SEIZURE DISSORDERS

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SEIZURE DISSORDERS

• by
• Dr SBA Oseni

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Definitions

• Convulsions are involuntary repetitive (clonic)
  or sustained (tonic) contractions of a group of
  muscles and can be localized or generalised.

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Definitions

•    Seizures are a variety of paroxysmal events
  due to abnormal electrical activity in the
  cerebral neurons (brain) and manifested by
  attacks of altered consciousness motor activity,
  sensory phenomenon or inappropriate behavior.

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Definitions

• Seizures disorder/Epilepsy is a recurrent
  paroxysmal disorder of cerebral function
  characterized by brief attack of altered
  consciousness, motor activity, sensory
  phenomenon or inappropriate behavior.
• gt Epilepsy recurrent seizures.

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Definitions

• (1)   Convulsions are involuntary repetitive
  (clonic) or sustained (tonic) contractions of a
  group of muscles and can be localized or
  generalised.
• (2)   Seizures are a variety of paroxysmal events
  due to abnormal electrical activity in the
  cerebral neurons (brain) and manifested by
  attacks of altered consciousness motor activity,
  sensory phenomenon or inappropriate behavior.
• (3) Seizures disorder/Epilepsy is a recurrent
  paroxysmal disorder of cerebral function
  characterized by brief attack of altered
  consciousness, motor activity, sensory phenomenon
  or inappropriate behavior.

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Etiology

• - Febrile convulsion
• - Epilepsies
• - Cerebral malaria
• - Infections
• - Metabolic

• - Drugs/poisons
• - Cerebral hypoxia
• - Tumours etc.
• - Trauma
• - Intracranial hemorrhage
• -Genetic/chromosomal disorders

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Classification

• PARTIAL
• GENERALISED
• UNCLASSIFIED
• (ADDENDUM)

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PARTIAL

• (i) Simple partial with - motor manifestation
• - sensory
• - autonomic
• -psychic/behavioral
• (ii) Complex partial loss of consciousness
• from onset
• -
  later during seizure
• (iii) Secondarily generalized (i) ? (iii)
• (ii) ? (iii)
• (i) ? (ii) ? (iii)

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Generalised

• - Absence (typical/atypical)
• - Tonic
• - Clonic
• - Tonic-clonic
• - Myoclonic
• - Atonic

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Etiological types

• -         Idiopathic
• -         Symptomatic
• - Cryptogenic

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Clinical types / Egs

• Grand mal (generalized tonic-choric seizure)
• Petit mal (Absence seizure)
• Jacksonian epilepsy
• Benign partial Epilepsies of childhood with
• -         Rolandic spikes (BPERS)
• -         Occipital paroxysms (BPEOR)
• Myoclonic seizure
• Infantile spasms
• Status epilepticus
• Epilepsia partialis continua (partial continuous
  epilepsy)

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Investigation

• Blood FBC / RBS / E-Ur-Cr/ Toxicology, Others,
  Serum Ca/Mg, BC
• Urinalysis, MCS
• LP
• EEG
• Radiol CT, MRI, fMRI, MRA
• Genetics.

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Management

• Active convulsion
• -positioning/ oxygen / Anticonvulsant
• Prevention
• Long-term control AED / Surgery/ Dietary / VNS/
  Life style modification.

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Complications

• Coma
• Hypoglycemia, Acidosis, Aspiration
• Mono, hemi, para, quadri-plegia
• Blindness, Deafness, Aphasia
• Developmental regression
• Cognitive defects.
• SD

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??

• Syncope / Migraine / Jitteriness / Startle rxn /
  Hyperekplexia / Narcolepsy, Cataplexy /
• Breath-holding attacks / Titubation,
  Spasm nutans, Tics, Bruxism, Rumination,
  Opsoclonus,
• Head-banging / Nightmares, Night
  terrors / Masturbation, etc.

