PAROXYSMAL DISORDERS of the

NERVOUS SYSTEM
Ryndell G. Alava, M.D.

Paroxysmal Disorders
Seizure and Epilepsy
Dizziness and Vertigo
Sleep disorders

Headache
Movement disorders

Seizure
Sudden and uncontrolled
activity of the brain

electrical

Clinical manifestation depends on which

part of the brain is having an abnormal
activity during the time of the attack
Focal or generalized

Seizure Generation
Cellular level

Cations
Na++ channels

Ca++ channels

Increase influx of Na

Inc. intracellular Na and water

Neuronal swelling

Increase tissue excitability

K+ channels
Decrease intracellular K

Increase influx of Ca
Cell hyper-excitability

Firing of thalamic and cortical neurons

SEIZURE

Seizure Generation
Synaptic level

Neurotransmitters
GABA

Glutamate

Decrease concentration

Increase concentration

Hyper-excitable state
SEIZURE

BRAIN WAVES
Electrical recordings from the surface of the brain
or from the outer surface of the head show a
continuous electrical activity in the brain. The
intensity and the patterns of the electrical activity
are determined by the level of excitation of
different parts of the brain resulting from sleep,
wakefulness, or brain diseases. The undulations in
the recorded electrical potentials are called brain
waves, and the entire record is called an EEG.

Resting Membrane
Potential

EEG= PSP=EPSP-IPSP

EPSP
IPSP

Cortical Neurons

Thalamic projection
neurons

Afferent impulse
Inhibitory thalamic interneurons

Classification of Seizure
Focal Seizures
Simple
Complex

Generalized Seizures
Absence
GTC, myoclonic

Epilepsy
Two or more UNPROVOKED seizure
Syndrome wherein recurrent seizures
may or may not be the only main clinical
presentation

Classification of Epilepsy
Localization-related Epilepsy
Idiopathic
Symptomatic

Cryptogenic

Generalized Epilepsy

Treatment of Epilepsy
Anti-convulsants
Ketogenic diet
Epilepsy surgery

Vagal nerve stimulation

Dizziness and Vertigo

Is it Vertigo?
Syncope?
Loss of balance?

Psychogenic?

Physiology of Balance
Visual impulses from the retina and
proprioceptive impulses from the ocular
muscle
Impulses from the labyrinth
Impulses from the proprioceptors of the
joint and muscle

Vertigo
Menieres Disease
Benign Positional Vertigo
Vestibular Neuritis

Treatment of Vertigo
Anti-histamines
Low salt diet
Eply Maneuver

Avoid stress