Video Epilepsi

Epileptic fit (epileptick zchvat).wmv

EPILEPSY
Sam Lazuardi
EPILEPSY (EPSY) : a disorder caused by interruption of normal pattern by intermittent bursts of electrical energymore intense than usual causing epileptic seizures : episodes of uncontrolled movements, loss of consciousness, strange sensations, emotion & behavior, stare blankly for a few seconds or violent muscle spasms.
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SEIZURES - EPILEPSY
One in 100 people has experienced an unprovoked seizure at some point in life A solitary seizure does not mean an epilepsy High fever, severe head injury, lack of oxygen etc can affect the brain enough to cause a single seizure
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EPILEPSY CAUSE (1)

At least 2 unprovoked seizures are required for epilepsy diagnosis Epilepsy most common during childhood & after age 65 (32 % caused by stroke) Epilepsy has many causes (illnesses, infections, toxic substances, abn brain development & in many cases unkown causes)
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EPILEPSY CAUSE (2)

Epilepsy may develop because of abnormality in brain wiring / development Imbalance in neurotransmitter (abnormal high excitatory neurotransmitter or abnormal low inhibitory neurotransmitter GABA)

EPILEPSY MENTAL ILLNESS

Epilepsy in not contagious Epilepsy is not caused by mental illness or mental retardation Many people with epilepsy have normal & above average intelligence (Socrates, Alfred Nobel)

TRIGGER FACTORS
Seizures are often triggered by lack of sleep, stress, hormonal changes associated with menstrual cycle and smoking (nicotine acts on receptors for excitory neurotransmitter acetylcholine in the brain)

FOCAL SEIZURES
Kinds of seizures : 2 major categories : focal & generalized seizures Focal seizures partial seizures occur in one part of the brain (60 % of epilepsy) Simple focal: conscious but experience unusual feelings (joy, anger, sadness, nausea or hear, smell, taste, see or feel things that are not real Jacksonian march : progressive focal seizures

COMPLEX FOCAL SEIZURES

Change (dreamlike experience) or loss of consciousness & showed repetitious movements (automatism), blinks, twitches, washing dishes in repetitive unproductive fashion May show aura experience (= simple focal seizures) unusual sensations, warning of an impending seizure (stereotyped every time)
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GENERALIZED SEIZURES (1)

Abnormal neuronal activity on both sides of the brain, loss of consciousness, falls & massive muscle spasms 1.Absence seizures (petit mal), familial staring, jerking, twitching, may disturb concentration, but not IQ, starts in childhood & stop during puberty
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GENERALIZED SEIZURES (2)

2. Tonic seizures : stiffening of muscles of the body (back, legs, arms) 3.Clonic seizures : repeated jerking movements of muscles on both sides of the body 4.Myoclonic seizures : jerks or twitches of upper body, arms or legs 5.Atonic seizures : loss of normal muscle tone & fall down, drop head involuntarily
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GENERALIZED SEIZURES (3)

6.Tonic clonic seizures (grandmal) : stiffening of the body & repeated jerks of arms legs & loss of consciousness Some people show a focal & spread to entire brain (become generalized)

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OTHER KINDS OF EPSY (1)

1.Temporal lobe epilepsy (TLE) : most common, focal seizures with aura, begins in childhood, frequent seizures cause hippocampus shrinkage memory & learning problems treat early !

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OTHER KINDS OF EPSY (2)

2. Neocortical epilepsy : from brains cortex, focal or generalized, strange sensations, visual hallucinations, emotional changes, muscle spasms, convulsions depending on where it originate

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OTHER KINDS OF EPSY (3)

3.Lennox-Gastaut sy (children): severe epsy, different types of seizures incl. atonic seizures (sudden falls / drop attacks), very hard to treat 4.Rasmussens encephalitis : progressive epsy, continual inflammation in half of brain radical hemispherectomy
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OTHER KINDS OF EPSY(4)

