Epileptogenesis is the process by which normal brain tissue is transformed into tissue capable of generating spontaneous recurrent seizures. It involves multiple mechanisms including genetic and acquired factors. The hippocampus is particularly susceptible to epileptogenesis due to its circuitry. Status epilepticus animal models are commonly used to study the process. Epileptogenesis occurs in acute, subacute, and chronic stages. Acute changes include increased expression of immediate early genes and post-translational modifications of proteins. Subacute changes involve neuronal death, alterations in neurotrophic factors and inflammation. Chronic changes include mossy fiber sprouting and neurotransmission alterations.
Epileptogenesis is the process by which the brain becomes epileptic. It occurs in three phases - an initial injury, a latent period of neuronal changes, and chronic epilepsy. During the latent period, various molecular pathways are dysregulated, including mTOR and REST, and neuronal circuits like the dentate gate and temporoammonic pathway are altered. These changes involve loss of inhibitory interneurons and abnormal sprouting, leading to recurrent seizures. Understanding epileptogenesis may help develop new treatments targeting the latent period to prevent epilepsy.
Epileptogenesis is the process by which a brain network that was previously normal is functionally altered toward increased seizure susceptibility, thus having an enhanced probability to generate spontaneous recurrent seizures (SRSs). The process of epileptogenesis occurs in 3 phases: the occurrence of a precipitating injury; a 'latent' period of epileptogenesis and chronic, established epilepsy. Structural and molecular changes associated with epileptogenesis include selective neuronal loss,axonal and dendritic reorganisation, neurogenesis, altered expression of neurotransmitters, and changes at glial architecture. Antiepileptogenesis can be complete or partial. Complete prevention aborts the development of epilepsy while partial prevention can delay the development of epilepsy or reduce its severity. Targeting signaling pathways that alter the expression of genes involved in epileptogenesis may provide novel therapeutic approaches for preventing epileptogenesis. The mTOR and REST pathways are exciting new potential targets for intervention in the epileptogenic process.
Hyper-excitable neurons lead to excessive excitability in surrounding neurons, causing seizures (hyper-synchronization). This occurs due to an imbalance of excitatory vs inhibitory neurotransmitters - glutamate activation and lowered calcium channel thresholds increase neuronal excitation, while reduced GABA inhibition decreases the inhibitory surround. This disruption of the normal depolarization-afterhyperpolarization cycle in neurons results in a continuous firing state and seizure focus.
Epileptogenesis is the process by which normal brain tissue is transformed into tissue capable of generating spontaneous recurrent seizures. It involves multiple mechanisms including genetic and acquired factors. The hippocampus is particularly susceptible to epileptogenesis due to its circuitry. Status epilepticus animal models are commonly used to study the process. Epileptogenesis occurs in acute, subacute, and chronic stages. Acute changes include increased expression of immediate early genes and post-translational modifications of proteins. Subacute changes involve neuronal death, alterations in neurotrophic factors and inflammation. Chronic changes include mossy fiber sprouting and neurotransmission alterations.
Epileptogenesis is the process by which the brain becomes epileptic. It occurs in three phases - an initial injury, a latent period of neuronal changes, and chronic epilepsy. During the latent period, various molecular pathways are dysregulated, including mTOR and REST, and neuronal circuits like the dentate gate and temporoammonic pathway are altered. These changes involve loss of inhibitory interneurons and abnormal sprouting, leading to recurrent seizures. Understanding epileptogenesis may help develop new treatments targeting the latent period to prevent epilepsy.
Epileptogenesis is the process by which a brain network that was previously normal is functionally altered toward increased seizure susceptibility, thus having an enhanced probability to generate spontaneous recurrent seizures (SRSs). The process of epileptogenesis occurs in 3 phases: the occurrence of a precipitating injury; a 'latent' period of epileptogenesis and chronic, established epilepsy. Structural and molecular changes associated with epileptogenesis include selective neuronal loss,axonal and dendritic reorganisation, neurogenesis, altered expression of neurotransmitters, and changes at glial architecture. Antiepileptogenesis can be complete or partial. Complete prevention aborts the development of epilepsy while partial prevention can delay the development of epilepsy or reduce its severity. Targeting signaling pathways that alter the expression of genes involved in epileptogenesis may provide novel therapeutic approaches for preventing epileptogenesis. The mTOR and REST pathways are exciting new potential targets for intervention in the epileptogenic process.
Hyper-excitable neurons lead to excessive excitability in surrounding neurons, causing seizures (hyper-synchronization). This occurs due to an imbalance of excitatory vs inhibitory neurotransmitters - glutamate activation and lowered calcium channel thresholds increase neuronal excitation, while reduced GABA inhibition decreases the inhibitory surround. This disruption of the normal depolarization-afterhyperpolarization cycle in neurons results in a continuous firing state and seizure focus.
This document discusses electrodiagnostic criteria for Guillain-Barré syndrome (GBS) subtypes acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). It reviews the evolution of criteria sets over time, including those proposed by Asbury, Albers, Cornblath, Ho, Hadden, and others. Key findings include that early electrodiagnosis can be difficult, with reversible conduction failure in AMAN sometimes mimicking AIDP. Serial nerve conduction studies are important for distinguishing subtypes and determining prognosis, as features may change over time. The document also discusses pathological mechanisms and involvement of sensory fibers.
Dr. sarah weckhuysen kcnq2 Cure summit parent track learn more at kcnq2cure.orgscottyandjim
This document discusses KCNQ2 gene mutations which can cause different epilepsy phenotypes from benign familial neonatal seizures (BFNS) to more severe early-onset epileptic encephalopathy. It describes the discovery of KCNQ2 mutations in BFNS in 1998 and more recent findings of de novo missense mutations in 10% of patients with treatment-resistant neonatal epileptic encephalopathy. These mutations have a dominant-negative effect on channel function and cause neuronal hyperexcitability. The document also reviews other ion channel mutations associated with epilepsy phenotypes along a spectrum, such as SCN1A mutations which can cause GEFS+ or more severe Dravet syndrome.
