This document provides an overview of epilepsy presented by Dr. KD Dele Ijagbulu. It discusses the introduction and epidemiology of epilepsy, defining it as a neurological disorder characterized by recurrent seizures. It then covers the impact of epilepsy on quality of life, including risks of death from seizures, difficulties with accurate diagnosis, and challenges with medication and treatment options. The document also addresses the aetiology, pathophysiology, classification, diagnosis and differential diagnosis of epilepsy.
Epilepsy is a neurological disorder characterized by recurrent seizures. It affects over 50 million people worldwide. Seizures occur due to excessive excitatory activity and decreased inhibitory activity in the brain. While most patients can be managed with anti-epileptic drugs, 10-40% continue having seizures despite treatment. Common anti-epileptic drugs work by blocking sodium channels, enhancing GABA, or decreasing glutamate in the brain. Special consideration is required for treating epilepsy during pregnancy, in children, and in the elderly population.
Dr. Shamanthakamani Narendran provides an overview of epilepsy, including its definition, classification, causes, diagnosis, treatment, and management. Epilepsy is a chronic neurological condition characterized by recurrent seizures and affects approximately 50 million people worldwide. It is usually controlled through medication, though not cured. The causes can be genetic, due to injury or illness, or idiopathic. Treatment involves medication to prevent or reduce seizures, and in some cases surgery may be an option.
EPILEPSY AND SEIZURE DISORDERS
The document discusses epilepsy and seizure disorders. It defines seizures as paroxysmal events due to abnormal neuronal activity in the brain. It classifies seizures as either focal or generalized based on their origin. Focal seizures originate in one hemisphere while generalized seizures rapidly engage both hemispheres. Common types of seizures include absence seizures, tonic-clonic seizures, atonic seizures, and myoclonic seizures. The document also discusses the etiology, diagnosis, treatment and management of epilepsy through use of anti-epileptic drugs, surgery, or other methods.
1. The document discusses the prevalence and properties of alcohol use in India. It notes that according to national surveys, the prevalence of alcohol use in the general population over 15 years is 21.4% and among treatment seekers is 43.9%.
2. Details are provided on the metabolism and absorption of alcohol in the body. The various preparations of alcohol are outlined along with standard drink measurements.
3. Both acute and chronic complications of alcohol use are summarized, including effects on the liver, gastrointestinal system, cardiovascular system, nervous system and development of nutritional deficiencies and cancers. Psychiatric complications like dependence, withdrawal syndrome, and persistent amnesia are also covered.
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.
This document discusses alcohol use disorders and their treatment. It defines key terms like acute intoxication, withdrawal state, and dependence syndrome. It describes the major symptoms of alcohol withdrawal. It also outlines chronic health complications of alcohol use like Wernicke's encephalopathy and Korsakoff's psychosis. The document lists screening tools and treatments for alcohol dependence, including detoxification with benzodiazepines, vitamin supplementation, and approaches like psychotherapy, group therapy, and medications to reduce cravings or deter drinking.
This document provides information about epilepsy, including its definition, types of seizures, causes, symptoms, diagnosis, treatment and classification of antiepileptic drugs. Some key points:
- Epilepsy is a chronic neurological condition characterized by recurrent seizures. Seizures have focal or generalized onset in the brain.
- Common causes include genetic factors, brain injury, infections, tumors and metabolic imbalances. Symptoms vary depending on the seizure type and location in the brain.
- Diagnosis involves patient history, physical exam, EEG, imaging and lab tests. Treatment involves antiepileptic drugs to reduce seizures, with drug choices based on seizure type.
- Major antiepileptic drug classes work
Epilepsy is a disease of the brain defined by recurrent seizures that are not caused by an immediate brain insult. A seizure involves abnormal neuronal activity in the brain, while epilepsy describes the underlying brain condition causing recurrent seizures. Epilepsy is generally diagnosed after a person experiences at least two unprovoked seizures more than 24 hours apart or one unprovoked seizure and at least a 60% risk of having another within ten years. Epilepsy can be caused by genetic and structural/metabolic factors and in some cases the cause is unknown. Seizures are classified as generalized or partial based on where they originate in the brain. Diagnosing epilepsy involves taking a detailed history, physical exam, EEG, and brain imaging.
Epilepsy is a neurological disorder characterized by recurrent seizures. It affects over 50 million people worldwide. Seizures occur due to excessive excitatory activity and decreased inhibitory activity in the brain. While most patients can be managed with anti-epileptic drugs, 10-40% continue having seizures despite treatment. Common anti-epileptic drugs work by blocking sodium channels, enhancing GABA, or decreasing glutamate in the brain. Special consideration is required for treating epilepsy during pregnancy, in children, and in the elderly population.
Dr. Shamanthakamani Narendran provides an overview of epilepsy, including its definition, classification, causes, diagnosis, treatment, and management. Epilepsy is a chronic neurological condition characterized by recurrent seizures and affects approximately 50 million people worldwide. It is usually controlled through medication, though not cured. The causes can be genetic, due to injury or illness, or idiopathic. Treatment involves medication to prevent or reduce seizures, and in some cases surgery may be an option.
EPILEPSY AND SEIZURE DISORDERS
The document discusses epilepsy and seizure disorders. It defines seizures as paroxysmal events due to abnormal neuronal activity in the brain. It classifies seizures as either focal or generalized based on their origin. Focal seizures originate in one hemisphere while generalized seizures rapidly engage both hemispheres. Common types of seizures include absence seizures, tonic-clonic seizures, atonic seizures, and myoclonic seizures. The document also discusses the etiology, diagnosis, treatment and management of epilepsy through use of anti-epileptic drugs, surgery, or other methods.
1. The document discusses the prevalence and properties of alcohol use in India. It notes that according to national surveys, the prevalence of alcohol use in the general population over 15 years is 21.4% and among treatment seekers is 43.9%.
2. Details are provided on the metabolism and absorption of alcohol in the body. The various preparations of alcohol are outlined along with standard drink measurements.
3. Both acute and chronic complications of alcohol use are summarized, including effects on the liver, gastrointestinal system, cardiovascular system, nervous system and development of nutritional deficiencies and cancers. Psychiatric complications like dependence, withdrawal syndrome, and persistent amnesia are also covered.
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.
This document discusses alcohol use disorders and their treatment. It defines key terms like acute intoxication, withdrawal state, and dependence syndrome. It describes the major symptoms of alcohol withdrawal. It also outlines chronic health complications of alcohol use like Wernicke's encephalopathy and Korsakoff's psychosis. The document lists screening tools and treatments for alcohol dependence, including detoxification with benzodiazepines, vitamin supplementation, and approaches like psychotherapy, group therapy, and medications to reduce cravings or deter drinking.
