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INTRODUCTION OF
SEIZURES AND SEIZURE
MIMICKING DISORDERS
BY JEEVANA
SEIZURE AND EPILEPSY
 SEIZURE : paroxysmal event due to
abnormal excessive or synchronous
neuronal activity in the brain resulting
in abnormal involuntary , paroxysmal ,
motor , sensory , autonomic or
sensorial activity
 EPILEPSY : recurrent seizures due to
chronic , underlying disease process .
Clinical phenomenon rather than a
single disease entity , many forms
 5% children – convulsions during first
5 years of life
 Tonic clonic movements are most
common except in newborn period
NEONATAL SEIZURES
 Twitching of limbs , fluttering of eyelids
, sucking movements , conjugate
deviation of the eyes
 Should be distinguished from
jetteriness , tremors , stratle response
to stimuli , sudden jerks on awakening
, tremulousness of hungry child
CAUSES
 EARLY NEONATAL PERIOD ( O-7 )
days
birth asphyxia
difficult obstructed labour
intaventricular , intracerebral hmg
pyridoxine dependency
hypoglycemia , hypocalcemia
inborn errors of metabolism
maternal withdrawal of medicines
 NEONATAL PERIOD ( 7-30) days :
Transient Metabolic: hypocalcemia
hypomagnesemia
hypoglycemia
dyselectrolytemia
Developmental malformations
Infections : meningitis
tetanus neonatorum
intrauterine infections
 Metabolic errors of metabolism :
phenylketonuria
maple syrup urine disease
galactosemia
urea cycle disorders
BEYOND NEONATAL PERIOD :
 Simple febrile convulsions
 Epilepsy syndromes
 Infections : TB , Bacterial meningitis
encephalitis , reye syn
intrauterine infections
cerebral malaria
 Metabolic : dyselectrolyemia ,inborn
errors
 Space occupying lesions : neoplasm
brain abscess
tuberculoma
cysticercosis
 Vascular : AV malformations
intracranial thrombosis ,hmg
 Drugs and Poisons : CO , phenytoin,
salicylates ,
strychnine
SEIZURE MIMICKING
DISORDERS
Arrhythmias and syncope
 Decerebrate posturing
 Psychogenic events
 Dystonia
 Migraine with recurrent abdominal
pain and cyclical vomiting
 Benign paroxysmal vertigo
 Apnoea
 Night terrors and sleep walking
Arrhythmias
 Insufficient contractions of cardiac
muscle contraction
 low cardiac output
 impaired cerebral perfusion
 motor activity or hypoxic
convulsions
 ECG : Long QT and torsades
SEIZURE SYNCOPE
IMM Precipitating factors none Cardiac etiology
Premonitory symptoms aura Nausea ,
diaphoresis ,
tunneling of
vision
Duration of tonic clonic 30-60 sec never > 15 sec
Facial appearance during
event
Cyanosis ,
frothing at mouth
pallor
Disorientation and sleepiness
after event
many min to hrs < 5 min
Duration of unconscious min sec
Biting of tongue present not seen
BREATH HOLDING SPELLS
 Reflexive events intiated by provocative
events that causes anger , frustration
and pain causing the child to cry
 Crying stops at full expiration
 Child becomes apneic and cyanotic or
pale
 May lose consciousness , hypotonic ,
and fall
 If lasts for > few sec –tonic clonic
seizures
 Spells revert on their own with resuming
Dystonia
Sustained involuntary muscle
contractions associated with twisting
and abnormal posture
PRIMARY : Hereditary – DYT1-DYT16
mean age 14 yrs DYT1
begins inth foot and legs and
progresses to other parts
disabling postural deformities
 DRD or DYT5 – 1-12 yrs
 inhibit dopamine
formation
 foot dystonia
 SECONDARY : neuroleptic drugs ,
 lesions in striatum , cortex , brin
stem , due to infection , anoxia ,
metabolic disturbance , toxins , tumor ,
trauma
Introduction of seizures    and seizure mimicking disorders

