Definitie

Reprezinta o boala cronica sau un grup de boli cronice caracterizate prin aparitia de crize recurente, neprevazute si de obicei neprovocate. O criza de epilepsie este generata de o descarcare electrica sincrona a creierului.

Etiologie
Idiopatica conditionata genetic Secundara:
Traumatisme Tumori A.V.C. Infectii Boli degenerative

Canale ionice
Canalele ionice sunt constituite din proteine care formeaza pori la nivelul membranei celulare si permit trecerea selectiva a anumitor ioni (Na, Ca, K, Cl) contribuind astfel la mentinerea diferentei de potential intra- extracelular si formarea curentilor electrici transmembranari.
Canalele ionice au deasemenea rol in semnalizarea intercelulara, transportul transmembranar, reglarea ph-ului si a volumului celular.

Canalul de Calciu

Canalul de Sodiu

Na channel

Canalul de Potasiu

Clasificare
Partiale (focale)
Simple
Motorii Senzitive Vegetative Psihice

Generalizate
Tonice Atonice Clonice Tonico-clonice Mioclonice Absente

Complexe Secundar generalizate

Neclasificabile

International Classification of Seizures (ILAE, Epilepsia 1981)

Epilepsy Auras Prodrome Starting with LOC Starting with automatisms Prolonged postical confusion without generalization Generalized tonic-clonic seizure True versive head movements Focal motor clonic or tonic seizures Family history of seizures History of CNS infections, head truama, febrile seizures, CNS tumors, vascular malformation Neurologic examination Brain MRI

Primary Generalized Epilepsy Seizure Features Not present Occasionally present Present Not usually present Not usually present Present Not present Not usually present

Focal or Partial Present Occasionally present Present Present Present Present Present Present

Risk Factors for Epilepsy May be present Not usually present Not usually present May be present

Examination Findings Usually normal Usually normal EEG Findings

Copyright 2002 The Cleveland Clinic Foundation Generalized epileptiform activity

May be abnormal May be abnormal Not present

Neuroimaging Findings

Present

Return to Epilepsy Article

 Epileptogeneza
Descarcarea anormala are ca punct de plecare o zona bine delimitata focar epileptic.

Investigatii
Electroencefalografia analiza spectrala Computer Tomografia cerebrala (CT) Imageria prin rezonanta magnetica (IRM) Tehnici de imagerie functionala:
PET fMRI SPECT

Magnetoencefalografia Monitorizarea video - EEG

EEG - normal

Complexe virf-unda

fMRI

PET

Magnetoencefalograf

Crize generalizate
Crizele Grand Mal Crizele de absenta Crize tonice Crize atone Crize mioclonice

Epilepsia Grand Mal

Crizele de absenta

Crize partiale motorii

(clonii pe jumatate de corp) Crize Jacksoniene motorii Crize oculocefalogire Crize adversive Crize de arie motorie suplimentara (vocalizari si contractiile membrelor)

Crize partiale senzitive si senzoriale

Crize Jacksoniene senzitive Crize vizuale Crize auditive Crize vestibulare Crize olfactive si gustative Crize vegetative(transpiratii,raceala pe jumatate de corp)

Crize partiale complexe

Afectarea ariilor de asociatie: Alterarea partiala a starii de constienta Starea de vis, Dj vu, Jamais vu Crize de furie, frica, bucurie

Crize partiale motorii si senzitive

Crize partiale complexe

 Medicamentos Dieta cetogena

Chirurgical
Stimulare vagala

Principii de tratament
Monoterapie Politerapie Titrare Oprirea medicatiei

Medicamente eficiente in crizele de absenta

Etosuximida

Oxazolidindiona

Medicamente eficiente in toate crizele cu exceptia absentelor

Fenobarbital

Fenitoin
Carbamazepin Primidon

Medicamente eficiente in toate tipurile de crize

Valproat de sodiu Clonazepam

Status epileptic
Crize subintrante Tratament injectabil cu : Clonazepam Diazepam Fenitoin

Antiepileptice: spectru de activitate

Spectru larg Spectru ingust

Sodium valproate
Levetiracetam Phenobarbital Benzodiazepine Topiramate

Phenytoin
Carbamazepine Ethosuximide Gabapentin Oxcarbazepine

Lamotrigine

Pregabalin

* Based on preliminary evidence

Antiepileptice moderne
Topiramat Vigabatrin Oxcarbazepina Lamotrigina Clobazam Gabapentin Pregabalin Tiagabin Levetiracetam Zonisamid

Efecte secundare ale tratamentului antiepileptic

Hipertrofie gingivala
Hirsutism Ovar polichistic Carente de folat

Boala Dupuytren
Modificari ale metabolismului osos

Tratament chirurgical
Rezectia focarului epileptic Lobectomie Hemisferectomie Calosotomie

Stimularea vagala
Electrozii de stimulare sunt atasati pe nervul vag Stimularea se face intermitent Indicat in forme de epilepsie refractara

Particularitati
Conducerea autovehiculelor Sporturi cu risc Anumite profesii Sarcina si alaptarea

People with epilepsy have excelled in every area.

Napoleon Bonaparte

G. Julius Caesar Sokrates Gustave Flaubert

Hermann von Helmholtz

Alfred Nobel Margaux Hemingway Jeanne d'Arc Lord Byron

Vincent van Gogh

Wladimir Iljitsch Lenin

F.M. Dostojewskij Kardinal Richelieu