EEG measures the electrical activity of the brain through electrodes placed on the scalp. It can detect different wave patterns associated with different brain states. Evoked potentials involve stimulating a sensory pathway and measuring the electrical response along the pathway. This allows localization of lesions. Somatosensory evoked potentials involve stimulating a peripheral nerve like the median nerve and measuring the response along the pathway to detect spinal cord or brain injuries. Auditory evoked potentials involve measuring the brainstem response to a click stimulus to detect acoustic neuromas or other posterior fossa lesions. Both evoked potentials and EMG monitoring are used during surgery to detect injuries.
Neurotransmission involves the release of neurotransmitters from the axon terminal of one neuron that bind to and react with receptors on another neuron. Nerve signals travel as electrical nerve impulses along neurons. A neuron consists of a cell body, dendrites that receive signals, and an axon that transmits signals. When a neuron is stimulated, sodium ions enter the cell causing an action potential to propagate along the axon. At synaptic junctions, neurotransmitters are released from vesicles and bind to receptors, causing excitation or inhibition of the downstream neuron. Neurotransmitters are then removed from the synapse to terminate signaling.
This document discusses congenital myasthenic syndrome (CMS), which is an inherited disorder of neuromuscular transmission associated with weakness and fatiguability. It compares CMS to myasthenia gravis, which is an autoimmune condition. The document then provides details on the basic anatomy and physiology of the neuromuscular junction, including the roles of acetylcholine, acetylcholinesterase, and ion channels. It discusses various classifications and frequencies of identified mutations in CMS. The rest of the document focuses on different types of presynaptic CMS syndromes, including choline acetyltransferase deficiency, paucity of synaptic vesicles, Lambert-Eaton-like syndrome, and congenital end plate acetylcholin
Migraine is a central nervous system disorder with a genetic basis. People with migraines have a hyperexcitable brain that is more sensitive to triggers. During migraine attacks, there is a wave of reduced blood flow called cortical spreading depression that starts in the occipital cortex and progresses forward. Repeated attacks can lead to changes in brain structures involved in pain processing like the periaqueductal gray, and an increased risk of white matter lesions. Preventive treatments aim to reduce central nervous system excitability underlying migraine while acute treatments target trigeminal pain pathways activated during attacks.
Direct current stimulation (tDCS) involves passing a weak electric current through the brain. tDCS can affect neural excitability and behavior in a polarity-dependent manner. While some human studies show cognitive improvements from tDCS, results are highly variable across laboratories. Animal studies demonstrate tDCS reliably increases neural firing rates and improves cerebellum-dependent motor learning, effects that are reversed in mutant mice with long-term potentiation impairments. Further research is needed to better understand tDCS's mechanisms of action and improve control over its behavioral effects.
This document discusses critical care EEG monitoring. It provides information on the indications for EEG monitoring, including seizure assessment and brain death evaluation. It notes that about half of seizures in patients are identified within the first hour of monitoring, but up to 90% are identified within 24 hours. However, the duration of monitoring should be tailored to the individual patient. The document also discusses electrographic seizures versus clinical seizures and presents findings from a study which found that over 66% of events initially suspected to be seizures were actually non-epileptic based on EEG monitoring. It emphasizes that EEG monitoring is an important tool but remains labor-intensive.
This document discusses various techniques for monitoring patients in the intensive care unit (ICU), including electroencephalography (EEG), somatosensory evoked potentials (SSEPs), brain oxygen monitoring, intracranial pressure (ICP) monitoring, and cerebral blood flow monitoring using transcranial Doppler ultrasound. It provides examples of how these monitoring techniques can be used to detect seizures, brain injury, vasospasm, and other conditions in ICU patients.
This document provides information about chronic inflammatory demyelinating polyneuropathy (CIDP), including:
1) CIDP is an autoimmune disorder where the immune system attacks the peripheral nervous system, specifically targeting the myelin insulation around nerves.
2) Symptoms include numbness, tingling, muscle weakness, loss of reflexes, and abnormal sensations that typically start distally and progress proximally.
3) Diagnosis involves nerve conduction studies showing signs of demyelination in multiple nerves as well as EMG findings such as prolonged latencies and conduction blocks. Nerve biopsy may also show signs of inflammation and demyelination.
The document discusses electroencephalography (EEG) patterns during different states of consciousness such as wakefulness and sleep. It describes the different sleep stages including non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleep involves high-amplitude slow waves while REM sleep involves low-amplitude fast waves similar to wakefulness. The neural mechanisms controlling arousal, NREM sleep and REM sleep are also summarized.
The document summarizes the history and technical aspects of conventional EEG. It discusses how EEG works to detect and amplify the brain's electrical activity, which is measured using electrodes placed on the scalp. Different electrode placements and montages are used to view brain activity from various regions and perspectives. While imaging techniques now provide anatomical details, EEG remains clinically useful for evaluating brain function in various neurological disorders.
Regeneration of Brain with new understanding gives us good ground to be optimistic in matters of research and also day to day clinics. This presentation at the most introduces you to the potential stride of the field.
This document summarizes congenital myasthenic syndromes (CMS), which are genetic diseases characterized by dysfunction of neuromuscular transmission. CMS can be presynaptic, synaptic, or postsynaptic. Causes include mutations in genes encoding choline acetyltransferase (ChAT), acetylcholinesterase, acetylcholine receptor subunits, rapsyn, and sodium channels. Presentation and treatment vary depending on genetic cause, though cholinesterase inhibitors are often effective except for slow channel and acetylcholinesterase deficiency CMS. Diagnosis involves response to medication, electrophysiology, muscle biopsy, and genetic testing.