5. Benign epsy sy (benign myoclonic epsy & benign neonatal convulsions) do not impair cognitive functions, easily treated & stop spontaneously 5.Infantile spasms, most common seizures, started before 6 mo, infant bend & cry out during attack, anticonvulsant dont work ACTH or prednisone
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NONEPSY SEIZURES (1)

1. First seizure : seizure occur in reaction to anesthesia, strong drug (unless a family history of epsy or brain damage) no 2nd attack. 2nd attack within 4 yrs (33 %) Risk 3rd attack after 2nd attack 73 % (4 yrs) After 2nd attack anticonvulsant therapy Idiopathic epsy (children) seizure free after 20 yrs (68 92 %) not included severe epsy
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NONEPSY SEIZURES (2)

2. Febrile seizures: high fever in child + seizure, epilepsy 3. Psychogenic seizure dependence, attention seeking, stressful conditions 4. Other nonepsy seizures : narcolepsy, Tourette sy, cardiac arrhythmia 5. Eclampsy (pregnancy, hypertension, seizures)
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NONEPSY SEIZURES (3)

1.Physiologic nonepsy seizures : hypoglycemia, hyponatremia, cardiac arrhytmia, syncope, migraine, TIA, eclampsia, benign febrile convulsion 2. Psychogenic nonepsy seizures : stressful psychological conflicts or major emotional trauma
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PSYCHOGENIC SEIZURES
Seizures are usually witnessed No seizures-related injuries Begin slowly & escalates in intensity Cry in the middle or at the end Movements affect left & right alternately Unusual posturing Postictal state is brief & wake up immediately D/ video / EEG monitoring
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EPILEPSY DIAGNOSIS (1)

1.EEG monitoring : 24 hrs awake & sleeping record & video monitoring 2.Brain scan : CT-scan or MRI brain structure (tumor, cyst etc) 3.Medical history : detailed history (seizures, past illnesses, other symptoms) caregiver information is very important
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. Hypsarrhythmia in infantile spasms - Note the chaotic high-amplitude background

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Polyspike and wave discharges seen in juvenile myoclonic epilepsy

Caption: Picture 9.

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Absence epsy - Anteriorly dominant, typical 3-Hz spike & wave discharges
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Benign rolandic epilepsy associated with typical centrotemporal spikes

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EPILEPSY DIAGNOSIS (2)

4.Blood tests in children for metabolic or genetic disorders associated with seizures and to look for underlying cause (infections, lead poisoning, diabetes, anemia) 5.Developmental : neurological & behavioral tests

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EPILEPSY PREVENTION
1.Head injury prevention: seatbelts, helmets 2.Medication after 2nd seizure or complicated febrile seizures 3.Good prenatal care (hypertension, infections in pregnancy) 4.Treat cardiovascular disease, hypertension 5.Identifying genes, genetic screening
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EPILEPSY MANAGEMENT (1)

After D/ start therapy right away No cure for epilepsy, but medicine can control seizures for most people If not, surgery, implanted device (vagus nerve stimulators) & diet 80 % can be controlled, 20 % intractable

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EPILEPSY MANAGEMENT (2)

1.Try monotherapy first, combination polyth/ may cause side effects 2.Start with a low dose & monitor blood levels 3.Sudden stopping of medication status epilepticus

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EPILEPSY MANAGEMENT (3)

4. 75 % could stop medication if seizure free for 3 yrs & normal EEG 5. Never stop medication for people with family history of epsy (+), who need multiple medication, focal seizures and have abnormal EEG while on medication

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ADVANTAGES OF MONOTH/
70 89 % CONTROLLED FEWER SIDE EFFECTS REDUCED TERATOGENICITY NO DRUG INTERACTIONS EASIER DOSING GREATER COMPLIANCE LOWER COST
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ADVANTAGES OF POLYTH/
MAY CONTROL AN ADDITIONAL 20 % MAY OFFER SYNERGISTIC OR ADDON EFFECTS

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ANTICONVULSANT SIDE EFFECTS (1)

