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EPILEPSII
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Epilepsiile au fost numite de Jackson. Epilepsia consta in aparitia episodica a unei descarcari bruste excessive si rapide a unei populatii mai mult sau mai putin intinsa de neuroni din substanta cenusie a encefalului. Clinic: Epilepsiile au caracteristica elemental parosistic (brusc) alterarea constientei este mai mult sau mai putin intinsa convulsiile pot exista sau nu

Incidenta: Epilepsiile se intalnesc pana la 10 cazuri la mia de locuitori. Afectarea sexelor este egala. Clasificare: 1. Crize generalizate prezentate sub doua forme: convulsive: - epilepsiile grand-mall - epilepsiile generalizate amiotice - epilepsiile mioclonice - neconvulsive: - absente simple sau crizele petit-mall - absente complexe mioclonice - atonice - vegetative 2.Crizele de epilepsie partiala Exemple: - crizele Jecksoniene motorii

crizele Jecksoniene sensitive crizele senzoriale cu halucinatii ( auditive, vizuale, olfactive, vestibulare) - elementare - comlexe

3. Crizele psihomotorii si psihosenzoriale, numite si temporale Acestea se caracterizeaza prin alterarea starii de constienta si fara convilsii. Epilepsia poate aparea la orice varsta, astfel exista doua mari categorii de epilepsii: epilepsia secundara este forma care are doua varfuri de incidenta- in primii 2 ani de viata, sau al doilea varv la pubertate epilepsia secundara care are tot doua varfuri de incidenta- in primii 10 ani de viata si decada a3-a de viata Cauze: Factorul ereditar (genetic) este discutat, se transmite pragul convulsive. Etiologie: 1. CAUZE GENERALE ( valabile poentru epilepsiile secundare) intoxicatii exogene cu plumb, camfor, cocaine intoxicatie alcoolica, acuta si cronica

cause metabolice- hipoglicemii, deshidratare, uremia (lobul vezical trebuie sondat), tumori, litiaza intoxicatii cu monixid de carbon anemii severe cause alergice astmul bronsic asociat cu epilepsia sarcina

2. CAUZE LOCALE

cicatrici post inflamatorii meningoencefalite, parazitoze cerebrale, sifilisul ( 14% din cause constituie sifilisul ) traumatisme cranio-cerebrale epilepsiile apar mai ales dupa hematoame subdurale la adult cause vasculare ( 3% din cause) dupa hemoragii sau tromboflebite de sinus cavernos sinuzita afectiuni oculare

3. CAUZE PERINATALE (30%) SAU POSTNATALE

Clinic: prodroamele crizei epileptice sunt nespecifice- poate sa precada cu ore sau zile declansarea crizei cefalee anorexia balonarile insomnia dispozitie depresiva

Aura epileptica nu este egala cu prodromul. Aura epileptica face parte din criza jecksoniana epileptica. Doar in 50% din cazuri poate sa fie componenta crizei. Aura precede criza cu secunde, zeci de secunde. Se manifesta complex, poate fi somatica, viscerala, senzoriala sau psihica. Este important pentru ca prin repetitie este un semnal foarte clar pentru epileptic, pentru pacient, faptul ca urmeaza sa se declanseze criza. Aura somatica inseamna parestezii cu senzatia de curentare si rar poate sa apara dureri

Aura viscerala senzatia de epigastru crampe, tensiune ce urca din stomac in gat. Aure viscerale cardiace palpitatii, dureri precordiale (anginoase Aure viscerale cefalice cefalee Aure viscerale gustative aparitia de gustari neplacute Aure viscerale olfactive - mirosul Aure viscerale vizuale vede culori, scantei, stelute Aure viscerale auditive - sunete Aure viscerale vestibulare ameteli Aura este un semn de focalizare , adica zona encefalitica responsabila de integrarea stimulilor ar fi cea responsabila de instalarea epilepsiei, adica arata punctual pe plecare al undei epileptice . Aura psihica poate fi cateodata complexa; apare starea de vis . Inainte de declansarea crizei , bolnavul emite un strigat, apoi este urmat de cadere.

EPILEPSIILE MAJORE ( CRIZELE GRAND-MALL)

Este o prima faza tonica, de circa 10-30 de secunde in momentul cand cade brusc. Bolnavul este palid, opistotonus ( hipertonie musculara generalizata ) si in apnee. Globii oculari sunt deviate in sus si in afara, pupilele nidriatice, reflexele artrite, TA crescuta.

