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Seizure disorder
- 1. SEIZURE DISORDERS Presented By Mr. Rahat Ali NPCC 2nd Year PCNMS Haldwani
- 2. Introduction Normal brain function requires an orderly, organized, coordinate d discharge of electrical impulses. Electrical impulses enable the brain to communicate with the spinal cord, nerves, and muscles as well as within itself. Seizures may result when the brain's electrical activity is disrupted.
- 3. Definition A sudden, involuntary, time-limited alteration in behavior, motor activity, autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain. Seizure (medicine), sudden attack or spasm, as in epilepsy or a similar disorder. Seizures differ with the type of condition and may consist of loss of consciousness, convulsive jerking of parts of the body, emotional explosions, or periods of mental confusion.
- 4. Brain activity during seizures An electroencephalogram (an EEG) is a recording of the brain's electrical activity. The procedure is simple and painless. About 20 small adhesive electrodes are placed on the scalp, and the brain's activity is recorded under normal conditions. Then the person is exposed to various stimuli, such as bright or flashing lights, to try to provoke a seizure. During a seizure, electrical activity in the brain accelerates, producing a jagged wave pattern. Such recordings of brain waves help identify a seizure disorder. Different types of seizures have different wave patterns.
- 5. Types of seizure A. Primary generalized seizure: Begins with a widespread electrical discharge Involves both sides of the brain at once Hereditary factors are important B. Partial Seizure: Begins with an electrical discharge in one limited area of the brain Related to head injury, brain infection, stroke, or tumor
- 6. Types of Primary generalized seizure 1. Absence seizures: Brief episodes of staring Absence seizures are considered complex absence seizures Include a change in muscle activity Most common movement are eye blinks Complex absence seizures are often more than 10 seconds long
- 7. Usually begin between ages 4 and 14 no warning before a seizure, and the person is completely alert immediately afterward Other movements include slight tasting movements of the mouth, hand movements such as rubbing the fingers together ,etc. Children who get them usually have normal development and intelligence 70% of cases, absence seizures stop by age
- 8. 2. Atypical absence seizure: Atypical means unusual or not typical Person will stare but often is somewhat responsive Eye blinking or slight jerking movements of the lips may occur Hard to distinguish from the person's usual behavior, especially in those with cognitive impairment Generally begins at the age of 6 Most of the children affected have below-average intelligence
- 9. Other types of seizures that are difficult to control Seizures usually continue till adulthood Daydreaming and inattentiveness can mimic these seizures Diagnosis can be difficult if the behavior during seizures is similar to the child's usual behavior
- 10. 3. Monoclonic seizures: Very brief jerks, last only for 2 to 3 sec Seizures usually cause abnormal movements on both sides of the body at the same time Myo means muscle and clonus means rapidly alternating contraction and relaxation Seizures usually begin in childhood, but the seizures can occur at any age
- 11. Seizures occur in reflex epilepsies, triggered by flashing lights or other things in the environment Syndromes usually can be diagnosed on the basis of the medical history and often EEG patterns
- 12. 4. Atonic Seizures: Atonic means without tone In an atonic seizure, muscles suddenly lose strength Eyelids may droop, the head may nod, and the person may drop things and often falls to the ground Also known as drop attacks or drop seizures The person usually remains conscious
- 13. Another name for this type of seizure is “akinetic” which means without movement Seizures often begin in childhood Often last into adulthood People with atonic seizures are injured when they fall Seizures may cause people to fall when they're standing often have tonic seizures rather than atonic seizures Syndromes usually can be diagnosed on the basis of the medical history and often EEG patterns
- 14. 5. Tonic Seizures: Usually last less than 20 sec In such seizures, the tone is greatly increased and the body, arms, or legs make sudden stiffening movements Consciousness is usually preserved Seizures most often occur during sleep Usually involve all or most of the brain, affecting both sides of the body
- 15. Common in people who have the epilepsy syndrome called Lennox-Gastaut syndrome Movements cannot be stopped by restraining or repositioning the arms or legs These seizures are rarely found Common are tonic-clonic seizures, in which the jerking is preceded by stiffening
- 16. Sometimes tonic-clonic seizures start with jerking alone These are called clonic-tonic-clonic seizures Occur at various ages, including in newborns Brief and infrequent clonic seizures in infants usually disappear within very short period The EEG pattern will change during a seizure, so video- EEG is very useful for diagnosis
- 17. 7. Tonic-clonic seizures: Normally last for 2 to 3 min More than 5 min calls for immediate medical help Seizure that lasts more than 30 minutes indicate convulsion Person loses consciousness and falls to the floor Tongue or cheek may be bitten, so bloody saliva may come from the mouth Person may turn a bit blue in the face