Sedation, slurring of speech & unsteadiness, but slowly resolve as body accustomed Double vision, weight gain, hyperactivity in children, irritability, gum dysplasia Life-threatening skin reactions (Stevens Johnson sy) Asian ancestry genetic test before th/ carbamazepine
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ANTICONVULSANT SIDEEFFECT (2)

Side effect warning signs : Prolonged fever, rash, severe sore throat, mouth ulcers, easy bruising, pinpoint bleeding, weakness, excessive fatigue, swollen glands, lack of appetite, increased seizures Report to the doctor at once
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ANTICONVULSANT SIDE EFFECTS (3)

Side effects of medication in pregnancy birth defects : cleft lip / palate, cardiac abnormalities, spinal tube defects folic acid 400 microgram prior & during pregnancy Osteoporosis May raise suicide risk
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TREATMENT TIPS (1)

1.Take your medication regularly (through reminders), dont run of medication (especially on vacation) 2.Learn about your medication (side effects, strength, dosage, if you miss a dose, etc) 3.Dont ever stop medication abruptly 4.Dont try other peoples pills
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TREATMENT TIPS (2)

5.Never mix alcohol with medication 6.Keep medication out of reach of children 7.Keep medication away from direct sunlight, dampness & high humidity 8.Tell doctors, dentists, pharmacists that you are taking antiepileptic medication 9. Tell your doctor about your seizure control & unpleasant side effects
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THE RIGHT ANTIEPILEPTIC DRUG (AED) DEPEND ON :

Type of epilepsy Age, gender, other health issues How the AED work & side effects Other medicine youre taking Are the side effects acceptable In a female, pregnancy side effects
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FIRST AID FOR SEIZURE

Gently roll person on 1 side & put something soft under head, loosen neckwear Dont put fingers / something else in mouth Dont try to stop his movements & clear away dangerous objects Stay until the seizure ends naturally Try to bring him to emergency
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STATUS EPILEPTICUS
Seizure more than 5 minutes lifethreatening Prolonged seizure, without regaining consciousness between seizures Convulsive or nonconvulsive seizure (confusion or agitation state) Cause : trauma, tumor etc Medical emergency
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SURGERY
3 broad categories of epsy for successful surgery : 1. Focal seizures 2. Focal & spreading 3. Unilateral multifocal epsy with infantile hemiparesis (Rasmussens encephalitis) * After unsuccessful trying of 2 3 medication First WADA test areas for speech & memory Postoperative 2 yrs with anticonvulsant therapy
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VAGUS NERVE STIMULATOR

For patients not well-controlled by meds Device is surgically implanted under the chest skin & attached to vagus nerve like pace maker Do not stop medication Side-effect device minimal (sore throat, nausea)
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DIET
Ketogenic diet (rich in fats & low in carbohydrates) break down of fats instead of carbohydrates ketosis reduce seizures Side-effect : retarded growth due to nutritional deficiency Taking large doses of vitamins harmful Only folic acid as supplement is justified
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How does epilepsy affect daily life ?

Children often develop behavioral & emotional problems Do not reward negative behavior with unusual amount of attention Most people with epsy lead a normal life Poor self-esteem, depression & suicide are the result of lack of understanding & avoidance by the community
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EPILEPSY Tambahan dari EPILEPSY FOUNDATION & HEALTHDAY

SAM LAZUARDI

EPILEPSY PREVENTION HealthDay

24 Nov 2011 The US Centers for Disease Control and Prevention

1. Seek prenatal care during pregnancy to reduce risk of complications during pregnancy & delivery 2 Get all recommended immunizations to ward off serious infections 3.Protect against traumatic brain injury, use bicycle and sports helmets as appropriate 4.Manage risk factors such as high blood pressure, diabetes & high cholesterol to reduce your chances of stroke

EPILEPSY FOUNDATION
Pendapat salah mengenai epilepsi : Epilepsi : Karena kesetanan, kesambet Berkaitan dg retardasi mental, gangguan jiwa Bersifat heriditer Merupakan penyakit menular