The document discusses various current applications of electroencephalography (EEG) technology both within and outside of clinical settings. It outlines EEG's predominant use in epilepsy and sleep disorder diagnosis clinically. It also explores recent developments that enable portable and cheaper EEG units, allowing novel consumer and research applications. Specifically, the document examines EEG's role in investigating sleep disorders, assessing brain death, monitoring anesthesia depth, cognitive engagement, brain development, and more. It explores EEG's growing use in cognitive science, neuroscience, and other research domains. Finally, it discusses emerging areas like brain-computer interfaces, closed-loop systems, and neuromarketing.
EEG is a non-invasive method to measure electrical activity in the brain. It can help in psychiatry by ruling out physical causes for psychiatric symptoms, aiding in differential diagnosis and treatment selection, and predicting prognosis. EEG findings can provide clues to underlying conditions in disorders like schizophrenia, mood disorders, OCD, panic attacks, dementia, delirium, and substance abuse. However, EEG findings in psychiatry are often nonspecific and EEG has limitations due to only recording cortical activity from the scalp. It currently has no definitive role in diagnosing Axis I or II psychiatric disorders.
Pathology & pathogenesis of different toxins, poisons other than teratogenic ...Rahul Kadam
Rahul G. Kadam presented on neurotoxic compounds affecting the nervous system. The presentation included an overview of nervous system anatomy and physiology, mechanisms of neurotoxicity including neuronopathies and axonopathies, and various compounds that can cause neurotoxicity such as bacterial toxins, mycotoxins, and plant and animal toxins. Specific toxins discussed in more depth included botulinum toxin, tetanus toxin, pneumolysin, epsilon toxin, fumonisin B1, and T-2 toxin. The presentation concluded with a discussion of the lesions and neurological effects caused by these various neurotoxic compounds.
Neurotransmission and neuromuscular junctionInbarajAnandan
Neurotransmission occurs when signals are transmitted between neurons through chemical synapses or neuromuscular junctions. The document discusses the historical discoveries of neurons, dendrites, axons and synapses. It describes how neurotransmitters are released by the axon terminal of the presynaptic neuron, binding to receptors on the postsynaptic neuron or muscle cell. The types of synapses and neurotransmitters are also outlined, as well as the roles and components of the neuromuscular junction in facilitating muscle contraction.
EEG stands for Electroencephalography
It’s record the electrical activity of brain.
During an EEG test , small electrodes like cup or disc type are placed on the scalp.
They pick up the brain’s Eletrical signals and send them to a machine called Electroencephalogram.
This document discusses various epileptic syndromes categorized by age of onset - infantile, childhood, adolescent. Key syndromes described in detail include West syndrome, Dravet syndrome, GEFS+, Panayiotopoulos syndrome, Benign epilepsy with centrotemporal spikes, Electrical status epilepticus in slow sleep, Myoclonic-atonic epilepsy, Lennox-Gastaut syndrome. For each syndrome, the document outlines clinical features, investigations such as common EEG findings and genetic causes, treatment approaches, and typical prognosis.
This document discusses electrodiagnostic criteria for Guillain-Barré syndrome (GBS) subtypes acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). It reviews the evolution of criteria sets over time, including those proposed by Asbury, Albers, Cornblath, Ho, Hadden, and others. Key findings include that early electrodiagnosis can be difficult, with reversible conduction failure in AMAN sometimes mimicking AIDP. Serial nerve conduction studies are important for distinguishing subtypes and determining prognosis, as features may change over time. The document also discusses pathological mechanisms and involvement of sensory fibers.
Dr. sarah weckhuysen kcnq2 Cure summit parent track learn more at kcnq2cure.orgscottyandjim
This document discusses KCNQ2 gene mutations which can cause different epilepsy phenotypes from benign familial neonatal seizures (BFNS) to more severe early-onset epileptic encephalopathy. It describes the discovery of KCNQ2 mutations in BFNS in 1998 and more recent findings of de novo missense mutations in 10% of patients with treatment-resistant neonatal epileptic encephalopathy. These mutations have a dominant-negative effect on channel function and cause neuronal hyperexcitability. The document also reviews other ion channel mutations associated with epilepsy phenotypes along a spectrum, such as SCN1A mutations which can cause GEFS+ or more severe Dravet syndrome.
EEG measures the electrical activity of the brain through electrodes placed on the scalp. It can detect different wave patterns associated with different brain states. Evoked potentials involve stimulating a sensory pathway and measuring the electrical response along the pathway. This allows localization of lesions. Somatosensory evoked potentials involve stimulating a peripheral nerve like the median nerve and measuring the response along the pathway to detect spinal cord or brain injuries. Auditory evoked potentials involve measuring the brainstem response to a click stimulus to detect acoustic neuromas or other posterior fossa lesions. Both evoked potentials and EMG monitoring are used during surgery to detect injuries.
Neurotransmission involves the release of neurotransmitters from the axon terminal of one neuron that bind to and react with receptors on another neuron. Nerve signals travel as electrical nerve impulses along neurons. A neuron consists of a cell body, dendrites that receive signals, and an axon that transmits signals. When a neuron is stimulated, sodium ions enter the cell causing an action potential to propagate along the axon. At synaptic junctions, neurotransmitters are released from vesicles and bind to receptors, causing excitation or inhibition of the downstream neuron. Neurotransmitters are then removed from the synapse to terminate signaling.
This document discusses congenital myasthenic syndrome (CMS), which is an inherited disorder of neuromuscular transmission associated with weakness and fatiguability. It compares CMS to myasthenia gravis, which is an autoimmune condition. The document then provides details on the basic anatomy and physiology of the neuromuscular junction, including the roles of acetylcholine, acetylcholinesterase, and ion channels. It discusses various classifications and frequencies of identified mutations in CMS. The rest of the document focuses on different types of presynaptic CMS syndromes, including choline acetyltransferase deficiency, paucity of synaptic vesicles, Lambert-Eaton-like syndrome, and congenital end plate acetylcholin
Migraine is a central nervous system disorder with a genetic basis. People with migraines have a hyperexcitable brain that is more sensitive to triggers. During migraine attacks, there is a wave of reduced blood flow called cortical spreading depression that starts in the occipital cortex and progresses forward. Repeated attacks can lead to changes in brain structures involved in pain processing like the periaqueductal gray, and an increased risk of white matter lesions. Preventive treatments aim to reduce central nervous system excitability underlying migraine while acute treatments target trigeminal pain pathways activated during attacks.