This document provides information about epilepsy, including its definition, types of seizures, causes, symptoms, diagnosis, treatment and classification of antiepileptic drugs. Some key points:
- Epilepsy is a chronic neurological condition characterized by recurrent seizures. Seizures have focal or generalized onset in the brain.
- Common causes include genetic factors, brain injury, infections, tumors and metabolic imbalances. Symptoms vary depending on the seizure type and location in the brain.
- Diagnosis involves patient history, physical exam, EEG, imaging and lab tests. Treatment involves antiepileptic drugs to reduce seizures, with drug choices based on seizure type.
- Major antiepileptic drug classes work
Epilepsy is a disease of the brain defined by recurrent seizures that are not caused by an immediate brain insult. A seizure involves abnormal neuronal activity in the brain, while epilepsy describes the underlying brain condition causing recurrent seizures. Epilepsy is generally diagnosed after a person experiences at least two unprovoked seizures more than 24 hours apart or one unprovoked seizure and at least a 60% risk of having another within ten years. Epilepsy can be caused by genetic and structural/metabolic factors and in some cases the cause is unknown. Seizures are classified as generalized or partial based on where they originate in the brain. Diagnosing epilepsy involves taking a detailed history, physical exam, EEG, and brain imaging.
Epilepsy is a neurological disorder affecting around 1% of the population worldwide. It is characterized by recurrent seizures which are brief episodes of abnormal electrical activity in the brain. Approximately 30% of epilepsy patients do not achieve seizure control with antiepileptic medications alone. For these medically refractory cases, epilepsy surgery may be considered to remove the specific area of the brain responsible for generating seizures. The goal of both medication and surgery is to reduce or eliminate seizures while minimizing side effects from treatment.
This document discusses different types of seizures, including partial seizures (simple and complex), generalized seizures (absence, myoclonic, infantile spasms, clonic, tonic, tonic-clonic, atonic), and provides details on each type. It also covers topics like epilepsy, seizure classification, recognizing seizures, and complex partial seizures transitioning to generalized seizures.
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
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.
Epilepsy is a neurological disorder characterized by recurring seizures. A seizure occurs when there is a sudden surge of electrical activity in the brain. About 2.3 million Americans have epilepsy. While the specific cause is unknown in many cases, common causes include head trauma, brain tumors, strokes, genetic factors, and developmental issues. Treatment involves medications, surgery, dietary therapies and lifestyle modifications, with the goal of eliminating seizures without side effects. The choice of treatment depends on the seizure type, underlying causes, age, and other individual factors.
This document provides definitions and information about seizures and epilepsy. It defines a seizure as a sudden wave of synchronous electrical activity in the brain that affects how a person feels or acts for a short time. Epilepsy is defined as a condition that affects the central nervous system and requires a person to have had at least two seizures not caused by a known medical condition or extremely low blood sugar. The document discusses different types of seizures including partial and generalized seizures, as well as diagnostic testing and treatment options for epilepsy.
1. Psychosis is common in epilepsy patients, occurring in 1-35% of cases and being 8 times more prevalent than in the general population.
2. Psychosis in epilepsy is classified as ictal, inter-ictal, post-ictal, or antiepileptic drug induced.
3. Diagnosis requires distinguishing psychosis in epilepsy from schizophrenia based on symptoms and personality features, and treatment involves careful use of antiepileptic and antipsychotic drugs due to interactions.
This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
- Causes of coma can be structural/focal brain injuries or non-structural/diffuse issues like hypoxia, infections, or toxic exposures. An approach is outlined to initially stabilize an unconscious patient and guide further examination and investigations.
This document provides an overview of epilepsy including:
- Epilepsy is a chronic neurological condition characterized by recurrent seizures and affects around 50 million people worldwide.
- Seizures have various classifications based on factors like location in the brain, observable manifestations, underlying medical conditions, and triggers.
- Epilepsy is typically diagnosed and managed through medication but may also involve lifestyle changes, surgery, dietary therapies, or vagus nerve stimulation in some cases.
- The causes can be genetic, due to brain injury or infection, and in some cases the cause is unknown. Proper response in an emergency involves preventing injury and calling for help for prolonged seizures.
1) Disorders of consciousness range from mild impairment to coma and include conditions like confusion, delirium, vegetative state, and brain death.
2) The pathophysiology of consciousness involves the ascending reticular activating system and connections between the brainstem and cortex. Loss of consciousness can result from disruption of these systems.
3) Etiologies of impaired consciousness and coma include infectious or inflammatory causes, structural abnormalities, and metabolic/toxic derangements. Common causes in children are infections, trauma, seizures, and metabolic disorders.
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
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Neurologic manifestations of alcoholism By Adetunji T.A.Adetunji Adesegun
This document provides an overview of alcohol-related neurologic disorders. It discusses the definition and epidemiology of alcoholism and defines units of alcohol. It describes various neurologic effects of alcohol including withdrawal syndrome, Wernicke-Korsakoff syndrome, alcoholic neuropathy, and fetal alcohol syndrome. It provides details on the pathogenesis and treatment of Wernicke's encephalopathy and Korsakoff's psychosis. The document also discusses various imaging findings and emphasizes the importance of early thiamine treatment.
Epilepsy is a disorder characterized by recurrent seizures that involve abnormal neuronal activity in the brain. It is caused by an imbalance between excitatory and inhibitory neurotransmitters like glutamate and GABA. Anti-seizure drugs work by enhancing GABA activity, blocking sodium and calcium channels, or modulating glutamate activity. Treatment depends on the type of seizures, which can be focal, generalized tonic-clonic, absence or myoclonic. Adverse effects include skin rashes, weight changes, fatigue and cognitive issues. Novel approaches include targeted drug delivery and electrical brain stimulation to prevent seizures.
Neuropsychiatric aspects of epilepsy osmanaliOSMAN ALI MD
This document provides an overview of neuropsychiatric aspects of epilepsy. It discusses the epidemiology of epilepsy and describes different types of seizures. It covers psychiatric manifestations like ictal, perictal, and interictal features. It also addresses behavioral disturbances variably related to seizures, like mood disorders. The document outlines management implications and describes evaluating epilepsy versus non-epileptic seizures through tools like EEG, imaging, and response to medication.
The document discusses coma, including its definition, causes, clinical assessment, investigations, differential diagnosis and management. Coma is characterized by a total lack of arousal and awareness lasting at least 1 hour. It can be caused by structural brain injuries or metabolic derangements and represents a severe impairment of cerebral function. A systematic clinical approach is needed to identify treatable causes of coma such as head injuries, infections, drugs or toxic exposures.