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Introduction of seizures and seizure mimicking disorders

  • 1. INTRODUCTION OF SEIZURES AND SEIZURE MIMICKING DISORDERS BY JEEVANA
  • 2. SEIZURE AND EPILEPSY  SEIZURE : paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain resulting in abnormal involuntary , paroxysmal , motor , sensory , autonomic or sensorial activity  EPILEPSY : recurrent seizures due to chronic , underlying disease process . Clinical phenomenon rather than a single disease entity , many forms
  • 3.  5% children – convulsions during first 5 years of life  Tonic clonic movements are most common except in newborn period
  • 4. NEONATAL SEIZURES  Twitching of limbs , fluttering of eyelids , sucking movements , conjugate deviation of the eyes  Should be distinguished from jetteriness , tremors , stratle response to stimuli , sudden jerks on awakening , tremulousness of hungry child
  • 5. CAUSES  EARLY NEONATAL PERIOD ( O-7 ) days birth asphyxia difficult obstructed labour intaventricular , intracerebral hmg pyridoxine dependency hypoglycemia , hypocalcemia inborn errors of metabolism maternal withdrawal of medicines
  • 6.  NEONATAL PERIOD ( 7-30) days : Transient Metabolic: hypocalcemia hypomagnesemia hypoglycemia dyselectrolytemia Developmental malformations Infections : meningitis tetanus neonatorum intrauterine infections
  • 7.  Metabolic errors of metabolism : phenylketonuria maple syrup urine disease galactosemia urea cycle disorders
  • 8. BEYOND NEONATAL PERIOD :  Simple febrile convulsions  Epilepsy syndromes  Infections : TB , Bacterial meningitis encephalitis , reye syn intrauterine infections cerebral malaria  Metabolic : dyselectrolyemia ,inborn errors
  • 9.  Space occupying lesions : neoplasm brain abscess tuberculoma cysticercosis  Vascular : AV malformations intracranial thrombosis ,hmg  Drugs and Poisons : CO , phenytoin, salicylates , strychnine
  • 10. SEIZURE MIMICKING DISORDERS Arrhythmias and syncope  Decerebrate posturing  Psychogenic events  Dystonia  Migraine with recurrent abdominal pain and cyclical vomiting  Benign paroxysmal vertigo  Apnoea  Night terrors and sleep walking
  • 11. Arrhythmias  Insufficient contractions of cardiac muscle contraction  low cardiac output  impaired cerebral perfusion  motor activity or hypoxic convulsions  ECG : Long QT and torsades
  • 12. SEIZURE SYNCOPE IMM Precipitating factors none Cardiac etiology Premonitory symptoms aura Nausea , diaphoresis , tunneling of vision Duration of tonic clonic 30-60 sec never > 15 sec Facial appearance during event Cyanosis , frothing at mouth pallor Disorientation and sleepiness after event many min to hrs < 5 min Duration of unconscious min sec Biting of tongue present not seen
  • 13. BREATH HOLDING SPELLS  Reflexive events intiated by provocative events that causes anger , frustration and pain causing the child to cry  Crying stops at full expiration  Child becomes apneic and cyanotic or pale  May lose consciousness , hypotonic , and fall  If lasts for > few sec –tonic clonic seizures  Spells revert on their own with resuming
  • 14. Dystonia Sustained involuntary muscle contractions associated with twisting and abnormal posture PRIMARY : Hereditary – DYT1-DYT16 mean age 14 yrs DYT1 begins inth foot and legs and progresses to other parts disabling postural deformities
  • 15.  DRD or DYT5 – 1-12 yrs  inhibit dopamine formation  foot dystonia  SECONDARY : neuroleptic drugs ,  lesions in striatum , cortex , brin stem , due to infection , anoxia , metabolic disturbance , toxins , tumor , trauma