Direct current stimulation (tDCS) involves passing a weak electric current through the brain. tDCS can affect neural excitability and behavior in a polarity-dependent manner. While some human studies show cognitive improvements from tDCS, results are highly variable across laboratories. Animal studies demonstrate tDCS reliably increases neural firing rates and improves cerebellum-dependent motor learning, effects that are reversed in mutant mice with long-term potentiation impairments. Further research is needed to better understand tDCS's mechanisms of action and improve control over its behavioral effects.
This document discusses critical care EEG monitoring. It provides information on the indications for EEG monitoring, including seizure assessment and brain death evaluation. It notes that about half of seizures in patients are identified within the first hour of monitoring, but up to 90% are identified within 24 hours. However, the duration of monitoring should be tailored to the individual patient. The document also discusses electrographic seizures versus clinical seizures and presents findings from a study which found that over 66% of events initially suspected to be seizures were actually non-epileptic based on EEG monitoring. It emphasizes that EEG monitoring is an important tool but remains labor-intensive.
This document discusses various techniques for monitoring patients in the intensive care unit (ICU), including electroencephalography (EEG), somatosensory evoked potentials (SSEPs), brain oxygen monitoring, intracranial pressure (ICP) monitoring, and cerebral blood flow monitoring using transcranial Doppler ultrasound. It provides examples of how these monitoring techniques can be used to detect seizures, brain injury, vasospasm, and other conditions in ICU patients.
This document provides information about chronic inflammatory demyelinating polyneuropathy (CIDP), including:
1) CIDP is an autoimmune disorder where the immune system attacks the peripheral nervous system, specifically targeting the myelin insulation around nerves.
2) Symptoms include numbness, tingling, muscle weakness, loss of reflexes, and abnormal sensations that typically start distally and progress proximally.
3) Diagnosis involves nerve conduction studies showing signs of demyelination in multiple nerves as well as EMG findings such as prolonged latencies and conduction blocks. Nerve biopsy may also show signs of inflammation and demyelination.
The document discusses electroencephalography (EEG) patterns during different states of consciousness such as wakefulness and sleep. It describes the different sleep stages including non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleep involves high-amplitude slow waves while REM sleep involves low-amplitude fast waves similar to wakefulness. The neural mechanisms controlling arousal, NREM sleep and REM sleep are also summarized.
The document summarizes the history and technical aspects of conventional EEG. It discusses how EEG works to detect and amplify the brain's electrical activity, which is measured using electrodes placed on the scalp. Different electrode placements and montages are used to view brain activity from various regions and perspectives. While imaging techniques now provide anatomical details, EEG remains clinically useful for evaluating brain function in various neurological disorders.
Regeneration of Brain with new understanding gives us good ground to be optimistic in matters of research and also day to day clinics. This presentation at the most introduces you to the potential stride of the field.
This document summarizes congenital myasthenic syndromes (CMS), which are genetic diseases characterized by dysfunction of neuromuscular transmission. CMS can be presynaptic, synaptic, or postsynaptic. Causes include mutations in genes encoding choline acetyltransferase (ChAT), acetylcholinesterase, acetylcholine receptor subunits, rapsyn, and sodium channels. Presentation and treatment vary depending on genetic cause, though cholinesterase inhibitors are often effective except for slow channel and acetylcholinesterase deficiency CMS. Diagnosis involves response to medication, electrophysiology, muscle biopsy, and genetic testing.
The document discusses various current applications of electroencephalography (EEG) technology both within and outside of clinical settings. It outlines EEG's predominant use in epilepsy and sleep disorder diagnosis clinically. It also explores recent developments that enable portable and cheaper EEG units, allowing novel consumer and research applications. Specifically, the document examines EEG's role in investigating sleep disorders, assessing brain death, monitoring anesthesia depth, cognitive engagement, brain development, and more. It explores EEG's growing use in cognitive science, neuroscience, and other research domains. Finally, it discusses emerging areas like brain-computer interfaces, closed-loop systems, and neuromarketing.
EEG is a non-invasive method to measure electrical activity in the brain. It can help in psychiatry by ruling out physical causes for psychiatric symptoms, aiding in differential diagnosis and treatment selection, and predicting prognosis. EEG findings can provide clues to underlying conditions in disorders like schizophrenia, mood disorders, OCD, panic attacks, dementia, delirium, and substance abuse. However, EEG findings in psychiatry are often nonspecific and EEG has limitations due to only recording cortical activity from the scalp. It currently has no definitive role in diagnosing Axis I or II psychiatric disorders.
Pathology & pathogenesis of different toxins, poisons other than teratogenic ...Rahul Kadam
Rahul G. Kadam presented on neurotoxic compounds affecting the nervous system. The presentation included an overview of nervous system anatomy and physiology, mechanisms of neurotoxicity including neuronopathies and axonopathies, and various compounds that can cause neurotoxicity such as bacterial toxins, mycotoxins, and plant and animal toxins. Specific toxins discussed in more depth included botulinum toxin, tetanus toxin, pneumolysin, epsilon toxin, fumonisin B1, and T-2 toxin. The presentation concluded with a discussion of the lesions and neurological effects caused by these various neurotoxic compounds.
Neurotransmission and neuromuscular junctionInbarajAnandan
Neurotransmission occurs when signals are transmitted between neurons through chemical synapses or neuromuscular junctions. The document discusses the historical discoveries of neurons, dendrites, axons and synapses. It describes how neurotransmitters are released by the axon terminal of the presynaptic neuron, binding to receptors on the postsynaptic neuron or muscle cell. The types of synapses and neurotransmitters are also outlined, as well as the roles and components of the neuromuscular junction in facilitating muscle contraction.