Dementia is a syndrome involving the deterioration of memory, thinking, behavior and the ability to perform everyday activities. It is caused by damage to brain cells that interferes with communication between cells. Alzheimer's disease is the most common form of dementia, potentially contributing to 60-70% of cases. Dementia is diagnosed based on medical history, exams, tests and characteristic changes in thinking and functioning. While there is no cure, medications and therapies can help reduce symptoms or slow progression for some time.
Myasthenia gravis is an autoimmune disorder characterized by fluctuating weakness of skeletal muscles. It results from antibodies directed against acetylcholine receptors at the neuromuscular junction, which decreases the number of receptors and impairs signal transmission from nerves to muscles. Symptoms include weakness of eye muscles, facial muscles, limbs, and respiratory muscles that worsens with exertion and improves with rest. Diagnosis involves testing for acetylcholine receptor antibodies in blood and repetitive nerve stimulation or single fiber electromyography. Treatment options include acetylcholinesterase inhibitors, immunosuppressants, plasmapheresis, and thymectomy.
Epilepsy is defined as recurrent seizures that are not caused by immediate brain insults. The diagnostic criteria include at least two unprovoked seizures or one seizure and a high risk of future seizures. An estimated 6-10 million people have epilepsy in India, with prevalence higher in rural areas. Seizures can be partial or complex partial depending on whether consciousness is altered. Treatment involves controlling seizures through lifestyle modifications and antiepileptic drugs while addressing psychological and social issues. First-line drugs include carbamazepine, phenytoin, valproate, and lamotrigine, with newer drugs like levetiracetam also used. Treatment must balance seizure control and side effect risks on an individual basis.
Epilepsy is a neurological condition that causes seizures and is usually diagnosed after two or more seizures. It affects the nervous system and can develop at any age for various reasons, though the cause is often unknown. Seizures occur when there is abnormal electrical activity in the brain. While epilepsy cannot be cured, seizures can be controlled through antiepileptic medications in many cases. Getting proper sleep is also important for managing seizures.
Definition
Epidemiology
Etiology
Pathophysiology
Classification
Diagnosis
Treatment
Anti Seizure Drugs Prices in Jordan
Two Medical cases
New drug approvals
Epilepsy is a neurological disorder affecting around 1% of the population worldwide. It is characterized by recurrent seizures which are brief episodes of abnormal electrical activity in the brain. Approximately 30% of epilepsy patients do not achieve seizure control with antiepileptic medications alone. For these medically refractory cases, epilepsy surgery may be considered to remove the specific area of the brain responsible for generating seizures. The goal of both medication and surgery is to reduce or eliminate seizures while minimizing side effects from treatment.
This document discusses different types of seizures, including partial seizures (simple and complex), generalized seizures (absence, myoclonic, infantile spasms, clonic, tonic, tonic-clonic, atonic), and provides details on each type. It also covers topics like epilepsy, seizure classification, recognizing seizures, and complex partial seizures transitioning to generalized seizures.
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
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.
Epilepsy is a neurological disorder characterized by recurring seizures. A seizure occurs when there is a sudden surge of electrical activity in the brain. About 2.3 million Americans have epilepsy. While the specific cause is unknown in many cases, common causes include head trauma, brain tumors, strokes, genetic factors, and developmental issues. Treatment involves medications, surgery, dietary therapies and lifestyle modifications, with the goal of eliminating seizures without side effects. The choice of treatment depends on the seizure type, underlying causes, age, and other individual factors.
This document provides definitions and information about seizures and epilepsy. It defines a seizure as a sudden wave of synchronous electrical activity in the brain that affects how a person feels or acts for a short time. Epilepsy is defined as a condition that affects the central nervous system and requires a person to have had at least two seizures not caused by a known medical condition or extremely low blood sugar. The document discusses different types of seizures including partial and generalized seizures, as well as diagnostic testing and treatment options for epilepsy.
1. Psychosis is common in epilepsy patients, occurring in 1-35% of cases and being 8 times more prevalent than in the general population.
2. Psychosis in epilepsy is classified as ictal, inter-ictal, post-ictal, or antiepileptic drug induced.
3. Diagnosis requires distinguishing psychosis in epilepsy from schizophrenia based on symptoms and personality features, and treatment involves careful use of antiepileptic and antipsychotic drugs due to interactions.
This document provides information on consciousness and coma:
- Consciousness has two components - arousal from the reticular activating system and awareness from the cerebral cortex. Stimulation of the RAS produces arousal while its destruction causes coma.
- The Glasgow Coma Scale and newer scales like FOUR are used to evaluate patients in comatose or reduced states of consciousness. The FOUR scale assesses eye, motor, brainstem, and respiratory responses.
- Causes of coma can be structural/focal brain injuries or non-structural/diffuse issues like hypoxia, infections, or toxic exposures. An approach is outlined to initially stabilize an unconscious patient and guide further examination and investigations.
This document provides an overview of epilepsy including:
- Epilepsy is a chronic neurological condition characterized by recurrent seizures and affects around 50 million people worldwide.
- Seizures have various classifications based on factors like location in the brain, observable manifestations, underlying medical conditions, and triggers.
- Epilepsy is typically diagnosed and managed through medication but may also involve lifestyle changes, surgery, dietary therapies, or vagus nerve stimulation in some cases.
- The causes can be genetic, due to brain injury or infection, and in some cases the cause is unknown. Proper response in an emergency involves preventing injury and calling for help for prolonged seizures.
1) Disorders of consciousness range from mild impairment to coma and include conditions like confusion, delirium, vegetative state, and brain death.
2) The pathophysiology of consciousness involves the ascending reticular activating system and connections between the brainstem and cortex. Loss of consciousness can result from disruption of these systems.
3) Etiologies of impaired consciousness and coma include infectious or inflammatory causes, structural abnormalities, and metabolic/toxic derangements. Common causes in children are infections, trauma, seizures, and metabolic disorders.
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
A 31-year-old male presented with a fever for one week and seizures and altered sensorium for three days. He experienced generalized tonic-clonic seizures that were initially uncontrolled. Imaging showed findings suggestive of viral or autoimmune encephalitis. Refractory status epilepticus was diagnosed and treated with high doses of multiple antiepileptic drugs, including lacosamide, which eventually controlled the seizures. Status epilepticus is defined as a seizure that persists for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur. The pathophysiology involves reductions in inhibitory GABA receptors and increases in excitatory glutamate receptors over time.
