7. SEIZURES CAN BE PROVOKED
BY A READILY REVERSIBLE CAUSE
DR. MOSHFEQ 7
Fever
Hypo or hyperglycemia
Alcohol withdrawal
Metabolic disturbances
Head trauma
9. UPDATED CLINICAL DEFINITION OF EPILEPSY (2014)
Epilepsy is a disease of the brain defined by any of the following
conditions:
1. At least two unprovoked seizures occurring >24 h apart.
2. One unprovoked seizure and a probability of further seizures.
3. Diagnosis of an epilepsy syndrome.
* Presence of a neurological disorder, and an abnormal EEG are
significant factors in indicating future seizures.
DR. MOSHFEQ 9
10. IMPORTANT CAUSES OF EPILEPSY
A. Structural
1. Cerebral birth injury
2. Hippocampal sclerosis
3. Trauma
4. Tumors and other space-occupying lesions
5. Stroke and other vascular diseases
6. Alzheimer disease and other degenerative disorders.
B. Genetic
DR. MOSHFEQ 10
11. IMPORTANT CAUSES OF EPILEPSY
C. Infectious diseases
Acute: bacterial meningitis, herpes encephalitis.
Chronic: neurosyphilis, cerebral cysticercosis.
D. Inherited metabolic conditions
Pyridoxine deficiency, mitochondrial disease
E. Autoimmune diseases
Systemic lupus erythematosus, autoimmune limbic encephalitis
DR. MOSHFEQ 11
14. CLASSIFICATION OF SEIZURES
DR. MOSHFEQ 14
Primary Generalized
Focal / Partial
Parts of cortex
discharges abmormally
Symptoms occur in a
particular body part
Entire cortex
discharges abnormally
Symptoms occur in the
whole body
15. CLASSIFICATION OF SEIZURES
DR. MOSHFEQ 15
Primary Generalized
Focal / Partial
Neuroimaging is
mandatory
Neuroimaging is
unnecessary
16. CLASSIFICATION OF SEIZURES
DR. MOSHFEQ 16
Primary Generalized
Focal / Partial
Motor
Non Motor
Focal to bilateral
tonic–clonic
Motor
(GTCS, Atonic, Myoclonic etc.)
Non Motor
(Absence)
17. TYPES OF PARTIAL SEIZURES
ACCORDING TO CONSCIOUSNESS
DR. MOSHFEQ 17
Complex Partial
Simple Partial
Intact consciousness
Frontal / Parietal /
Occipital lobe
Impaired consciousness
Temporal lobe
19. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 19
AURA
TONIC
CLONIC
RELAXATION
RECOVERY
20. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 20
AURA
Abnormal Sensation
[Smell / Sound / Tactile]
Occurs in secondary generalized seizure
21. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 21
TONIC
Generalized hypertonia
Sustained contraction of all muscles
Loss of consciousness
Sudden fall → Head injury
Cyanosis
22. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 22
CLONIC
Generalized muscle contraction & relaxation
Jerky movement
Tongue bite
23. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 23
RELAXATION
Relaxation of all muscles
Loss of sphincter tone
Incontinence of urine & faeces
24. STAGES OF GENERALIZED TONIC CLONIC SEIZURE
DR. MOSHFEQ 24
RECOVERY
Gradual regain of consciousness
30 minutes
Headache (post-ictal headache)
Hemiparesis (Todd’s palsy) : In secondary GTCS
26. DISTINCTION IS VERY IMPORTANT
DR. MOSHFEQ 26
Primary Generalized
Secondary Generalized
Neuroimaging is
mandatory
Neuroimaging is
unnecessary
27. DETERMINING IF A GTCS IS PRIMARY OR SECONDARY
IS OFTEN DIFFICULT
DR. MOSHFEQ 27
Focal onset
Clinical features favoring secondary GTCS
Aura Todd’s palsy
Focal feature (head
or eyes turning to
one side)
Abnormal focal
CNS sign
Extreme of age (<5
or >50 years)
28. ABSENCE SEIZURE
DR. MOSHFEQ 28
Activity stops
Blank stare
Activity resumes within few seconds
No fall or convulsion
Numerous Very brief Episodes
10 to 100 < 10 seconds
35. SIMPLE PARTIAL SEIZURE
DR. MOSHFEQ 35
Involuntary movement or tingling in one half of body.
Begins in one part and spreads to the rest of the half.
Frontal Patietal Lobe
Motor area Sensory area
Seizure focus is located in:
OR
38. COMPLEX PARTIAL SEIZURE
DR. MOSHFEQ 38
Activity stops
Automatism
Lasts for few minutes
Remains confused for 30 minutes after the episode
No fall or convulsion
Temporal Lobe
Seizure focus is located in:
39. COMPLEX PARTIAL SEIZURE
DR. MOSHFEQ 39
Eye blinking
Lip smacking
Making noise
Picking with hands
Walking
AUTOMATISM
41. SEIZURE MIMICS
DR. MOSHFEQ 41
SEIZURE
SYNCOPE
PSEUDO-
SEIZURE
Transient
Unconsciousness
Involuntary
Movement
Cerebral
Hypoperfusion
Psychogenic
Pathogenesis
42. SEIZURE VS SYNCOPE
DR. MOSHFEQ 42
TRAIT SEIZURE SYNCOPE
Posture at onset No particular posture Only in upright posture
Appearance Blue Pale
Involuntary movement Prominent Uncommon & minor
Tongue bite Common Does not occur
Incontinence Common Does not occur
Duration Few minutes <1 minute
Recovery Gradual Abrupt
43. SEIZURE VS PSEUDOSEIZURE
DR. MOSHFEQ 43
TRAIT SEIZURE PSEUDOSEIZURE
Eyes Open Closed
Involuntary movement Particular pattern Bizarre
Tongue bite Common Does not occur
Head injury Common Does not occur
Cyanosis Common Does not occur
Circumstance Any circumstance Only in front of others
Occurrence in sleep May occur Does not occur
47. INVESTIGATIONS OF EPILEPSY
From where is the epilepsy arising?
• Standard EEG • Sleep EEG
• EEG with special electrodes (foramen ovale, subdural)
What is the cause of the epilepsy?
Structural lesion?
• CT • MRI
Metabolic disorder?
• Urea and electrolytes • Liver function tests
• Blood glucose • Serum calcium, magnesium
DR. MOSHFEQ 47
48. INVESTIGATIONS OF EPILEPSY
Inflammatory or infective disorder?
• Full blood count, ESR, CRP
• Chest X-ray
• Serology for syphilis, HIV, collagen disease
• CSF examination
Are the attacks truly epileptic?
• Ambulatory EEG
• Videotelemetry
DR. MOSHFEQ 48