EEG stands for Electroencephalography
It’s record the electrical activity of brain.
During an EEG test , small electrodes like cup or disc type are placed on the scalp.
They pick up the brain’s Eletrical signals and send them to a machine called Electroencephalogram.
This document discusses various epileptic syndromes categorized by age of onset - infantile, childhood, adolescent. Key syndromes described in detail include West syndrome, Dravet syndrome, GEFS+, Panayiotopoulos syndrome, Benign epilepsy with centrotemporal spikes, Electrical status epilepticus in slow sleep, Myoclonic-atonic epilepsy, Lennox-Gastaut syndrome. For each syndrome, the document outlines clinical features, investigations such as common EEG findings and genetic causes, treatment approaches, and typical prognosis.
1) 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 in the next 10 years.
2) GABA, glutamate, and other neurotransmitters play a role in epileptogenesis. During seizures, GABAergic inhibition is compromised while glutamatergic excitation increases.
3) Many factors can cause seizures including vascular, metabolic, infectious, autoimmune, genetic, and drug-induced causes by altering excitatory and inhibitory neurotransmission in the brain.
Prophylactic antiepileptics are used after traumatic brain injury to prevent post-traumatic seizures. While prophylaxis with phenytoin decreases early seizures, it does not reduce the risk of late post-traumatic epilepsy. Levetiracetam may be superior to phenytoin as it has antiepileptogenic properties in animal models. However, evidence is still lacking and more research is needed to determine the ideal drug, duration of treatment, and whether prophylaxis reduces long-term disability from post-traumatic epilepsy. Genetic factors may also influence an individual's risk, and warrant further investigation.
Epilepsy is a neurological disorder that causes recurring seizures and affects over 5 million people in the US. Seizures occur when brain cells misfire and send too many electrical signals at once, causing changes in awareness, movement, or sensation. While epilepsy can be caused by head injuries or other brain damage, in many cases the cause is unknown. The Epilepsy Foundation provides resources and support for those affected by epilepsy and works to reduce the stigma around this common condition.
This document summarizes the pathophysiology of seizures. It outlines predisposing factors like family history and precipitating factors like sensory stimuli. It then describes how an epileptogenic focus becomes hyperexcitable, leading to partial depolarization and neurotransmitter release. This lowers the seizure threshold and can be activated by precipitating factors, spreading abnormal electrical discharges between hemispheres. During the tonic phase, muscles stiffen and consciousness is lost. The clonic phase involves rapid muscle contractions and jerking. Finally, the post-ictal phase involves exhaustion and impaired coordination or consciousness.
- Seizures are caused by abnormal excessive neuronal activity in the brain and can be classified as either partial or generalized seizures. Partial seizures originate in a localized region of the brain while generalized seizures involve both hemispheres.
- Common types of generalized seizures include absence seizures, characterized by brief lapses of consciousness, and tonic-clonic seizures which involve tonic muscle contraction followed by clonic movements.
- Complex partial seizures originate in the temporal lobe and involve psychic experiences such as hallucinations followed by automatisms like lip smacking and confusion after the seizure.
This document provides an overview of the basic mechanisms of epilepsy. It begins with definitions of seizures and epilepsy. It then discusses the histology of the cerebral cortex and key neurotransmitters like GABA and glutamate. Genetic factors that can contribute to epilepsy, like mutations in sodium channels, are reviewed. The role of neuroinflammation in the development and persistence of seizures is also examined. The conclusion emphasizes that epilepsy arises from disturbances in the excitation-inhibition balance in the brain due to various causes, and this involves multiple biological factors interacting in a self-reinforcing manner.
- Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It affects approximately 1% of the population worldwide. While medications can control seizures for many, there is no cure currently.
- Anti-epileptic drugs work by various mechanisms such as enhancing GABA inhibition, blocking sodium or calcium channels, or reducing glutamate excitation in the brain. Common drug classes include hydantoins, barbiturates, benzodiazepines, and succinimides.
- Choosing an anti-epileptic drug depends on seizure type, epilepsy syndrome, side effect profile, interactions with other medications, and cost. While monotherapy is preferred, multiple drugs may be needed to control seizures in some cases.
EPILEPSY CLASSIFICATION, PATHOENESIS, AND MANAGEMENT.pdfAdamu Mohammad
The document summarizes key aspects of epilepsy classifications, pathogenesis, and management. It describes:
1. The ILAE's 2017 classification system which focuses on seizures, epilepsies, and epilepsy syndromes, introducing new terminology like focal impaired awareness and focal to bilateral tonic-clonic.
2. Factors in epilepsy pathogenesis including neurotransmission pathways, molecular/genetic mechanisms, neurogenesis/rewiring, and inflammation. Epileptogenesis involves increased neuronal excitability.
3. Epilepsy categories of idiopathic, acquired, and cryptogenic based on identifiable brain lesions, and management considers seizure type, age of onset, family history, and test results.
The document discusses epilepsy, including its definition, causes, classification of seizures, and treatment. Epilepsy is defined as a group of disorders that cause recurrent, unprovoked seizures. Seizures are caused by abnormal electrical discharges in the brain and can have various causes including genetic defects, brain injuries, tumors, or lack of sleep. Seizures are classified as either partial/focal or generalized depending on where they originate and spread in the brain. Treatment involves anticonvulsant drugs which work by various mechanisms to prevent neuronal overexcitation as well as surgical removal of epileptic brain regions.
This document provides information about epilepsy and seizures. It begins with a brief history of epilepsy, noting that ancient cultures believed it was caused by supernatural forces. It was not until the 19th century that epilepsy began to be viewed as a medical condition. The document then discusses the physiology and causes of seizures, classifying them as partial or generalized seizures. Partial seizures can be simple, involving isolated symptoms, or complex, involving impaired awareness. The pathophysiology involves abnormal electrical firing in groups of neurons in the brain. In summary, the document covers the history, types, causes and neurological mechanisms of epilepsy and seizures.