Neurologic manifestations of alcoholism By Adetunji T.A.Adetunji Adesegun
This document provides an overview of alcohol-related neurologic disorders. It discusses the definition and epidemiology of alcoholism and defines units of alcohol. It describes various neurologic effects of alcohol including withdrawal syndrome, Wernicke-Korsakoff syndrome, alcoholic neuropathy, and fetal alcohol syndrome. It provides details on the pathogenesis and treatment of Wernicke's encephalopathy and Korsakoff's psychosis. The document also discusses various imaging findings and emphasizes the importance of early thiamine treatment.
Epilepsy is a disorder characterized by recurrent seizures that involve abnormal neuronal activity in the brain. It is caused by an imbalance between excitatory and inhibitory neurotransmitters like glutamate and GABA. Anti-seizure drugs work by enhancing GABA activity, blocking sodium and calcium channels, or modulating glutamate activity. Treatment depends on the type of seizures, which can be focal, generalized tonic-clonic, absence or myoclonic. Adverse effects include skin rashes, weight changes, fatigue and cognitive issues. Novel approaches include targeted drug delivery and electrical brain stimulation to prevent seizures.
Neuropsychiatric aspects of epilepsy osmanaliOSMAN ALI MD
This document provides an overview of neuropsychiatric aspects of epilepsy. It discusses the epidemiology of epilepsy and describes different types of seizures. It covers psychiatric manifestations like ictal, perictal, and interictal features. It also addresses behavioral disturbances variably related to seizures, like mood disorders. The document outlines management implications and describes evaluating epilepsy versus non-epileptic seizures through tools like EEG, imaging, and response to medication.
The document discusses coma, including its definition, causes, clinical assessment, investigations, differential diagnosis and management. Coma is characterized by a total lack of arousal and awareness lasting at least 1 hour. It can be caused by structural brain injuries or metabolic derangements and represents a severe impairment of cerebral function. A systematic clinical approach is needed to identify treatable causes of coma such as head injuries, infections, drugs or toxic exposures.
Dementia is a syndrome involving the deterioration of memory, thinking, behavior and the ability to perform everyday activities. It is caused by damage to brain cells that interferes with communication between cells. Alzheimer's disease is the most common form of dementia, potentially contributing to 60-70% of cases. Dementia is diagnosed based on medical history, exams, tests and characteristic changes in thinking and functioning. While there is no cure, medications and therapies can help reduce symptoms or slow progression for some time.
Myasthenia gravis is an autoimmune disorder characterized by fluctuating weakness of skeletal muscles. It results from antibodies directed against acetylcholine receptors at the neuromuscular junction, which decreases the number of receptors and impairs signal transmission from nerves to muscles. Symptoms include weakness of eye muscles, facial muscles, limbs, and respiratory muscles that worsens with exertion and improves with rest. Diagnosis involves testing for acetylcholine receptor antibodies in blood and repetitive nerve stimulation or single fiber electromyography. Treatment options include acetylcholinesterase inhibitors, immunosuppressants, plasmapheresis, and thymectomy.
Epilepsy is defined as recurrent seizures that are not caused by immediate brain insults. The diagnostic criteria include at least two unprovoked seizures or one seizure and a high risk of future seizures. An estimated 6-10 million people have epilepsy in India, with prevalence higher in rural areas. Seizures can be partial or complex partial depending on whether consciousness is altered. Treatment involves controlling seizures through lifestyle modifications and antiepileptic drugs while addressing psychological and social issues. First-line drugs include carbamazepine, phenytoin, valproate, and lamotrigine, with newer drugs like levetiracetam also used. Treatment must balance seizure control and side effect risks on an individual basis.
Epilepsy is a neurological condition that causes seizures and is usually diagnosed after two or more seizures. It affects the nervous system and can develop at any age for various reasons, though the cause is often unknown. Seizures occur when there is abnormal electrical activity in the brain. While epilepsy cannot be cured, seizures can be controlled through antiepileptic medications in many cases. Getting proper sleep is also important for managing seizures.
Definition
Epidemiology
Etiology
Pathophysiology
Classification
Diagnosis
Treatment
Anti Seizure Drugs Prices in Jordan
Two Medical cases
New drug approvals
This document discusses complications that can arise from epilepsy. It notes that epilepsy can affect various body systems like the cardiac, pulmonary, and metabolic systems, potentially leading to complications such as arrhythmias, respiratory issues, and changes in electrolyte levels. The document also outlines how epilepsy can significantly impact one's education, employment, social life, and relationships by causing issues like cognitive impairments, communication problems, and stigma. Managing the condition requires strict medication adherence, a healthy lifestyle, safety precautions, and addressing any mental health issues that may arise from living with epilepsy.
This document discusses possible complications from epilepsy and managing the disease process. It outlines potential complications that can affect cardiac, autonomic, pulmonary, metabolic, endocrine and other body systems. Repeated seizures can also cause issues like rhabdomyolysis and kidney failure. Epilepsy impacts various aspects of life including education, employment, social interactions and relationships. Managing the disease requires taking medications regularly, maintaining a healthy lifestyle, being aware of seizure triggers, and addressing any mental health issues. Two classes of anticonvulsant medications are used to treat epilepsy - very rapidly acting ones for status epilepticus and less rapid acting ones to prevent future seizures.
A 45-year-old male was admitted to the hospital with a history of seizures. He reported having 5-6 generalized tonic-clonic seizures per day for the past 3 days with loss of consciousness. His past medical history included epilepsy with poor drug compliance. On examination, his vitals were stable. Laboratory tests showed abnormal calcium and creatinine levels. He was diagnosed with epilepsy and started on intravenous anti-seizure medications, vitamins, and antibiotics to treat any underlying infection. The patient was educated on avoiding seizure triggers and the side effects of his medication regimen.
Epilepsy is a disorder of the brain's electrical system that causes seizures. Seizures occur due to abnormal electrical impulses in the brain and can cause changes in movement, behavior, sensation, or awareness. Epilepsy has various causes including genetic factors, injuries, infections, and strokes. While there is no cure for epilepsy, treatments like medication, surgery, diet changes, and nerve stimulation can help control seizures. Epilepsy affects about 3% of Americans at some point in their lives and costs over $15 billion annually in the United States.
The patient is an 80-year-old male who was brought to the hospital due to complaints of memory loss from his wife. She noticed he had been experiencing gradual onset memory loss over the past 15 days, including an inability to remember daily tasks and financial duties. On examination, he was conscious and oriented but demonstrated memory impairment. A diagnosis of Alzheimer's disease was suspected given his age and symptoms.
Epilepsy by hosam Maarouf Alhussin.. typesHosamAlhussin
Epilepsy is defined as two or more unprovoked seizures occurring more than 24 hours apart or one unprovoked seizure with a high risk of further seizures. Seizures occur due to abnormal excessive firing of neurons in the brain. Epilepsy can be focal, originating in one area of the brain, or generalized, engaging networks across both hemispheres. Treatment involves medications to prevent seizures as well as surgery for drug-resistant focal epilepsies.