PENYEBAB EPILEPSI
Infeksi, demam tinggi, trauma di kepala, keracunan Pb, kekurangan oksigen, alkohol, drug abuse, cacad lama bekas trauma kapitis, kelainan dalam kandungan, penyebab tak jelas

TINDAKAN MENGHADAPI SERANGAN EPILEPSI

Tetap tenang, menunggu hingga serangan selesai & angkat benda benda tajam disekitarnya Berikan alas utk kepalanya & miringkan kepalanya ke satu sisi Jangan masukkan sesuatu kedalam mulutnya Longgarkan bajunya terutama di daerah leher Harus di bawa ke RS bila : kejang > 5 menit, kejang pertama kali, kejang bentuknya lain, timbul luka, sedang hamil, serangan di air, bernafas kurang baik setelah kejang

PENGOBATAN EPILEPSI -1
Sebagian besar medikamentosa dan bila kurang berhasil, dpt dicoba : diet ketogenik pada anak dan operasi n vagus (vagus nerve stimulation therapy- VNS) Epilepsi tak dpt diobati dg vitamin atau herbal Obat hrs dijaga ketat, diminum teratur, jangan kehabisan, krn penghentian mendadak bisa menimbulkan kejang hebat Bila timbul efek samping, cepat melapor

PENGOBATAN EPILEPSI - 2
Bila berobat ke dokter lain utk penyakit lain, informasikan ttg penyakitnya & obat yg diminum Diet ketogenik pd anak : tinggi lemak tanpa gula selama 2 th. Sering sukar pelaksanaannya VNS ditanam spt pacemaker yg mengirim energi listrik ke otak dari batere yg ditanam di dada & berhubungan dg n.vagus di leher. Letupan energi berupaya mencegah serangan epilepsi Bila serangan datang juga, pakai magnet utk menghentikannnya. Efek samping suara parau

TIDUR DAN SERANGAN EPILEPSI

KADANG SERANGAN DPT TIMBUL DI WAKTU TIDUR LELAP, TAPI BUKAN PADA REM SLEEP SERANGAN DPT JUGA TIMBUL PD WAKTU TIDUR NGOROK (SLEEP APNOE) KURANG TIDUR DPT MENIMBULKAN SERANGAN KEJANG, YG DPT DICEGAH DG : JANGAN MINUM KAFEIN, ALKOHOL, MAKAN TERLALU BANYAK, SIANG BANYAK TIDUR, JANGAN TEGANG (LATIHAN RELAKSASI)

MENCEGAH KECELAKAAN PADA PENDERITA EPILEPSI - 1

Semua harus direncanakan berdasarkan fakta pd penderita epilepsi tersebut Keluarga harus tahu harus dibawa kemana bila timbul serangan hebat yg sukar diatasi Harus membawa tanda pengenal Harus selalu bawa obat yg cukup, terutama bila mau menginap di luar Bawa Hp utk beritahu dimana serangan mulai timbul

MENCEGAH KECELAKAAN PADA PENDERITA EPILEPSI 2

Harus cukup tidur, cukup makan, jangan stres, jangan minum alkohol atau obat terlarang Bila sering dpt serangan, selalu cari tempat yg baik di lantai utk dpt tiduran bila serangan & tidurlah dg kepala dimiringkan Bila ke toilet jangan dikunci & bila mandi hati hati jangan sampai tenggelam bila serangan Bila ke dapur, waspada terhadap api Jangan pakai bahan gelas, tapi plastik Jangan mengendarai kendaraan

EPILEPSY & AUTISM (HealthDay, 5 Dec 2011)

Fetal exposure in uterine to epilepsy drug valproate might raise autism risk nearly three times higher and almost five times more likely to have early onset autism Autistic teens with epilepsy are often light sensitive

CATAMENIAL EPILEPSY (HealthDay 3 Dec 2011)

Seizures among women of childbearing age with epilepsy may worsen during menstruation or ovulation : catamenial epilepsy Two-third of them had a diagnosis of partial epilepsy & the rest had primary generalized epilepsy About 75 % of them are medically refractory seizures, resistant to treatment and a high percentage of them reported having more seizures during pregnancy