Hippocrates first suggested epilepsy was a brain disorder in 400 BC. It is defined as brief episodes of loss of consciousness due to abnormal brain neuron firing. Seizures can be focal or generalized. Common seizure types include generalized tonic-clonic, absence, myoclonic, complex partial, and simple partial. Antiepileptic drugs work by modifying ion conductances like sodium channels, increasing GABA effects, or blocking glutamate receptors. Common antiepileptic drugs include phenytoin, carbamazepine, valproic acid, ethosuximide, and phenobarbital. Adverse effects and drug interactions must be monitored with long-term antiepileptic treatment.
1) Electroconvulsive therapy (ECT) involves delivering electricity to the brain to induce a seizure. It is a standard psychiatric treatment used to improve abnormal mental states.
2) ECT was developed in the 1930s-1940s as an alternative to inducing seizures through chemicals. It gained acceptance after Italian scientists successfully applied electricity to a patient's scalp in 1938.
3) The exact mechanisms of how ECT works are unclear but theories involve effects on neurotransmitter systems, neuroendocrine functions, anticonvulsant properties, and psychological factors. Modern ECT aims to optimize safety and efficacy.
- Seizures are caused by abnormal excessive neuronal excitation and synchronization in the brain. Epilepsy is a tendency toward recurrent seizures. Antiepileptic drugs (AEDs) work by decreasing neuronal excitability through various mechanisms like enhancing GABA inhibition, blocking sodium and calcium channels, and modulating glutamate.
- Common AED targets include GABA receptors, sodium channels, and calcium channels. Older AEDs like phenytoin, carbamazepine, and phenobarbital are effective but have more side effects due to sedation. Newer AEDs have fewer side effects. AEDs can interact through metabolic pathways and altering drug levels. Proper AED selection
The document summarizes key aspects of the endocrine system and hormone signaling. It describes two main coordinating systems - the endocrine system which secretes hormones to regulate slower processes like growth and metabolism, and the nervous system which uses fast electrical signals. Hormones are classified by their range and effects. The endocrine system uses hormones to coordinate processes in the body and maintain homeostasis via feedback loops, such as insulin and glucagon regulating blood glucose levels. Disorders like diabetes occur when these regulatory processes are disrupted.
Epilepsy is caused by excessive and synchronous discharge of cerebral neurons resulting in seizures. Seizures can be detected by EEG and categorized by origin, etiology, clinical presentation, and electrophysiology. They are broadly classified as partial or generalized. Anti-epileptic drugs work by enhancing GABA, inhibiting sodium channels, inhibiting calcium channels, or blocking glutamate receptors. Phenytoin is a first-line treatment for tonic-clonic, simple partial, and complex partial seizures as well as status epilepticus. It has many potential adverse effects and drug interactions that require monitoring.
1. Septic encephalopathy is an acute brain dysfunction that can occur in patients with sepsis and is characterized by impaired consciousness including coma.
2. The pathophysiology is multifactorial but is thought to involve the action of inflammatory mediators and free radicals on the brain resulting from systemic inflammation.
3. Septic encephalopathy is associated with worse prognosis and higher mortality in sepsis patients. The severity of encephalopathy correlates with mortality.
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.
This document summarizes various in vitro and in vivo models used for anti-epileptic drug screening. The in vitro models described include tests measuring effects on GABA and glutamate receptors, transporters, and uptake/release. The in vivo models involve inducing seizures chemically or through focal lesions in rodents and examining effects of test compounds. Several genetic and transgenic animal models of epilepsy are also mentioned. The document provides details on procedures and evaluation methods for key screening tests involving GABA uptake/release in hippocampal slices and electroshock induction in mice.
This document discusses various mechanisms of cell death, specifically necrosis and apoptosis. It describes the roles of caspases, cytochrome c, Bcl-2 family members, and other factors in apoptotic signaling pathways. It then discusses evidence of apoptosis in different neurodegenerative diseases like Alzheimer's, Parkinson's, Huntington's, and ALS. Various potential therapeutic targets and strategies aimed at inhibiting apoptosis are also outlined.
This study investigated how immune signaling and cell stress gene expression changes in the hippocampus and cerebellum of a rat model for glutamate excitotoxicity neurodegeneration. RNA was extracted from these brain regions in mutant and normal rats at different ages. Gene expression analysis found that genes involved in cytokine signaling were downregulated while cell stress genes were upregulated in mutant rats, suggesting altered immune regulation contributes to neurodegeneration. Specifically, genes related to glutamate metabolism and clusterin expression changed over time and differed between brain regions in ways that could enhance excitotoxic cell damage and death. The results provide insight into how the immune system may initiate neurodegeneration during glutamate excitotoxicity.
- 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
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
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3. An seizure is a transient occurrence of signs and/or
symptoms due to abnormal excessive or synchronous
neuronal activity in the brain.
A person is considered to have epilepsy if they meet any
of the following conditions:(As per ILAE)
1. At least two unprovoked (or reflex) seizures occurring
greater than 24 hours apart.
2. One unprovoked (or reflex) seizure and a probability of
further seizures similar to the general recurrence risk (at
least 60%) after two unprovoked seizures, occurring
over the next 10 years.
4. Babylonians-presence of
demons
Greeks and romans-
curse of gods
Hippocrates offered
epilepsy as a disease
Electrical hypothesis was
discovered by hans berger
when he invented the EEG
John Jackson (father of
epilepsy)-“occasional
sudden,excessive,rapid and
local discharge of gray matter”
5. The process of the brain
acquiring an initial insult and
secondarily undergoing a
series of epileptic events until
the first observable seizure
occurs.