A review of epilepsy in the elderly, the etiopathogenesis, clinical challenges, diagnosis, use of antiseizure drugs and outcomes. Also the various special considerations in managing elderly patients with epilepsy.
Epilepsy is a common neurological disorder in the elderly population. Incidence and prevalence of both seizures and epilepsy are highest in those over age 75. The most common causes of epilepsy in the elderly are cerebrovascular disease, brain tumors, and dementia. Seizures may present differently in elderly patients, often appearing as subtle changes in mental status rather than overt convulsions. Treatment involves identifying and managing the underlying cause, with antiseizure drugs chosen based on safety and tolerability over efficacy due to increased risk of interactions and side effects. Careful dosing and monitoring is needed due to age-related changes in pharmacokinetics and pharmacodynamics.
alzhemier's disease in neurological.pptxDrYeshaVashi
- Holoprosencephaly (HPE) is a malformation where the two cerebral hemispheres appear fused, caused by failure of cleavage of the embryonic cerebral vesicle. It has a spectrum of severity from alobar to lobar.
- HPE is diagnosed based on midline facial dysplasias present in 93% of patients. It is associated with developmental delay and seizures.
- Treatment focuses on managing complications like hydrocephalus, seizures, and endocrine issues. The prognosis depends on the severity of anatomical and neurological involvement.
This document outlines a pediatric epilepsy slide deck presented by the American Epilepsy Society. It covers several key topics:
Section 1 discusses seizures and epilepsy syndromes that present in neonates and early infancy, including Ohtahara syndrome, early myoclonic encephalopathy, benign familial neonatal epilepsy, and others.
Section 2 covers epilepsy syndromes that present in early childhood and adolescence, such as West syndrome (characterized by epileptic spasms and a hypsarrhythmia EEG pattern), Doose syndrome, and Lennox-Gastaut syndrome.
Section 3 describes unique etiologies of epilepsy that often present with pediatric onset. Section 4 discusses surgical evaluation of int
Epilepsy is a disorder characterized by recurring seizures caused by abnormal electrical activity in the brain. A seizure is a brief, temporary disturbance in brain activity. While the specific cause is unknown in many cases, common causes include head trauma, brain infections, tumors, strokes, and genetic factors. Epilepsy is diagnosed based on the patient's medical history, symptoms, and tests like EEGs, CT scans, MRIs. Treatment involves medications, surgery, dietary changes, and lifestyle modifications to control seizures and allow patients to live normal lives.
This document provides information about epilepsy including:
- It defines epilepsy as a chronic neurological disorder characterized by recurrent seizures.
- Some key causes of epilepsy include birth injuries, infections, brain tumors, and genetic factors.
- Diagnostic tests include blood tests, EEG, CT/MRI scans. Treatment involves pharmacotherapy with anti-seizure medications and possibly surgery for refractory cases.
- Nursing management focuses on patient safety during seizures, monitoring for complications, educating patients and families, and ensuring proper treatment adherence.
This document discusses the neuropsychiatric aspects of epilepsy. It begins by introducing the topic and defining key terms like seizure, epilepsy, convulsion, and fits. It then discusses the epidemiology of epilepsy, noting its prevalence worldwide and risk factors. It describes the classification of epileptic seizures and epilepsy syndromes. The document then covers the association between epilepsy and various psychiatric disorders like depression, bipolar disorder, anxiety, OCD, and psychoses. It discusses features of these conditions as they relate to epilepsy, including potential causes and treatment considerations. Post-ictal psychosis is described in depth.
This document discusses neurocognitive disorders including delirium, major neurocognitive disorders such as dementia and amnestic syndrome, mild neurocognitive disorder, epilepsy, and traumatic brain injury. It provides details on the diagnostic criteria, clinical features, epidemiology, treatment, and prognosis of these conditions. Case studies are also presented to illustrate delirium and complex partial seizures.
This document provides information on genetic epilepsy and juvenile myoclonic epilepsy. It defines epilepsy and describes its various classifications including idiopathic, symptomatic and cryptogenic epilepsy. Juvenile myoclonic epilepsy is discussed in detail, including its genetics, clinical manifestations such as myoclonic jerks and absence seizures, diagnosis through EEG findings, and treatment options involving anti-seizure medications. Circumstances for genetic testing in epilepsy cases are outlined.
This document discusses reversible causes of dementia and delirium. It begins by defining major neurocognitive disorder and reversible dementias. Common reversible causes of dementia include central nervous system infections, normal pressure hydrocephalus, nutritional deficiencies, drugs, endocrine disorders, depression, and sleep apnea. Delirium is then discussed, including risk factors, pathophysiology, clinical subtypes, DSM-5 criteria, assessment scales, differential diagnosis, course, prevention, and management. Reversible dementias are estimated to account for 8-40% of dementia cases. Early diagnosis and treatment of the underlying cause can improve cognitive functioning.
Similar to Epilepsy. Presented by Dr KD DELE. 17102019 (20)
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.
TB remains an important disease condition globally, particularly with the high prevalence of HIV in many parts of the world. While there is interest in providing the adequate and often readily-available treatment, it might do more harm to the patient. In this presentation, I explored the concept of IRIS in the management of tuberculosis.
Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.
Headache is a common condition encountered by clinicians in general practice and primary care on a daily basis. Although most headaches are mild, some can be severe and debilitating. It is therefore crucial to recognize common symptoms, identify warning signs, and develop an appropriate management plan for headaches.
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
The document discusses disorders of kidney function, providing information on kidney anatomy, physiology, and common renal diseases. It describes the key components of the nephron including the glomerulus, Bowman's capsule, and renal tubules. Investigations for evaluating kidney function such as urine analysis, blood tests, ultrasound, and biopsy are outlined. Common renal disorders like acute kidney injury, chronic kidney disease, glomerular diseases including nephrotic and nephritic syndromes are mentioned.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
This presentation focuses on the all important topic of childhood malnutrition. It addresses the different components, both acute and chronic, but focuses more on the severe acute malnutrition which is the most important killer, particularly for the under-5s.
terms like kwashiokor and marasmus are no longer in use.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This presentation addresses respiratory emergencies, and the approach to their management. These include: anaphylaxis, pneumonias, flail chest, pleural effusion, pulmonary embolism,
This presentation focuses on informed decision making in clinical practice making use of evidence based practice. It addresses the use of PICO to formulate clinical question, searching the evidence/literature, critically appraising the evidence, and application of the evidence to improve the quality of clinical practice
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Spinal Cord Injuries are uncommon, but they are a leading cause of high cost disability, and with ageing population, the incidence is expected to increase. This presentation looks at the many facets of spinal cord injuries.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- 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
4. INTRODUCTION
• Epilepsy is a neurological disorder that is characterized by an enduring
predisposition to generate epileptic seizures and is associated cognitive,
psychological and social consequences (Fischer et al, 2017)
• An epileptic seizure is a transient behavioural change caused by abnormal
excessive or synchronous neuronal activity in the brain, and is associated
with objective signs or subjective symptoms such as loss of awareness,
stiffening, jerking, a sensation that rises from the abdomen to the chest, a
smell of burnt rubber or déjà vu
5. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• Epilepsy affects all age
• No sex difference, however it is often underreported among females.
