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• Epilepsy – The condition of unprovoked seizures (two or more), usually in a person who has a
predisposition because of a chronic pathologic state (e.g. brain tumor, cerebral dysgenesis,
posttraumatic scar) or genetics.
• Post-ictal period The time after the ictus during which the patient maybe drowsy,
confused or disoriented
Adapted from Prof. Milos 2018 lecture
• Reflects epileptiform
discharge of a single
neuron
• Prolonged
depolarization +
multiple action
potentials
Stafstrom C. Back to Basics: The Pathophysiology of Epileptic Seizures: A Primer For Pediatricians. Pediatrics in Review 1998
Stafstrom C. Back to Basics: The Pathophysiology of Epileptic Seizures: A Primer For Pediatricians. Pediatrics in Review 1998
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Excessive uncontrolled firing excitotoxicity cell death
Kaur et al., Antiepileptic drugs in development pipeline: A recent update eNeurologicalSci, 2016
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1. Where seizures begin (medication choice/surgery)
2. Level of awareness Safety
Terminology 3. Motor or non-motor onset
Grand mal
Petite mal
Simple partial
Complex partial
Secondarily generalized tonic-clonic
• Epilepsy Syndrome:
• a group of clinical characteristics that consistently
occur together, with similar seizure type(s), age of
onset, EEG findings, triggering factors, genetics,
natural history, prognosis, and response to
medications
• Refractory epilepsy = seizures not controlled by two or Framework for epilepsy classification
more appropriately chosen antiepileptic medications
Scheffer et al., Epilepsia, 58(4):512–521, 2017
or other therapies
• Lateral temporal
• Aura: often structured hallucinations: visual, auditory
• Consciousness may be preserved for longer time
• MRI may show structural lesion
Adapted from Prof. Milos 2018 lecture
Stafstrom and Carmant , Cold Spring Harbor Laboratory Perspectives in Medicine, 2015
• Uncontrolled tonic-clonic seizures > 30 minutes will have long term consequences
• Premorbid history
• Birth, development, history of febrile seizures, comorbid conditions like
cerebral palsy, developmental delay, recent stroke, CNS tumor, CNS
surgery
• Abnormal activity:
• Focal spikes or waves focal epilepsy
• Diffuse bilateral spike waves generalized epilepsy
• Types
• Routine EEG (hyperventilation/photic stimulation)
• Overnight EEG (sleep deprivation / capture states of consciousness)
• EEG/Video monitoring in epilepsy monitoring unit
• Intracranial EEG recording (surgical)
• EEG telemetry (Home monitoring) The first EMU at Tawam Hospital
- IV Lorazepam
- IM Midazolam
- IV Diazepam
If not available
- Rectal Diazepam
- Intranasal Midazolam
• Strategy:
• Plan ahead of pregnancy, start folate supplementation
• Switch to pregnancy safe option Avoid Safe
• Start with monotherapy with lowest effective dose Valproic Acid Levetiracetam
Phenobarbital Lamotrigine
• Monitor the dose and therapeutic levels
• Screen for fetal malformations
Sensory symptoms
Well localized, discriminatory, and spread relatively parietal lobe (primary somatosensory cortex, S1)
slowly (like a sort of ‘jacksonian march’)
Ill-defined, often accompanied by pain, spread within posterior insula-parietal operculum (supplementary
seconds somatosensory area, S2)
and may be contra-or ipsilateral
Gustatory aura insular region
Visual aura contralateral occipital cortex
Elementary auditory primary auditory cortex
Complex auditory Temproparietal junction
Olfactory aura) anterior mesiotemporal(uncinate)
Adapted from Prof. Milos 2018 lecture
Dystonic posturing
Unilateral limb dystonia Contralateral temporal or frontal
Automatisms
Unilateral automatism Ipsilateral temporal or orbitofrontal
Postictal nose wiping Ipsilateral temporal
Rhythmic ictal non clonic hand movement Contralateral temporal lobe