Sloviter & Bumanglag
(2012) have proposed a
secondary term “epileptic
maturation” to describe the all
encompassing processes that
happen after epileptogenesis
and that influence the
secondary changes in the
clinical phenotype.
7. It consists of mainly 2 receptors:
GABA A
GABA B
8. Location of GABA A receptors-
• Synaptic receptors -gamma
subunits(mostly post synaptic)
• perisynaptic /extra synaptic -
deltas sub units responsible
for phasic and tonic inhibition.
During status epileptics, there is
increased neuronal hyper
excitability and inhibitory
GABAergic synaptic transmission
becomes compromised
• Miniature inhibitory post-
synaptic currents (mIPSCs) are
reduced
• Number of active GABAA
receptors per dentate granule
cell is also decreased.
9. Short term(during SE)
• In vitro-large
decrease in GABA-
gated chloride
currents.
• In vivo-rapid
reduction in the
number of
physiologically
active GABA
receptors.
10. Changes in latency period-
1.Minutes to hours –
Activation of plasma
membrane receptors result in
changes in the intracellular
signal transduction pathways
involved in the maintenance of
vital cellular functions.
2. Hours to days-
Long term changes in gene
expression result from the
combined effects of repeated
seizures, seizure-induced cell
death, and subsequent
neuronal reorganization
11. 2 types of receptors:
GABA B 1
GABA B2
Types:
Slow - downstream
Ca2+/K+ channels upon
binding with its
endogenous ligand,
GABA.
Long term- Ligand
activation of GABAB
receptors initiates G
protein–dependent cell
signaling pathways.
12. Presynaptic receptors prevent
neurotransmitter release
• Down-regulating the activity of
voltage-sensitive Ca 2+-channels
• Direct inhibition of the release
machinery.
Auto receptors inhibit the release of
GABA, whereas hetero receptors inhibit
the release of glutamate and several
other neurotransmitters.
Postsynaptic receptors induce sIPSCs by
activating Kir3-type K+-channels, which
hyperpolarizes the membrane, favors
voltage-sensitive block of NMDA
receptors and shunts excitatory
currents
Dendritic receptors inhibit back
propagating action potentials through
activation of K+-channels.
13. Two types of receptors:
1.Ionotropic
NMDA
AMPA
Kainate
2.Metabotropic(8)
Group1
Group2
Group3
14. 1.NMDA-
An increase in glutamate excitatory transmission in the
hippocampus.
Increase in the pool of ready-release glutamate at the mossy fiber-
pyramidal cell synapse in the CA3 as well as in DG.
Number of NMDA receptors present in neuronal cell membranes
appears to increase.
2.AMPA:
• Ca2+ influx into neurons causing excitotoxicity and cell death.
• Synaptic changes due to alterations in second messenger signaling
15. 3.KAINATE:
Causes slow EPSP’s to promote epileptogenesis.
4. METABOTROPIC RECEPTORS:
Group I- epileptogenic in nature when bound by glutamate.
Group II- promote antiepileptogenic effects when bound by
glutamate
5.Several morphological changes in the hippocampus occur during
epileptogenesis associated with glutamate dysregulation:
Hippocampal sclerosis, shrinkage, and reactive gliosis
Neuronal loss in hilar mossy cells, interneurons, and pyramidal
neurons of the CA3 and CA1 are also observed in the granule cell
layer
16. Receptor Mechanism of action
NMDA Glutamate and Glycine
mediated
AMPA Influx of Na+,Ca+ and
efflux of K+
KAINATE Slow EPSP’s
Group I(1,5) Phospholipase C (PLPC),
protein kinase C (PKC)
Group II(2,3) Inhibits c-amp formation,
directly activates K+
channels and inhibits
voltage sensitive
Ca2+ channels
Group III(4,6,7,8) Inhibits neuro-transmitter
release
17. Promote epileptogenesis such as a decrease in
GABAergic interneurons (which could cause an in
increase in glutamate neurotransmission)
A decrease in membrane expressed GABAB receptors
(which could also cause an increase in glutamate
neurotransmission)
18. Ach causes increased seizure activity by
acting on following brain parts:
Piriform cortex>amydala>hippocampus>
thalamus >cortical areas &striatum
Specific areas:
Piriform cortex-(substantia nigra & area
tempestas)
19. MECHANISM-
Cytotoxic activity seen in hippocampus and
cortical neurons
Disruption of polymerization of microtubules
Altered sensitivity to glutamate excitotoxicity
Decrease in expression of synaptic proteins.
Area tempestas-hyperactivity in hippocampus
Direct cholinergic input/indirect to ento-
rhinal cortex.
20. Dopamine
receptors
Location in brain
D1 CP, nucleus
accumbens ,
substantia nigra
D2 CP, nac, SN pars
compacta
D3 Limbic system
D4 Frontal cortex,
amygdala, SN,
hippocampus
D5 Entorhinal cortex,
SNR, and
hippocampus
(dentate gyrus)
21. Receptor Action
D1 type(D1,D5)(PRO-
CONVULSANT)
increases cAMP levels and
protein kinase A (PKA) activity via
the stimulation of adenylyl
cyclase (AC)
D2 type(ANTI-CONVULSANT)
(D2,D3,D4)
inhibit AC activity,antogonises D1
action(c-amp dependent)
Activation of glycogen synthase
kinase 3β(c-amp independent)
22.
23. Serotonin has a
protective mechanism
against epilepsy.
Main mechanism:
Hyperpolarization of
glutamatergic neurons by 5-
HT1A receptors(K+
conductance)
Depolarization of
GABAergic neurons by 5-
HT2C receptors.
24.
25.
26.
27.
28. Considered to have
protective role in
epilepsy.
Highest affinity for a2
adrenergic receptors.
Established role in the
control of limbic seizures
by increasing
noradrenaline levels in
structures that are
critically involved in the
generation of limbic
seizures, such as the
hippocampus.
35. Various mechanism seen are:
A particular body system has been sufficiently
impaired to produce a lowering of the seizure
threshold and the induction of “reactive seizures.
