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Subject: MEDICINE

Topic: SEIZURES
Lecturer: DR. ROBERT BARJA
Shifting /Date:
JULY 16, 2008
Trans group: JAVICI
CODE

INTERNATIONAL CLASSIFICATION OF EPILEPTIC


SEIZURES SEIZURES:
- abnormal excessive, hypersynchronous electrical I. Partial Seizures
discharges of cerebral cortical neurons II. Generalized Seizures
- increased excitatory neurotransmitter, III. Unclassified Seizures
diminished inhibitory neurotransmitter
- paroxysmal or episodic cerebral dysfunction I. PARTIAL SEIZURES (Focal Seizures)
characterized by: A. Simple Partial Seizures
1. motor disturbances 1. with motor signs
2. sensory disturbances 2. with sensory symptoms
3. autonomic disturbances 3. with autonomic symptoms or signs
4. alteration of consciousness 4. with psychic symptoms
5. behavioral or psychic disturbances

Definition of Terms: B. Complex Partial Seizures (Temporal Lobe


or Psychomotor Seizures; consciousness
• EPILEPTIC SEIZURE (FIT) impaired)
 the manifestation of an abnormal and 1. simple partial onset, followed by
excessive synchronized discharge of a set of impairment of consciousness
cerebral neurons a. with simple partial features
followed by impaired
• EPILEPSY consciousness
 a chronic condition, of various etiologies, b. with automatisms
characterized by recurrent, usually 2. with impairment of consciousness at
spontaneous, epileptic seizures onset
 when 2 or more unprovoked seizure fits a. with impairment of
occur consciousness only
b. with automatisms
• EPILEPTOGENESIS
C. Partial Seizures Evolving to Secondary
 the transformation of a normal neuronal
Generalized Seizures (Tonic-Clonic, Tonic
network into one that is chronically
or Clonic)
hyperexcitable
1. simple partial seizures evolving to
 an injury initiates a process that gradually
generalized seizures
lowers the seizure threshold until a
2. complex partial seizures evolving to
spontaneous seizure occurs
generalized seizures
3. simple partial seizures evolving to
• EPILEPSY SYNDROME complex partial seizures, evolving to
 disorder in which epilepsy is a predominant generalized seizures
feature
 with sufficient evidence (clinical EEG,
radiologic, genetic) to suggest a common
II. GENERALIZED SEIZURES (Bilaterally
Symmetrical And Without Local Onset,
underlying mechanism
Convulsive Or Nonconvulsive)
 more common in pediatric age group A. Absence (petit mal) seizures
B. Myoclonic seizures
EPIDEMIOLOGY: C. Clonic seizures
 second most common neurological condition D. Tonoi\ic seizures
after headache E. Tonic Clonic (grand mal) seizures
 incidence in developing countries: 100- F. Atonic seizures
190/100,000 population
 incidence in developed countries: 40-70/100,000 III. UNCLASSIFIED SEIZURES
 age incidence: 50-60% <16 years  Includes all seizures that cannot be classified
o prevalence: 5-10 per 1,000 because of inadequate or incomplete data
and some that defy classification in any of
the above categories. This includes some

