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q d!I I,l-t!' "U 'iI

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nuinluL~'E)~l'lt':l"l1~LVhJ'l¥'fItJfl::: 47.4 llJiJbfl11J..:i MRI lU1N'V'ltJl'IJ1flfSr:lnt:::~'U1.U1Jnmfl ~'1ufu~nnuiniJ VPA 1.ut:::tKlJ1N"I'ImU1flMUtl IN'V'lU1111fl'JllJ"JjU¥1JtJfl::: 20,10 (;11lJ~1~UtJ1~ii1fluYlm:::til'Uh-1't'ltJ1U'1MhU

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1u'lJ~'1l Phenobarb,phenytoin 'l.ulN't'ltJ1tJ'1fl~u61N'V'ltJ1mflf'l~<)(fI Phenobarb, phenytoin CBZ,VPA. bb~ tN't'lmU'1fl~'1lJl'1lLLfl:::1N"I'ItJ1lJ'1fl'l1muiJ CBZ ¥1JtJ~::: 80,67 m1lJihtilu tc'i~1J-1 CT scan brain ~1lJ'1H1l'lr':l"l

,

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DR = Phonnh~rhit~1

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Palliative surgery (I'ILHJ~il8)

Medical treatment

Pa II iative/No n resection

hippocampectomy

Dominant lobe

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'\-1'lJ1'1l~1~b1I

Eloquent region

++

MTR

Phase III:

Invasive long-term video EEG monitor, EcoG, Cortical stjrn u lat ion

-ATL

-Amygdalo-

Disconnection

- Hemispherectomy

- Corpus cailosotomy

- 'MST

Augmentation

• Vagal nerve stimulation

CURE

MTR++ = Mesial temporal lobe resection AL T = Anterior ternoorat lobectornv

• Q

tJVIVI 1

n1~~ntJ~~~bb~~n1~~~'d,...i1'1n1~1 tJtJt1'd~~~\)i~d1ij'illn1~orn

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n'u''ilU''IitJ'Elln1~oDnbb~:::m~~lbb'Wmh:::u)l'I'lJ'El~'Elln1~niJA'"lll-Jfll~'lJl-Jln ~~IOj:::ulhJ~rnn~'ElnLL'W'l'YI1~ m~fn~l~mm:;~l-J bbt1:::fl1m~(11~m~l'Itnmru1~~1~'Elth~bLlJ'W~1~~~'W bcPlfJ'tI1«fJ~n~ru:::"lI'El~n1~oDn 'El1tj~b1-l-JiJ 'El1n1~n t'l1U.Jl'J bbt1:::th::1A"r'W1!nmJ

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1. 'U'"I'"I!.In'S'~I?JlJ,[)1n1i"lln (seizure precipitants or triggers) rnbbn 'lJ nW8cPl'W'El'W rnl-Jbb'1l~n'1lertl~ bb~-lm:::l'I~'lJ

bmtl~cK-l ji1}'l1).JbA1fJrn'l'l1-lh:jn1m.~1'El~f111Oj~~'WbbN n15'iJ5''1l'lJb~'1l'W

2. ,[)1n1ifl'lhmri'iJ'W fl'"l:::ii'iJ1n1i-nn (procromes) tl1"l tn l?l dj'W~:::tJ::b'd~1'W1'WlIfl1t1'W1V1n~lItlltJ.t'] bl-J-l n'El'Wn1j' in :!1mth.l'1l1m~~hJij5n~ru::b'!l'W1:; b'll'WM'dll-Jffin'Wfi'1ltJ~'lJ1tJ nj':::6'lJm:::f.'hu '!..l':lcPl~h~::: btl'W~'W

