Epilepsy- Causes, Differentials etc., Jacksonian, Complex partial seizures, Status epilepticus, grand mal, syncope vs siezure, ILAE classification of siezure, siezure and pseudosiezure, absence/petitmal, Myoclonic, Juvenile myoclonic epilepsy

1. Epilepsy

2. 
Chronic,recurrent, unprovoked

Hughlings – excessive & disorder discharge in
brains on muscles

Discharge – aura,ictal phase; instant loss of
consciousness,alteration of perception &
sensation,impaiment of psychic function,
convulsive movements; post ictal phase

Convulsions – involuntary repetitive muscular
contractions

Seizure – paroxysmal electrical discharge in
brain

3. causes

Idiopathic ;SNAC

Sleep deprivation, alcohol, stress

Vascular malformation (CT,MRI)

Infection (CBC)

Trauma

Alzheimer

Neoplasm

psychiatric

10. Grand Mal

Prodromal – apathic, depressed, ecstatic

Abdominal pains, jerks,headaches, jerks

Motor signs – flextion of trunk, open mouth,
eyelids, upward deviation,hands
pronated,elbows flexed, tonic phase – extended

Tonic spasm of respiratory muscles – breath on
hold – cyanotic

Urination, dilation of pupil

Clonic phase transistion

11. 
Generalized tremor mild

Violent flexor spasm at 8 -4 sec interval

Violaceous face, series of grimaces

Salivation,sweating, BP, Dilation of pupil

Deep inspiration

Violent contraction may result – vertebral body
crush, periorbital hemorrhages, subdural
hematoma

13. differentials

Stoke adams

Limb shaking

Basilar artery occlusion

Treatment – CBZ, valproate,phenytoin

14. Absence/ petitmal

Brevity, frequency & paucity of motor activity

Absent mindedness, day dreaming

Sudden interuption of consciuosness

Patient stares, briefly stops responding

Minor automatisms – lip smacking, chewing,
fumbling movements of fingers

Remain motionless movements of eyelids,
facial muscles or fingers

Voluntary hyperventilation - triggers

17. Absence variants

2-2.5 spike wave

Atypical; Long runs of slow waves – can be
interrupted

Lennox gastaut syndrome – serious

1-2 slow wave

Intellectual impairment, minor tonic,clonic,
partial seizures

valproate

18. Myoclonic

Brief myoclonic jerks involving one part of
muscle – 50 – 100 ms

Associated with GTC, petit mal

Childhood – lafora type, myoclonus
-opsoclonus- ataxia

uremia

19. Juvenile myoclonic epilepsy

15 yrs

Morning

4-6 HZ irregular polyspike interval

valproate

20. Focal/ partial

Focal lesion

Simple and complex

Simple – sensorimotor cortex

Complex – focal lesions in limbic, temporal lobe

21. Frontal/ focal motor jacksonian
seizures

Supplementary motor area

Head and eyes turn opposite side – adversive,
area 6

Extension of limbs before loss of
consciousness due to expansion to thalamus,
mid brain RF

22. Jacksonian

Muscles of fingers, foot, arm, face

Premotor – 6, jacksonian

Fencing posture, 4,6,(8 choreathetotic,dystonic
); tonic extension and elevation of contralateral
arm

Todds paralysis

23. SOMATOSENSOR, visual

Numbness, tingling, pins and needles

Sylvian fissure – head

Superior sagital fissure – legs

Visual seizures – striate cortex, antero, occipito
temporal lobe

Darkness, flashes of light – opp eye

Auditary – buzzing or roaring – temporary lobe

Gustatory, vertigenous

24. Complex partial seizures

Adolscence, following febrile convulsions,
Secondary GTC

Focal seizure; temporal lobe – hallucinations,
alterd behaviour

Illusions – macro,micropsia, tilting of visual
environment, hallucinations,

dyscognitive states – strangeness to
environment, unfamiliar

Fear, anxiety

25. 
Motor components – fumbling fingers,
chewing, lip smacking, daze walking,
unresponsiveness

Violence – temporal lobe

Gelastic epilepsy – no memory

Volvular – revolving in circles

Simple wndering aimless

No memory of aura, attack

Lesions in hippocampal,medial temporal
sclerosis

26. 
Disoriented to time and place – right sided
lesion

Non – fluent aphasia

Nose wiping -temporal

27. Transient amnesic epileptic
seizures

Temporal lobe

Tendency to occur on awakening, impaired
performance

Psychic, behavioural, personality

28. Status epilepticus

Seizure lasted 5-30 min with brief interval

Non compliance with antiepileptic drug regimen

ABC management

Iv lorazepam, fosphenytoin

Correct hypoglycemia

EKG monitoring

Continue treatment every,5,10,15 (IV
fosphenytoin),20 minutes ( IV Phenobarbital)

Call anesthesia - propofol