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC
PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU
RACHE ESTHER JOEL GLENN TONI
Su
bject: MEDICINE
Topic:
SEIZURES
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neonatal sezixures (eg. rhythmic eye salivation, pallor, flushing, papillary
movements) chewing and swimming dilatation or constriction
movements (eg. infantile spasm)
GENERALIZED SEIZURES
PARTIAL SEIZURES  generalized EEG features, bilaterally synchronous
 focal EEG features onset
 seizure activity restricted to discrete areas of the  non-focal features clinically (though may be
cortex asymmetric) and characterized by diffuse cerebral
 variety of clinical symptoms used to localize involvement
focus  may result from cellular, biochemical, or structural
abnormalities with widespread distribution
Two Types:
1. Simple Partial Seizures Case 1:
 generally brief  7 y/o boy
 not associated with alteration of  consult due to frequent “blank stares” that would
consciousness last for a few seconds, several times a day, in the
2. Complex Partial Seizures past 6 months
 associated with altered consciousness/ lack  academic record deteriorated in the last few
of contact with the environment months
1. Simple Partial Seizures  NE: Normal
 caused by a focal cortical discharge that result in
seizure symptoms appropriate to the function of 1. Absence (Petit Mal)
the area of the brain, without impairment of  begins in childhood (4-8 y/o) or adolescence
consciousness  sudden, brief lapses of consciousness w/o loss of
o with motor signs postural control
o with sensory symptoms  rapidonset and offset with change in facial
o with autonomic symptoms or signs expression, motionless blank stare and
o with psychic symptoms automatism
 EEG: Focal Spikes  no post-ictal confusions
 patient continues previous activities
2. Complex partial Seizures  EEG: generalized, symmetric 3 Hz spike and
 temporal lobe or psychomotor seizures wave
 medial temporal lobe or inferior frontal lobe origin
 transient impairment of ability to maintain normal 2. Generalized Tonic-Clonic (Grand Mal)
contact with environment  in 10% of patients with epilepsy
o simple partial onset, followed by  most common type resulting from metabolic
impairment of consciousness abnormalities
o with impairment of consciousness at onset
Tonic Phase
 Cognitive disturbance – sense of derealization,  sudden loss of consciousness with
depersonalization decerebrate posturing with all muscles in
 Psychomotor activity – automatic stereotyped tonic contraction
activity  “ictal cry”
o lip smacking  contraction of jaw muscles
o picking at clothing
o masticatory movement  from a few sec to 3 mins (10-20 sec) with
o simple gestures such as scratching or absence of respiration and cyanosis
stroking  enhanced sympathetic tone
 Psychosensory phenomena 9hallucination, Clonic Phase
illusions)  muscle relaxation superimposed on tonic
 Speech disturbance – sppech arrest, dysarthric, contraction
dysphasic  bilateral jerking movement which maybe
 Affective disturbance –stereotyped behavior and accompanied by violent expiratory
recurs during attack contractions with expulsion of saliva
o sadness, crying, happiness, laughing,
feeling of ecstasy Post-ictal Phase
 Autonomic activity  coma, confusion, irritability, severe headache,
o Epigastric pain, borborygmi, sweating, muscle aches, extreme fatigue, somnolence
palpitation, piloerection, excessive  stridor, partial airway obstruction
Su
bject: MEDICINE
Topic:
SEIZURES
Page 3 of 3
 urinary and bladder incontinence o hundreds of seizures may occur per day
 once the disorder appears, patients show rapid
3. Tonic deterioration with loss of previously attained
 characterized by the sudden onset of sustained developmental level
contraction or extensor axial muscles and limb
musculature with loss of consciousness IV. Mesial Temporal Lobe Epilepsy Syndrome
 EEG: Rapid Spikes  most common syndrome associated with
complex partial seizures
4. Clonic  partial epilepsy
 Bilateral jerks  hippocampal sclerosis on MRI
 EEG: Rapid Spikes with Slow Waves  AED treatment refractory
 responds to surgery
5. Myoclonic
 sudden, brief, shock like contractions maybe
generalized or confined to trunk or face or one
more extremities or individualized muscles or
group of muscles
 EEG: Spikes, Polyspikes and Wave

6. Atonic
 sudden diminution of muscle tone leading to
drop attacks

EPILEPSY SYNDROMES
 epilepsy is predominant feature
 common underlying mechanism

I. Juvenile Myoclonic Epilepsy


II. Lennox-Gestaut Syndrome
III. West Syndrome
IV. Mesial Temporal Lobe Epilepsy Syndrome

I. Juvenile Myoclonic Epilepsy


 generalized seizure, unknown cause
 early adolescence, (+) family hx
 bilateral myoclonic jerks, single or repetitive
 most frequent in am after awakening provoked
by sleep deprivation
 benign, AED responsive

II. Lennox-Gestaut Syndrome


 begins in children
 triad
o multiple seizure types, mental retardation, 2-
2.5 Hz spike-wave EEG activity
 25% has West syndrome
 Seizures maybe tonic-clonic, tonic-atonic or
atypical absence
 Intellectual, cognitive and psychosocial deficits
are permanent and status epilepticus is common
 Treatment is usually unsatisfactory

III. West Syndrome


 triad of infantile spasm, mental retardation and
EEG findings of hypsarrythmia
 infantile spasm
o occurs before 1 year of age (peak at 3
months)
o brief head nodding to violent flexion of the
head, limbs and trunk