A doua faza este faza cronica 30-40 de secunde . Sunt prezente convulsii puternice la nivelul membrelor si fetei. Se reia respiratia care este aritmica si bolnavul prezinta secretie salivara sanghinolenta prin miscarea limbii si a mucoasei jugare ( a gurii) , incontinenta urinara, rar fecale, dupa care criza scade in intensitate. Bolnavul este intr-o stare de coma care nu se poate scoate. ( Fenobarbital, Fenitoinul)

A treia faza postcritica apare dupa incetarea convulsive si ramane intr-o stare de coma linistita pana la 2-3 minute, poate fi 15 minute, rar cateva ore, dupa care intra intr-o stare de somnolenta , apoi se trezeste. - amnesia incomplete - deficite motorii de tip hemiparetic ore, luni, ani - afazii - stari crepusculare sunt mai rae , potential foarte periculoase si constau intr-o stare de obnubilare postcritica caracterizate prin halucinatii terifiante, groaznice, agiatie psihomotorie, anxietate. Dau cauza actelor de violenta si a crimei.

Crizele petit-mall ( absentele simple sau micul abces epileptic)

Apar exclusive la copii, mai rar peste 20 de ani. Aspecte: scurta pierdere a starii de constienta de 3-15 secunde si fara convulsii bolnavul are amnesia crizei bolnavul se poate opri brusc si apoi inexplicabil din vorbit

Frecvent este pentru elevi, se opreste si scapa obiectele din mana. In timpul accesului, bolnavul are senzatia de rotatie, de ameteala, privirea devine fixa si fata usor palida. Bolnavul isi revine imediat ce accesul s-a oprit. Nu exista stari postcritice, nu halucinatii, dupa aceea bolnavul este mirat de stupoarea celor din jur, in unele cazuri poate aparea chiar un clipit. Investigatia care evidentiaza acest caz clinic este EEG. Absentele complexe sunt cele mai cunoscute epilepsiile cornice gen petit-mall sunt arhinetice, sunt foarte scurte, 1-2 secunde si constau fie in flexia capului sau flexia genunchiului ( cade in picioare si isi revine imediat) petit-mall mioclonic in timpul unei crize poate aparea miscari mioclonii uneori violente

spasmoflexie apare de regula in prima copilarie, flexia brusca a capului si agatului, apare odnubilarea crizele de epilepsie partiala

crizele epileptice jecksoniene motorii bolnav care nu are pierdere ce constienta, debutul crizei este frecvent in portiunea distala a unui membru ( mana, police, fata), este ca un mars de niste contractii ( fata , umar , antebrat, police) crizele jecksoniene sensitive similare cu cele motorii, dar afectarea este senzitiva la nivelul zonei partiale si se generalizeaza. Toate au cauza organica, procese expansive intra-craniene. Diagnosticul paraclinic: EEG o inscriere amplificata a unor diferenta de potential generate de celulele nervoase afectate. Viteza 1-5 cm/sec CT RMN

Epilepsy Epilepsies have been called by Jackson. Epilepsy consists of an episodic occurrence of sudden excessive and rapid discharge of a population more or less stretched neurons in the brain gray matter. Clinic have characteristic elemental parosistic epilepsies (suddenly) - Impaired consciousness is more or less stretched - Seizures may exist or not Incidence: epilepsy meet up to 10 cases per thousand inhabitants. Affecting the sexes is equal. Classification: 1. Generalized seizures presented in two forms: - Seizures - epilepsy grand-mall - Amniotic generalized epilepsies - Myoclonic epilepsies - Neconvulsive: - simple or absent seizures petit-mall - Absent complex - myoclonic - Atonic - Vegetative 2.Crizele partial epilepsy Examples: - Jecksoniene motor seizures - Jecksoniene sensitive crises - Sensory seizures - with hallucinations (auditory, visual, olfactory, vestibular) - Incremental