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SOME TYPES/ CAUSES OF SEIZURE DISORDER
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FEBRILE CONVULSION
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Defn

• Convulsion
• - in a child 6mo-5yrs
• -   associated with fever
• - cause of fever is outside the CNS and
• -   child is otherwise neurologically normal
• ie

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Types

• (ii) Complex
• - convulsion may be focal
• - may last more than 15(20) min
• -  there may be more than one episode within the
  same febrile illness

• Simple
• -convulsion is generalized tonic-clonic
• -does not last for more than 15 (20) min
• -not more than one convulsion in the same febrile
  illness

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Etiology of the fever

• - Malaria 60
• - URTI 30
• - Gastroenteritis 5
• -Others eg.
• Pneumonia / Septicemia / Cellulitis /
  Pyoderma /UTI /Arthritis / Osteomyelitis /etc

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Clinical fxs

• - positive family hx of FC or seizures
• - past hx of FC or medical illness in the child
• - time of last meal b/4 convulsion
• - what was done to the child during / after
  convulsion
• - obstetric, developmental, immunization Hx.

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Physical exam

• Look for fx of etiology of the fever
• Evidence of what was done for the child while
  convulsing
• Full neurologic examination.
• Check BP

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Investigation

• LP
• FBC / MP / RBS / E, Ur, Cr / Urinalysis / BC /
  others as necessary
• EEG is not important in diagnosis of FC.

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Management

• - if still convulsing, position well give O2 and
  abort convulsion
• -  control fever
• -  treat etiology of the fever
• -  note remedies given to the convulsing child
  and treat as appropriate
• -   educate relations on the benign nature of FC
  and against the harmful measures taken on a
  convulsing child.

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CEREBRAL MALARIA
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Defn

• - rapidly progressive encephalopathy,
• - due to sludging of the cerebral capillaries
  - by rbcs parasitised by sexual forms of P.
  falciparum and
• - leading to cerebral hypoxia, edema
  irritation.

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• NB 1. it is not an infection of the blood
  vessels
• 2. There is no MP in CSF
• At risk All age groups especially the U-5s,
  non-or semi-immuned immigrants to malarious
  environment.
• Mortality up to 50 (ave 20)

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Xtic fxs

• Fever
• Convulsion
• Altered sensorium for more than 30 min
• Blood ve for MP
• No other cause attributable for the loss of
  consciousness
• gt LP for CSF imply normal (slight protein
  increase possible)
• NB Diagnosis require high index of suspicion

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Essential investigations

• PCV, MP, CSF for MCS, RBS, E/U/Cr,
• (? LFT)
• others as needed.

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Management

• 1. Antimalarial
• 2. Anticonvulsant
• 3. Anemia
• 4. Feeding
• 5. Management of other problems as applicable

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Antimalarial

• Quinine infusion Startum 20mg/kg in 10ml/kg
  IVF over 4hrs
• Follow-up 10mg/kg in 10ml/kg IVF EVERY
  8hrs(each running for 4hrs) until
• Patient regains consciousness, than change
  to p.o.
• Artemether 3.2mg/kg/d im
• Chloroquine infusion abandoned for widespread
  drug resitance.
• Statum 10mg/kg in 20ml/kg IVF over 12hrs
• Follow-up 15mg/kg in 20ml/kg IVF over 24hrs
• Combination of drugs may be given to pre-empt
  resistance

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Complications

• Intractable convulsions - Severe anemia
• 2o bacterial infection - Metabolic
  acidosis
• Hypoglycemia - DIC
• Neurologic deficits eg
• Deafness Cortical blindness
• Speech loss Hemiparesis
• Loss of developmental milestones
• Cerebral palsy Epilepsy

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Defferential diagnosis

• those of convulsion

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Prevention

• Prompt adequate treatment of acute attack of
  malaria
• Malarial chemoprophylaxis
• Physical / chemical barriers against mosquito
  bites
• Protective clothing
• Eradication of mosquito-breeding sites
• Repellent creams / coils / plants
• Mosquito netting of windows,
  doors beds (insecticide treated)