• It is a common and one of the most disabling neurological disorders.
• Epilepsy can substantially impair quality of life owing to seizures, comorbid
mood and psychiatric disorders, cognitive deficits and adverse effects of
medications.
6. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• Seizures can be fatal owing to direct effects on autonomic and arousal
functions or owing to indirect effects such as drowning and other
accidents.
• The accurate diagnosis of seizures is essential as misdiagnosis and
inaccurate medication often have severe consequences.
• Although many patients have seizure control using a single medication,
others require multiple medications, resective surgery, neuromodulation
devices or dietary therapies.Also or clinical trials of new ASDs
7. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• Epilepsy can be a significant burden for patients and caregivers.
• Adverse effects (by the condition and the medications) contribute to
decreased quality of life.
• One-third of patients will continue to have uncontrolled seizures.
• Children and adolescents who are trying to be socially accepted have
increased difficulty e.g. when their AED cause sedation
8. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• There have been different moves to reduce stigma associated with
epilepsy
• For example, changing the nomenclature: It is strongly encouraged to
discontinue the use of the term epileptic to reduce stigma;
• however, antiepileptic drug (AED) remains the terminology used in the
literature; however, newer literatures are beginning to use the term “Anti-
seizure drugs” (ASD)
9. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• For many patients, seizures can remit; however some might relapse after
remission.
• Epilepsy is considered resolved when
• an individual is seizure free and older than the applicable age for an
age-dependent epilepsy syndrome, or,
• when the person has remained seizure free for ≥10 years with no anti-
seizure medication for the past 5 years
10. IMPACT OF EPILEPSY ON QUALITY OF LIFE
• The loss of driving privileges
• Social stigma
• Employment difficulties
• Loss of marriage, and other relationships
• Wrong diagnosis of epilepsy (common) leads to the improper use of anti-
seizure medications leading to anti-seizure-drug-associated adverse effects,
including inducing further seizures
11. EPIDEMIOLOGY
• Almost 10% of people will experience a seizure during their lives.
• Epilepsy is the third leading contributor to the global burden of disease
for neurological disorders and affects 65 million people worldwide.
• the prevalence of epilepsy is 6.4 cases per 1,000 persons and the annual
incidence is 67.8 cases per 100,000 person-years
• Both prevalence and incidence are higher in low-income and middle-
income countries (LMICs) than in high-income countries, however
underreported due to stigma associated, mostly among women.
12.
13. EPIDEMIOLOGY
• The incidence of epilepsy is bimodal: highest in younger age groups (for
example, in infancy and early childhood) and in older age groups (for
example, more than 50–60 years of age).
• Whereas the prevalence tends to be lowest in infants and children,
increases in early adulthood – midlife and decreases later in life.
• The higher prevalence of Epilepsy in LMICs is believed to be partly due to
a higher frequency of traffic accidents, birth injuries and neuroinfectious
disorders (such as neurocysticercosis) that can cause epilepsy in LMICs
14. Incidence of epilepsy by age—composite of 12 studies in developed countries, 1988–2005.. SOURCE:
Thurman, 2011. https://www.nap.edu/read/13379/chapter/3#26
15. estimated number of patients in Scotland consulting a GP or practice nurse at least once in the financial year 2012/13.
https://www.isdscotland.org/Health-topics/General-practice/Gp-consultations/Health-Conditions/Epilepsy/index.asp
20. CAUSES OF EPILEPSY…
• Other causes include primary CNS dysfunction or underlying metabolic
derangement or systemic diseases
• Common causes:
• In children, congenital and genetic causes
• In young adult, tumours, alcohol and drugs
• In elderly, cerebrovascular diseases
21. CAUSES ACCORDINGTO AGE
• Neonates
• Perinatal hypoxia and ischaemia
• Intracranial haemorrhage/trauma
• Acute CNS infection
• Metabolic disturbance (hypo – glycaemia, calcaemia and magnesaemia;
pyridoxine deficiency)
• Drug withdrawal
• Developmental disorders
• Genetic disorders
24. CAUSES ACCORDINGTO AGE
• 18-35yrs
• Trauma
• Alcohol withdrawal
• Illicit drug use
• Brain tumour
• Idiopathic
25. MORTALITY
EPILEPSY CAN BE LETHAL DUETO THE DIRECT & INDIRECT EFFECTS
OF SEIZURES
• THE DIRECT EFFECTS: e.g.
• sudden unexpected death in epilepsy
• status epilepticus
• Accidents such as : drowning motor
vehicle accidents, falls and burns
• THE INDIRECT EFFECTS: e.g.
• aspiration pneumonia,
• suicide 5-25x more in epileptics
• adverse effects of ASDs or psychiatric
drugs, such as obesity and
cardiovascular side effects
27. PATHOPHYSIOLOGY
• The spread of electrical activity between cortical neurones is normally
restricted.
• Synchronous discharge of neurones in normal brain takes place in small groups
only.
• During a seizure, large groups of neurones are activated repetitively and hyper-
synchronously,There is failure of inhibitory synaptic contact between neurones.
• This causes high voltage spike-and-wave activity on EEG.
28. Epilepsy and inflammation in the brain. https://www.semanticscholar.org/paper/Epilepsy-and-inflammation-in-
the-brain%3A-overview-Vezzani/86351e1c5e25a373c2b3b13977efd2ec679cfa7a
30. HISTORICAL PERSPECTIVES
• For over 35 years, the terms partial and generalized seizures were used to
describe types of seizures:
• Partial (seizures starting in one area or side of the brain) and
• Generalized (seizures starting in both sides of the brain at the same time).
• Partial seizures were further classifies into
• Simple partial seizures (Person is aware of what happens during the event.)
• Complex partial seizures: (Person has some impaired awareness during the
seizure.)
31. CLASSIFICATION
1. Seizures may present with a variety of symptoms, and awareness may be
either intact or impaired.
2. Seizures are further described by the presence of motor movements,
including automatisms or other motor activity, and by nonmotor onset
symptoms, including sensory or autonomic symptoms.