A state of cortical neuronal instability, such as a
(stroke with infarction, hemorrhage, embolus)
Encephalopathy
36.
37. Study of inheritance of heritable changes in
gene expression that occur with no
modifications to the DNA sequence.
Different types:
DNA methylation
histone modification
action of non-coding RNA
42. Drug Mechanism
Anti-infective
Peniciilin and related drugs Inhibits GABA binding to GABAA
receptor(allosteric modulation)
Blocks GABAA chloride channel
Fluoroquinolones Inhibit GABA binding to GABAA receptor
Isoniazid Inhibits pyridoxine kinase, resulting in
decreased GABA synthesis(formation of IPH)
Bromocriptine,pergolide Blocks dopaminergic transmission
Metronidazole Leads to accumulation of hydroxy- and 1-
acetic acid metabolite
TCA Inhibition of serotonin uptake in the cleft
Phenothiazine Dopamine blocking property
MOA –A inhibitor Produces serotergic activation(alpha-motor
neuron excitability)
Selective serotonin reuptake
Inhibitor
Decreases GABA transmission in the
hippocampus
Phenothiazines Antagonizes postsynaptic, mesolimbic
dopamine receptors in the brain
43. Local anesthetics Antagonizes Na1 channels
Meperidine Leads to accumulation of normeperidine
metabolite
Tramadol Inhibits monoamine uptake
Theophylline Antagonizes anticonvulsant effects of brain
adenosine
Calcineurin Down regulates GABAA receptor activation
Brain-stem stimulants
Pentetrazol
Picro-toxin
GABA excitation and inhibits GABA
inhibition respectively
Spinal stimulants
strychnine
Blocks inhibitory action of glycine at post
synaptic receptor
General anesthesia
Enflurane
etomidate
Increased excitability in limbic system
Disinhibit ion of sub-cortical activity
Local anaesthesia+epinephrine Ischemia in spinal cord(transient epilepsy)
Radio contrast dye(gadolinium) Direct action on cerebral cortex
47. The PRES has been described
after the intake of
immunosuppressants such as
tacrolimus, Cyclosporine.
It is characterized by capillary-leak
syndrome in the brain caused by
changes affecting the vascular
endothelium.
Clinical symptoms are headache,
vomiting, confusion, seizures,
cortical blindness and other visual
symptoms.
48. Drug Effect
Variant methionine synthetase,
modified effect of methotrexate
On homocysteine metabolism
Methotrexate encephalopathy
Human thymidylate synthetase gene 5- fluorouracil-associated
hyperammonemic encephalopathy
49. Benzodiazepine- in association with LENNOX
GASTAUT Syndrome or WEST Syndrome
Valproate/carbamazepine induced
encephalopathy(accumulation of CBZ
epoxide) esp. in children
Vigabatrin-increased GABA in brain
50.
51. Use in animal experimental model
PENICILLIN MODEL
PENTYLENTETRAZOL MODEL
BICUCULLINE MODEL
KAINIC ACID MODEL
52. 1.Marco I. Gonzáleza, Amy Brooks-Kayala; Altered GABAA receptor expression during epileptogenesis; Neuroscience Letters497 (2011) 218–
222
2. Amy R. Brooks-Kayal, M.D.; Regulation of GABAA Receptor Gene Expression and Epilepsy; Jasper's Basic Mechanisms of the Epilepsies
3. Mauro DiNuzzoa, Silvia Mangiab; REVIEW Physiological bases of the K+and the glutamate/GABA hypotheses of epilepsy; Epilepsy Research
;1st April(2014)
4. Seth R. Batten; GLUTAMATE DYSREGULATION AND HIPPOCAMPAL DYSFUNCTION IN EPILEPTOGENESIS; University of Kentucky, Theses and
Dissertations--Medical Sciences Medical Sciences,2013.
5. YuriBozzi, EmilianaBorrelli; The role of dopamine signaling in epileptogenesis; Frontiers in Cellular Neuroscience; September 2013 |
Volume7 | Article 157
6. Carl J. Vaughan, MD, MRCPI and Norman Delanty, MB, FRCPI; Pathophysiology of Acute Symptomatic Seizures; Seizures: Medical Causes
and Management;
7. Niels Hansen; Drug-Induced Encephalopathy; Miscellanea on Encephalopathies – A Second Look; 25, April, 2012
8. L. Pulido Fontesa, P. Quesada Jimeneza, M. Mendioroz Iriarte ; Epigenetics and epilepsy; NEUROLOGÍA; 2015;30(2):111—118
9. Rocio Sanchez-Carpintero;Genetic causes of epilepsy; THE NEUROLOGIST; DECEMBER 2007
10. PRATIBHA SINGHI; Infectious causes of seizures and epilepsy in the developing world; Developmental Medicine & Child Neurology 2011,
53: 600–609
11.Dennis o brien; Toxic and Metabolic Causes of Seizures; Clinical Techniques m Small Animal Practice, Vol 13, No 3 (August), 1998: pp 159-
166
12. Todd H Ahern, Martin A Javors, Douglas A Eagles, Jared Martillotti, Heather A Mitchell, Larry Cameron Liles and David Weinshenker; The
Effects of Chronic Norepinephrine Transporter Inactivation on Seizure Susceptibility in Mice; Neuropsychopharmacology (2006) 31, 730–738
13. Gyorgy Bagdy, Valeria Kecskemeti; Serotonin and epilepsy; Journal of Neurochemistry, 2007, 100, 857–873
14. LEONARDO COCITO, M.D., EMILIO FAVALE, M.D.; Epileptic Seizures in Cerebral Arterial Occlusive Disease; Stroke, Vol 13, No 2,1982
15. ROBRECHT RAEDT;VNS, noradrenaline and seizure suppression|; Journal of Neurochemistry, 2011; International Society for
Neurochemistry, J. Neurochem. (2011) 117, 461–469