- Complexes 3. Psychomotor seizures and psycho, called temporal They are characterized by altered mental status without convilsii. Epilepsy can occur at any age, so there are two main categories of epilepsy: - Secondary epilepsy is a form that has two peaks of incidence, in the first 2 years of life, at puberty or second varv - Secondary epilepsy who also has two peaks of incidence, in the first 10 years of life and the life a3 decade Causes: Heredity (genetic) is discussed, is transmitted seizure threshold. Etiology: 1. GENERAL CAUSES (valid for someone epilepsies secondary) - Exogenous poisoning with lead, camphor, cocaine - Alcohol poisoning, acute and chronic --Metabolic causes hypoglycaemia, dehydration, uremia (lobe must be surveyed bladder), tumors, stones - Monixid carbon poisoning - Severe anemia - Allergic causes - asthma associated with epilepsy - Pregnancy 2. LOCAL CAUSES - Post inflammatory scars - meningoencephalitis, brain parasites, syphilis (14% of causes are syphilis) - Cranio-cerebral trauma - Epilepsy occur especially after subdural hematoma in adults - Vascular causes (3% of causes) - After hemorrhage or cavernous sinus thrombophlebitis - Sinusitis - Eye diseases 3. Causes Perinatal (30%) or postnatally Clinic: - Prodroamele seizures can be nonspecific, especially with the hours or days triggered crisis - Headache - Anorexia - Flatulence - Insomnia - Depressed mood Aura epileptic prodrome is not equal. Aura is part of the crisis jecksoniana epileptic seizure. Only 50% of cases may be part of the crisis. Aura seconds before the crisis, tens of seconds. Manifest complex may be somatic, visceral, sensory or mental. It is important that the rehearsal is a very clear signal for epilepsy, the patient, that is to trigger the crisis. Aura somatic - is the sensation of electrical paraesthesia and pain may occur rarely Aura visceral - the feeling of the epigastrium - cramps, tension goes from the stomach into

the throat. Aure visceral heart - palpitations, chest pain (angina Cephalic visceral auras - headache Aure visceral taste - the appearance of bad snacks Aure visceral olfactory - smell Visceral visual aura - seeing colors, sparkles, stars Visceral auditory auras - sounds Aure visceral vestibular - vertigo Aura is a sign of focus, that is responsible for integrating the stimuli encephalitis would be responsible for installing the epilepsy, that shows the starting point of wave seizures. Aura psychic - can sometimes be complex, is "the dream state." Before the crisis started, the patient emits a scream, then followed by the fall. Epilepsy MAJOR (CRISIS GRAND MALL) Toning is a first phase, about 10-30 seconds when you suddenly falls. The patient is pale, opistotonus (generalized muscle hypertonia) and apnea. Eyeballs are deflected upward and outward, nidriatice pupils, reflexes arthritis, high BP. The second phase is the chronic phase - 30-40 seconds. Are strong convulsions in the limbs and face. Resume is arrhythmic breath and saliva sanghinolenta patient shows by moving the tongue and mucous jugare (mouth), urinary incontinence, fecal rarely, decreases in intensity after the crisis. The patient is in a coma can not be removed. (Phenobarbital, phenytoin) The third phase - postcritica - occurs after the cessation of seizures and remain in a quiet coma up to 2-3 minutes, may be 15 minutes, often several hours after falling into a state of sleepiness, then wakes up. - Incomplete amnesia - Type hemiparetic motor deficits - hours, months, years - Aphasia - Twilight state - are rae, potentially very dangerous and consist of a condition characterized by hallucinations dizziness postcritica terrifying, horrible agiatie anxiety, anxiety. Give cause acts of violence and crime. Petit-mall seizures (simple or small abscess epileptic absences) Appear exclusively in children less than 20 years. Aspects: - Brief loss of consciousness without convulsions 3-15 seconds - Patient has amnesia crisis - Patient may suddenly stop talking and then inexplicably - Frequently it is for students to stop and drop the objects. During access, the patient has the sensation of rotation, dizzy, eyes become fixed and pale face gently. The patient recovers as soon as access has stopped. There postcritice states, not hallucinations, then the patient is amazed at the amazement of others, may occur in some cases even a flinch. This case report highlights the investigation which is EEG. Complex absences - are the most common - Type of chronic epilepsy are arhinetice petit-mall are very short, 1-2 seconds and consist of either the head or flexing the knee in flexion (up and he falls back immediately) - Myoclonic petit-mall - during a crisis can occur sometimes violent movements myoclonus

- Spasmoflexie - usually occurs in early childhood, sudden flexion of the head and hang on, there odnubilarea - Partial seizures - Jecksoniene motor seizures - has not lost to sick consciousness, the onset of the crisis is frequently in the distal portion of a member (hand, thumb, front) is that a march of some contractions (face, shoulder, forearm, thumb) - Jecksoniene sensitive crises - similar to the motor, but the damage is sensitive to the partial and generalized area. All have physical cause, intra-cranial expansive processes. Paraclinical diagnosis: - EEG - a sign of potential difference amplified generated by the affected nerve cells. Speed 1-5 cm / sec - CT - MRI

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