32. CLASSIFICATION
• Seizure onset can be :
• Focal: when abnormal neuronal activity arises in one or more localized
brain regions or hemisphere;
• Generalized: when abnormal neuronal activity begins in a widespread
distribution over both hemispheres; or
• Of unknown onset: if the available clinical and laboratory data cannot
identify whether the onset is focal or generalized.
33. CLASSIFICATION
• The International League against Epilepsy (ILAE) published in the April
2017 edition of Epilepsia three companion articles on the classification of
seizures and the epilepsies,
• (These represent a long-awaited update on the original 1981 and 1989
classifications).
• The new classification provide a modern descriptive template for epilepsy;
by using more accessible, transparent language suitable for clinicians,
scientists, and patients
34. CLASSIFICATION
• The new classification presents three levels of terminology, involving
1. Where seizures begin in the brain
2. Level of awareness during a seizure
3. Other features of seizures – e.g. motor vs non-motor.
35. The management of epilepsy in children and adults by Perucca P, et al. MJA 208 (5) j 19 March 2018
37. The management of epilepsy in children and adults by Perucca P, et al. MJA 208 (5) j 19 March 2018
38. ONSET: DEFINING WHERE SEIZURES BEGIN
• The first step is to separate seizures by how they begin in the brain.
• The type of seizure onset is important because it affects choice of seizure
medication, possibilities for epilepsy surgery, outlook, and possible causes.
39. ONSET: DEFINING WHERE SEIZURES BEGIN
• Focal seizures: Previously called partial seizures, these start in an area or network of
cells on one side of the brain.
• Generalized seizures: Previously called primary generalized, these engage or involve
networks on both sides of the brain at the onset.
• Unknown onset: If the onset of a seizure is not known, the seizure falls into the
unknown onset category. Later on, the seizure type can be changed if the beginning of a
person’s seizures becomes clear.
• Focal to bilateral seizure: A seizure that starts in one side or part of the brain and
spreads to both sides has been called a secondary generalized seizures.The new term for
secondary generalized seizure would be a focal to bilateral seizure. (Now the term
generalized refers only to the start of a seizure. )
40. DESCRIBING AWARENESS
• Whether a person is aware during a seizure is of practical importance
• This is because it is one of the main factors affecting a person’s safety
during a seizure.
• Awareness is used instead of consciousness, because it is simpler to
evaluate.
41. DESCRIBING AWARENESS
• Focal aware: If awareness remains intact, even if the person is unable to talk or respond
during a seizure, the seizure would be called a focal aware seizure.This replaces the term
simple partial.
• Focal impaired awareness: If awareness is impaired or affected at any time during a seizure,
even if a person has a vague idea of what happened, the seizure would be called focal impaired
awareness.This replaces the term complex partial seizure.
• Awareness unknown: Sometimes it’s not possible to know if a person is aware or not, for
example if a person lives alone or has seizures only at night
• Generalized seizures: These are all presumed to affect a person’s awareness or
consciousness in some way.Thus no special terms are needed to describe awareness in
generalized seizures.
42. OTHER FEATURES OF SEIZURES
• Many other symptoms may occur during a seizure.
• In this basic system, seizure behaviours are separated into groups that
involve movement.
43. 1. DESCRIBING MOTOR AND OTHER SYMPTOMS IN
FOCAL SEIZURES
• Focal motor seizure: This means that some type of movement occurs during the event.
For example twitching, jerking, or stiffening movements of a body part or automatisms
(automatic movements such as licking lips, rubbing hands, walking, or running).
• Focal non-motor seizure: This type of seizure has other symptoms that occur first, such
as changes in sensation, emotions, thinking, or experiences. It is also possible for a focal
aware or impaired awareness seizure to be sub-classified as motor or non-motor onset.
• Auras: The term aura, which describes symptoms a person may feel in the beginning of a
seizure, is not in the new classification.Yet people may continue to use this term. It’s
important to know that in most cases, these early symptoms may be the start of a seizure
44. 1. DESCRIBING MOTOR AND OTHER SYMPTOMS IN
FOCAL SEIZURES
MOTOR ONSET
• automatisms
• atonic
• clonic
• epileptic spasms
• hyperkinetic
• myoclonic
• tonic
NON-MOTOR ONSET
• autonomic
• behaviour arrest
• cognitive
• emotional
• sensory
45. 2. DESCRIBING GENERALIZED ONSET SEIZURES
• Generalized onset seizures can be motor or non-motor.
• Generalized motor seizure:
• The generalized tonic-clonic seizure term is still used to describe seizures with stiffening (tonic)
and jerking (clonic).This loosely corresponds to “grand mal.” Other forms of generalized motor
seizures may happen. Many of these terms have not changed, and a few new terms have been
added. (see image below)
• Generalized non-motor seizure:
• These are primarily absence seizures, and the term corresponds to the old term "petit mal."
These seizures involve brief changes in awareness, staring, and some may have automatic or
repeated movements like lip-smacking.