- 18. After the tonic phase comes the clonic phase Arms and usually the legs begin to jerk rapidly and rhythmically Bending and relaxing at the elbows, hips, and knees After a few minutes, the jerking slows and stops Bladder or bowel control sometimes is lost as the body relaxes
- 19. Consciousness returns slowly, and the person may be drowsy, confused, agitated, or depressed Tonic-clonic seizures can be controlled by seizure medicines They affect both children and adults
- 20. Types of Partial seizures 1. Simple partial seizures: Different from person to person, depending on the part of the brain where they begin One thing they all have in common is that the person remains alert and can remember what happens Usually last for less than 2 min People who have had a head injury, brain infection, stroke, or brain tumor likely to get them These seizures often can be controlled by seizure medicines
- 21. 2. Complex Partial Seizures: Usually last between 30 seconds and 2 minutes Afterward, the person may be tired or confused for about 15 minutes and may not be fully normal for hours Seizures usually start in a small area of the temporal lobe or frontal lobe of the brain. Quickly involve other areas of the brain that affect alertness and awareness These seizures (usually ones beginning in the temporal lobe) start with a simple partial seizure Also called an aura, this warning seizure often includes an odd feeling in the stomach
- 22. Less often, people may repeat words or phrases, laugh, scream, or cry Some people do things during these seizures that can be dangerous People need to take precautions in advance people who have had a head injury, brain infection, stroke, or brain tumor are more likely to get seizures If medication is not effective, some can be eliminated by epilepsy surgery
- 23. 3.Secondarily generalized seizures: Start in one limited area of the brain Can also spread throughout the brain becoming generalized Convulsive phase of these seizures usually lasts no more than a few minutes Preceding partial seizure is usually not very long Happen when a burst of electrical activity in a limited area (the partial seizure) spreads throughout the brain Seizures occur in more than 30% of people with partial epilepsy
- 25. Common Symptoms Change in consciousness, so that you can't remember some period of time Change in emotion, like unexplainable fear, panic, joy, or laughter Change in sensation of the skin, usually spreading over the arm, leg, or trunk Changes in vision, including flashing lights, or (rarely) hallucinations (seeing things that aren't there) Loss of muscle control and falling, often very suddenly
- 26. Muscle movement such as twitching that might spread up an arm or leg Muscle movement such as twitching that might spread up an arm or leg Muscle tension/tightening that causes twisting of the body, head, arms or leg Tasting a bitter or metallic flavor
- 27. Stages Beginning State: This stage can be said as warning or aura Sometimes an individual may not be aware of such aura In middle stage this aura is followed by other symptoms It may be considered as simple partial seizure
- 28. Middle State: People have aura in beginning, the aura may convert into convulsion For those who don’t have aura, the seizure may continue as complex partial seizure
- 29. End state: This state represents a transition from seizure back to normal state Also referred as the “Post-ictal period” Signifies recovery period of brain May last from a second to minutes to hours If a person has a convulsion, the level of awareness gradually improves during the post- ictal period, much like a person waking up from anesthesia after an operation
- 30. Early Seizure Symptoms Sensory/ thoughts Smell Sound Taste Visual loss or blurring Racing thoughts Strange feelings Stomach feelings Tingling feelings Physical Dizziness Headache Nausea Numbness No Warnings Some times seizures come with no feelings Emotional Fear/ panic Pleasant feelings
- 31. Middle Seizure Symptoms Sensory/ thoughts Black out Confusion Deafness / sound Electric shock feelings LOC Smell Spacing out Visual loss or blurring Physical Chewing movements Convulsions Eye rolling up Falling down Foot stomping Inability to move Emotional Fear/ panic
- 32. Causes Metabolic disorders Hing fever Brain infections Inadequate oxygen supply to the brain Structural damage to the brain Abnormalities present or occurring at birth Fluid accumulation in the brain
- 33. Diagnostic Evaluation History collection Physical examination CT scan MRI scan ECG EEG Blood investigation ABG analysis LP
- 34. Management Consider rapid work-up for underlying etiologies CNS infection Metabolic disease Electrolyte imbalance TBI Drugs, intoxications, poisonings Cerebrovascular event
- 35. Drugs used to treat seizures Drug Use Acetazolamide Absence seizures when Kidney stones and other anticonvulsants are ineffective Carbamazepine Generalized seizures Partial seizures Clonazepam Atonic seizures , Atypical absence seizures Infantile spasms , Myo clonic seizures Divalproex Absence seizures, Febrile seizures , Generalized tonic-clonic seizures Infantile spasms, Juvenile myoclonic epilepsy, myoclonic seizures
- 36. Drug Use Ethosuximide Absence seizures Felbamate Atypical absence seizures, Partial seizures Fosphenytoin Status Epilepticus Gabapentin Partial seizures
- 37. Drug Use Lamotrigine Generalized seizures Partial seizure Levetiracetam Juvenile myoclonic epilepsy, Myoclonic seizures, Partial seizures Oxcarbazepine Partial seizures Valporate Absence seizures Febrile seizures Generalized tonic-clonic seizures Infantile spasms, juvenile myoclonic epilepsy
- 38. SUMMARY
- 39. THANK YOU