Epilepsy

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Epilepsy

• Shi Xue Chuan

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General Considerations

• A seizure is a sudden, transient disturbance of
  brain function, manifested by involuntary motor,
  sensory, autonomic, or psychic phenomena, alone
  or in any combination, often accompanied by
  alteration or loss of consciousness.
• A seizure may occur after a metabolic, traumatic,
  anoxic, or infectious insult to the brain.
• Repeated seizures without evident cause justify
  the label of epilepsy.

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General Considerations

• Incidence is greatest in early and late life,
  with a prevalence of approximately 36 .
• Chance of having a second seizure after an
  initial unprovoked episode is 30.
• Chance of remission from epilepsy in childhood is
  80.

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General Considerations

• Recurrence rate after the withdrawal of drugs is
  about 30.
• Idiopathic or genetic epilepsy most often appears
  between ages 4 and 16 yaers.

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General Considerations

• Factors adversely influencing recurrence include
• Difficulty in getting the seizures under control
• Neurologic dysfunction or mental retardation
• Age at onset under 2 years
• Abnormal EEG at the time of discontinuing
  medication
• Type of epilepsy

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Etiology

• Genetic factor
• Brain damage and dysmetabolism
• Inborn
• Acquired
• Causative factor

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Classification

• Classified by etiology
• Idiopathic (essential) epilepsy
• Symptomatic (secondary) epilepsy
• Cryptogenic epilepsy

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Classification

• Classified by epileptic seizures
• Partial (foal, local) seizures
• Simple partial seizures, without impairment of
  consciousness
• With motor signs
• With somatosensory or special-sensory symptoms
• With autonomic symptoms or signs
• With psychic symptoms

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Classification

• Classified by epileptic seizures
• Complex partial seizures, with impairment of
  consciousness
• Partial seizures evolving to secondarily
  generalized seizures

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Classification

• Classified by epileptic seizures
• Generalized seizures
• Absence seizures
• Typical absence
• Atypical absence
• Myoclonic seizures
• Clonic seizures
• Tonic seizures
• Tonic-clonic seizures
• Atonic seizures
• Infant spasm, tonic-spasm
• Unclassified epileptic seizures

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Classification

• Classification of epilepsy and epilepsy syndromes
  
• Benign children epilepsy with centrol-temporal
  spike
• Lennox-Gastaut syndrome
• Infantile spaams
• Juvenile myoclonic

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Clinical manifestation

• Partial epilepsy
• Focal epilepsy may arise from an intracerebral
  structural defect, causing motor or sensory
  symptoms localized to one body part, which may
  then spreads to contiguous regions of the cortex
  (e.g. jacksonian seizures).
• There are simple partial seizures without
  impairment of consciousness.
• Complex partial seizures associated with
  disturbance of consciousness usually arise in the
  temporal lobe.

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Clinical manifestation

• Partial epilepsy
• Seizures arising in the medial temporal lobe may
  produce disturbances of smell and taste, visual
  hallucinations.
• These may evolve to a tonic-clonic seizures (
  secondary generalization).
• Weakness following the event may occur for
  minutes or hours (todds paresis).

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Clinical manifestation

• Generalized seizures
• Absence attacks usually consist of a brief
  interruption of activity, sometimes with complex
  motor activity (such as fumbling with clothes),
  but without collapse.
• EEG during this event shows a three-per-second
  spike-and-wave activity.

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Clinical manifestation

• Generalized seizures
• In a generalized tonic-clonic seizures, the tonic
  phase is a sudden tonic contraction of muscles
  usually with upward eye deviation. The clonic
  (with clonus-type activity) phase follows.
• Initial EEG changes are often bilateral.
• This condition usually has its onset in childhood.

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Diagnosis of epilepsy

• The integrate diagnosis should include seizure
  type, anatomy, etiology and concomitant mental
  disorders.
• For example
• Epilepsy--grand malsecondary (symptomatic)
  mental retardation
• Epilepsycentrotemporal spike wave--benign
  childhood epilepsy

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Diagnosis of epilepsy

• Clinical picture
• Clinical history
• Description of Sz
• Symptomatology
• Physical/Neurologic examination
• Therapy

• EEG
• Background activity
• Epileptiform activity
• Interictal
• Ictal
• Postictal
• Laboratory tests
• Neuroimaging

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Differenial diagnosis

• Febrile Seizures
• Ages 3 months to 5 years
• Fever
• Non-CNS infection
• Generalized seizures
• Last less than 5 minutes
• Migraine
• Positive family history.
• Pulsatile headache
• Manifestations of autonomic nerve disorder
• Visual disorder
• Sensory disturbance

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Differenial diagnosis

• Breath-holding spells
• Age 6 months to 3 years,
• Cry, loss of consciousness
• Apnea and cyanosis
• Family historypositive in 30
• Normal EEG.
• Sleeping disturbance
• Sleepwalking ,
• Nightmare
• Night terrors

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Differenial diagnosis

• Masturbation
• Consciousness not impaired
• Normal EEG
• Pseudoseizures
• Effectual Suggestive therapy
• Normal EEG
• Tourette sydrome
• Simple or complete stereotyped jerks or movements
• Cough and grunt
• Normal EEG
• Positive Family history

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An approach to Seizures
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Treatment of epilepsy

• Therapeutic principle of ntiepilepsy drugs (AEDs)
• Early treatment
• Treatment as the types of epileptic seizure
• Treatment with one drug
• Individual therapy
• Long course of treatment
• Slow drug withdrawal
• Periodic re-examination

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Treatment of epilepsy

• AEDs selection on types of epileptic seizure

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Antiepilepsy drugs,AEDs
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Update on newer AEDs
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Treatment of epilepsy
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Status epilepticus

• Status epilepticus is a clinical or electrical
  seizure lasting at least 30 minutes, or a series
  of seizures without complete recovery over the
  same period of time.
• Emergency Treatment
• ABC(airway, breathing, circulation)
• Diazepam 0.3-0.5mg/kg may repeat in 15-30
  minutes
• Phenytoin 10-20mg/kg
• Phenobarbital 5-20mg/kg

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Thank you