50. DIAGNOSIS
• Often over-diagnosed
• Diagnosis is essentially clinical
• Description of the seizure provided by an eye witness (MOST seizures)
• Sometimes patient self especially in partial onset
• Good history and examination
• Generally no place for a therapeutic trial
51. DIAGNOSIS/CASE DEFINITION
• The case definition of epilepsy, based on combined clinical and epidemiological
evidence, includes the following:
• Patients with two or more unprovoked or reflex seizures that are >24 hours
apart;
• Patients with one unprovoked or reflex seizure and who have a ≥60% chance of
further seizures over the following 10 years, e.g. patients with a known structural
lesion such as stroke, severe traumatic brain injury or brain infection
• Patients with one or more seizures in the context of a well-defined epilepsy
syndrome (for example, childhood epilepsy with centrotemporal spikes)
52. NEUROLOGICAL DIFFERENTIAL DIAGNOSIS
EPILEPTIC SEIZURES ARE OFTEN CONFUSED WITH OTHER PHYSIOLOGICAL
DISORDERS AND PSYCHIATRIC DISORDERS
• Benign paroxysmal positional vertigo
• Breath-holding attacks
• Daydreaming
• Migraine
• Parasomnias (such as REM sleep
behaviour disorder)
• Narcolepsy and/or cataplexy
• Syncope; tics
• Periodic leg movements during sleep
• Panic attacks
• Paroxysmal dyskinesia
• Psychogenic non-epileptic seizures
• Sleep apnoea
• Transient global amnesia. and
• Transient ischaemic attacks
55. LIFESTYLE MODIFICATION
AVOID FACTORS THAT COULD LOWER SEIZURE THRESHOLD
• Stress
• Alcohol use or withdrawal
• Dehydration
• Drugs & drug interactions
• Photosensitive stimuli (flashing TV
program or computer games)
• Hyperventilation
• Diet & missing meals
• Sleep deprivation
• Extreme fatigue
• Systemic infections
56. LIFESTYLE MODIFICATION
• Never stop anti-epileptic drug suddenly or omit dose
• Avoid potential harmful situations
• Avoid heights & open fires
• Prefer showering to bathing
• Prefer microwave cooking to gas or electric hobs
• Avoid swimming alone
• Avoid cycling on a busy road
• Avoid solo canoeing
57. EDUCATION
• Understand epilepsy
• Keep a seizure chart
• Keep a pill box to facilitate daily medication
• Obtain a Medic Alert kit
• Know the name and the dose of the drugs prescribed, and the frequency
of dosing and the necessity of regular ongoing use
• Refrain from driving
58. CLINICAL APPROACH: EMERGENCY MEASURES
• ABCDE & Manage
• Airway
• FMO2,
• Left lateral position
• HGT,
• Valium 10mg/Ativan 4mg IVI stat
59. HISTORY
• Main complaint
• Description of seizure
• Duration
• Frequency
• Prev. seizures
• History of trauma
• Associated symptoms
• Past Medical History
• HPT/IHD/AF – Cerebrovascular disease
• DM – Hypoglycaemia
• Social history
• Alcohol – trigger
• Smoking – CVA risk
• Illicit drugs
• Family history of epilepsy (increasedrisk of
recurrence)
60. EXAMINATION
• Vitals, Saturations
• JACCOLD
• Systemic examination focusing on Neurological exam
• Exclude focal signs
• Check orientation and level of consciousness
• Check for signs of injury
61. SIDE ROOM/SPECIAL INVESTIGATIONS
• HGT
• FBC
• UEC
• CMP
• LFTs
• Toxic screen/Anti-epileptic levels
• ECG
• CT Brain / MRI
• EEG
• Individualise your patient, based on
history and examination findings
64. ANTIEPILEPTIC DRUGS
• Principles
• Start low, go slow
• Monitor levels
• Inform of side-effects
• Refractory Epilepsy: Add second drug with different mechanism of
action
65.
66. FIRST GENERATION AEDS: EFFICACY
AED EFFICACY SPECTRUM
Valproic acid All seizure types
Benzodiazepines All seizure types
Phenobarbital Most seizure types
Carbamazepine Focal seizures and generalised tonic-clonic seizures
Phenytoin Focal seizures and generalised tonic-clonic seizures
Ethosuximide Absence seizures
Primidone Most seizure types
67. SECOND GENERATION AEDS: EFFICACY
AED EFFICACY SPECTRUM
Lamotrigine Most seizure types
Gabapentin Focal seizures
Oxcarbazepine Focal seizures and generalised tonic-clonic seizures
Topiramate Most seizure types
Vigabatrin Focal seizures and infantile spasm
Pregabalin Focal seizures
Brivaracetam Focal seizures
71. WOMEN’S HEALTH
• The highest risk of major congenital malformations is with exposure to
valproate, which has an odds ratio of 6.7–9.3,
• Exposure to carbamazepine, lamotrigine, levetiracetam, or phenytoin resulted in
a risk of major congenital malformations with odds ratios of 2–3 with a 95% CI
of 1.2–5.
• There is a greater risk with exposure to phenobarbital and topiramate (OR 4.2–
5.5; 95% CI, 2.4–9.7).
• Beyond teratogenicity risk, in utero exposure to valproate results in reduced
neurocognitive abilities and low IQ.
Meador KJ, Loring DW. (2016). Developmental effects of antiepileptic drugs and the need for
improved regulations. Neurology 2016;86:297-306.
72. WOMEN’S HEALTH
• Pre-pregnancy planning and education are important.
• Ideally, the woman has to be seizure free for at least 9 months before
pregnancy.
• Folic acid should be taken while trying to become pregnant or while at
risk of pregnancy, ideally for at least 1–3 months before conception.
73. STUDY ON AED IN PREGNANCY
• The same principles apply for withdrawal of AEDs in seizure-free women as in any
person with epilepsy
• This needs to be carefully planned months before conception
• In those women who continue to need treatment the aim should be to achieve seizure
control with the lowest possible dose of monotherapy. Polytherapy is best avoided where
possible
• Treatment should be optimised and where necessary the continuation of AEDs reviewed
Review Management of women with epilepsy during pregnancy.Authors Naghme Adab / DavidW
Chadwick. 2016. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.8.1.020.27204
74. STUDY ON AED IN PREGNANCY…
• The choice of AED is determined primarily by the type of epilepsy
• There is accumulating evidence of a greater risk with valproate exposure in utero for
both major malformations and later development
• Safer alternatives include carbamazepine, lamotrigine
• There is clinical consensus and observational data indicating the superiority of valproate
over other AEDs for seizure control, and no justification for switching every woman of
childbearing age on valproate to an alternative drug
Review Management of women with epilepsy during pregnancy. Authors Naghme Adab / DavidW
Chadwick. 2016. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.8.1.020.27204
75. CHILDREN
• A large, randomized, double-blind trial addressed the relative difference in efficacy and
tolerability between ethosuximide, valproate, and lamotrigine.
• The study included 451 children, and the primary outcome was freedom from treatment
failure, with failure defined as continued seizures or excessive drug toxicity, evaluated at
weeks 16 and 20.
• There was no difference between ethosuximide and valproate (53% and 58% respectively,
p=0.35), whereas patients taking lamotrigine were less likely to meet the study outcome,
probably because of a lack of seizure control (29%, p<0.0001).
• Adverse effects were not significantly different between the drugs.
Glauser TA, Cnaan A, Shinnar S, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy:
initial monotherapy outcomes at 12 months. Epilepsia 2013;54:141-55.
76. REFERENCES
1. Fisher, R. S. et al. (2017). Operational classification of seizure types by the
International League Against Epilepsy: Position Paper of the ILAE
Commission for Classification and Terminology. Epilepsia 58, 522–530.
2. Devinsky O, et al, (2018). Epilepsy. Disease PrimersVolume 3, Article
Number 18024, doi:10.1038/Nrdp.2018.24
3. Brodie, M.J. et al. (2018).The 2017 ILAE classification of seizure types and
the epilepsies: what do people with epilepsy and their caregivers need to
know? Epileptic Disord,Vol. 20, No. 2,April 2018
77. 4. Conway JM & Tallian KB (2018). Epilepsy. PSAP 2018 BOOK 3 •
Neurology /Psychiatry
5. Perucca P, et al. (2018). The management of epilepsy in children and
adult. MJA 208 (5) j 19 March 2018