CSF studies
• Serological tests-for trepanoma pallidum and
HIV

20. 6) Look for the cause

21. Causes of epilepsy
• Epilepsy can be
1. Symptomatic epilepsy-(has some underline
abnormility and epileptic attack is secondary to
that (tumour,infarction,vascular anomaly,infection)
2. Idiopathic epilepsy-inherited(weak GABA system
throughout)
• What types of epilepsies that have a high chance in
which you would find a underline structural lesion.
1. Partial epilepsy
2. Adult onset epilepsy
3. Epilepsy refractory to management

22. Causes of partial epilepsy
Less commonly idiopathic mainly symptomatic
Focal structural lesions(tuberous sclerosis.nodules in
cns and skin)
Neurofibromatosis type 2
Von hipple lindu disease(tumours in eyes and
brain,renal complications)
Dysembryonic problem(cortical dysgenesis)
Mesial temporal sclerosis(temporal lobe
sclerosed.temporal lobectomy needed)
Tumours
Trauma to somepart of the brain
Inflammatory conditions-sarcoidosis
Vasculitis-SLE

23.  Infective processes
• Otitis media-most common cause of cerebral abscess
• Toxoplasmosis-parasite attacks brain and retina.sulfa drugs given
• Cysticercosis-taenia solium form pork.calcified in cns.only cause of
epilepsy which can be diagnosed by xray
• Tuberculoma
• Subdural empyema
• Temporal lobe encephalitis-herpes is the most common cause produce
hemorrhagic lesions in temporal lobe
• Hiv and aids
Q.Cerebrovascular events
a) Thrombotic cerebro arterial infarction
b) Embolic cerebro arterial infarction
c) Cerebrovenous thrombosis
 AV malformations-rapture causes subarachnoid hemorrhage.

24. Causes of general epilepsy
 Genitical causes-inborn errors of metabolism,storage
diseases(taysachs disease)
 Cerebral birth injury
 Hydrocephalus
 Prolong cerebral anoxia
 Drugs
• Penicillins-in some patients penicillin metabolites block
GABA channels
• Isoniacid
• Antimalarial
• Cardiac antiarrythmic drugs
• Psychotropic drugs-tricyclics,phenothiacine,cocaine
• Withdrawal or toxicity of amphetamine
• Alcohol withdrawal

25.  Hypocalcemia
 Hyponatremia
 Hypomagnecimia
 Hypogycemia
 Renal failure
• Acute renal failure-rising k+ disturbing CNS
• Chronic renal failure-urea,creatinine disturbing
microenvironment of cns
 Hepatic encephalopathy
 Infective processes
• Meningitis
• Encephalitis
 Inflammatory conditions-SLE
 Degenerative diseases in cns
• Alzeimer
• Prion diseases-spongiform encephalitis

26. 7) Most appropiate first line drug???

27. Treatment of epilepsy
Mechanism of antiepileptic drugs Hyperpolarization of neuronal cells.that can be
obtained by
 Sodium loading inhibition
• Phenytoin
• Carbapamazine
• Valporic acid
• Lamotrigine
• Topiramate
 Calcium loading inhibition
• Ethosuxamide(in thalamic neurons)
• valporic acid
• Topiramate
 Potassium deloading
• Valporic acid
 Cloride influx
• Valporic acid
• Topiramate

28. Partial epilepsy
 1st line drug-carbapamazine
 2nd line drug-valporic acid
Generalized tonic-clonic epilepsy
 1st line-valporic acid
 2nd line-lamotrigine
Generalized absence epilepsy
 1st line-ethosuxamide
 2nd line-valporic acid
Generalized myoclonic epilepsy
 1st line-valporic acid
 2nd line-clonazepam
Partial becoming generalized epilepsy
 1st line-valporic acid
 2nd line-lamotrigine
Status epilepticus
 1st line-lorazepam
 2nd line-phenytoin or fosphenytoin

29. 8) How to manage

30.  In pregnancy-safest drug that can be used is phenobarbital or
diazepam.In later months mother should be given vitamin k heavy dose
because many antiepileptic drugs block the transfer of vit.k to fetus.so in
fetal blood vit.k depended coagulation factors will be deficit and after
birth it may develop hemorrhagic disease.
 After 2 years of seizure absence its patients choice to stop the
treatment.Most suitable patients to stop treatment after 2 years of
absence of seizures
a) Adult onset seizures
b) IQ normal
c) EEG normal
 But 50 % of patients develop seizures again after stopping the
treatment.
 Councelling of the patient.
 80% of patients who are on the drugs will have well controlled seizures.

31. Status epilepticus
• Medical emergency
• Prolong seizure(More than 10 minutes )or
• Multiple seizures and in between patient
doesn’t regain complete consiousness

32. Management of status epilepticus
1. Secure airway-give high concentration of oxygen (in tonic conditions
respiratory muscles are not working)
2. Give IV bolus of lorazepam and continue slow infusion of
lorazepam.(diazepam acts shorter in duration)
3. After 10 min if it is not controlled give fosphenytoin.(fosphenytoin doesnot
irritate veins like phenytoin)
4. If it is not controlled yet(3rd line) give phenobarbital or valporic acid
5. If the status epilepticus continue more than 20min give general anesthesia
and continue it until abnormal electrical activity stops(EEG).
6. For general anesthesia inducing barbiturate coma(giving sodium
thiopental).or IV propofol used
7. Give thyamine(100mg) followed by 50ml of 50% glucose.(because thyamine
deficient patient will develop wernickes korsakoff syndrome)

33. Differential Diagnosis
 Syncope
 Cardiac (Arrhythmia)
 Non-Cardiac Syncope (Vasovagal, Dysautonomic)
 Metabolic (Hypoglycemia)
 Migraine
 Sleep Disorders (Narcolepsy)
 Movement Disorders (Paroxysmal Dyskinesia)
 Transient Ischemic Attacks
 Psychogenic Seizures
 Panic Attacks
 Intermittent Explosive Disorder
 Breath-holding Spells

34. THANK YOU !!!!!!