~

3. Aura d]'W'El1n1j'bb~cPl-l"ll'M simple partial sensory seizure '1l19~un~lbil'W'El1n1H~'1l'W ~n~ru:::'lI'1l-l'1l1n1j'''It~'W 'ElQn'lJ[ihbbllU-l'lJtl-l~l-J'1l-l~~l-Jbnl?ln1~oDn b"ll'W ~'l1).Ji~n'!..l'dcPl lI1tltlln1ftl1'W'lJl'lri'd'W'lI'1l-l~1-ln1tJ tl1nl~lItl'fl'Wwl1-l1 Mmi fI1l'l b~~N n~'W bbt1ttfl 'fl1n1j'b':)t1'W~~~::: tl1n1j''Vl1~~:::'lJ'lJtl~tfl1Vl-erRbtJarM b"ll'W 'ei1n1j'-,mb"J'UYI'fl-l ~~'W1~ 'fl1b~U'U tnh:ncPl lI'\',i'lbbcPl-l m1'8w?ln 'lI'W~n '81mj'~cPl'!..ln~'lI'fl'l cognitive function b"ll'W ~cPlhn~ S'n1l-J~rn'!..ln~'YI1-l '81rl-JtU b"ll'W t~nn~':l ~'d'Wll1but'itJ'dtJarm::iJ'81n1~mii'8'WbWil-Jl'In~f-l bblli'lJl-l~'W'1l19"1:;ij aura 1Ji'1It11tJ"J!UcPl 'lJ'NfI'U

'lJ 1:00' cu ~

hjt'l1l-J1j'Cl'lJj'~tI1u«n'etrut'll'fl-l aura lI~'841aUra hJ1~ 'lIru:::~bn~ aura t'itJ,}tJ9:::¥anM':l~'LcPltlWlflilcPl bL~'lJ1-lAf'ln1~

" 'U

inil1q9:::~1bu'WlIi'81'!..lbnc?lbtl'Wil1n1rimr-lIif'dV' ~1-'8b'!..l~tJ'Ubtl'U n1j'oDmb'lJ'lJ~'Ul b'll'U complex partial seizure

4. 'el1n1ii'd3J (Associated symptoms) ~tlilln1j'~'W1~bncPl~:::lI~1-liln1rin 1~mi 1'lJmj1l11'1lll-Ji'h..hm~u':l nc?l~'U ifmfl1'd::: ~"I91i:::hJiM'dn1~'lJ1l?lb~'lJ~'U191n~ill1b'M~ l'U'WM'W

5. 'el1m'a.a-mb~t:,[)1n1'J'VIi~in (seizure and post-ictal phase) '1l1n1~n'!..l~:::u)'YIl1i1'l1"l:::il6n~ru::~blliltl'Wn'W flil

....... ..t 11.' ...... IV 6'J

1) Lnrn'll'U'I'l'U'YI'I'l'W bcPl

2) ~'d'Wl'MrY9:::bnc?lbtl'W~:::I'J:::b'dmJ''U1 hlLn'W 5 'W111 ~'d'Ul-J1n9:::bncPl~'Wb'fl-l bbwl'lJ1-lPlf-l'fl1QQ:;iJ if94'tlm::~'W (precipitating factors) bbfl:::ri'd'Ull1rY9:::m.!cPl1~b'1l'l iJb.wU-l'lJ1'lAf-l~n1j'in"l:::~1tti'UlIi'flb;i'1l-l1'!..ltil'W status epilepticus

3) '1l1n1j'imbffifl:::'jjU~ ~'}'Wll1'lJ'9:;il6n'etru:::milil'W'M1'ElA~1I'Jn'WVJnAf~(stereotype)

';n~ru~"1Ill~1l1n1'3"li'n ~1bVWn(?l13-J ILAE 19811l?iiiju 2 'I.h~bJlVlltKbLri

5.1 'fl101rimuvn:::&'l,)u (partial seizure) Ln(?]'"l1M),)1J.JWl1ltJn~"lI'i:NA~u1yh''h~J.J'fl~b'ilYl1:::~ bLf'l:::brJ.JR'W

tl1iJn1ntJ~tI'WbbtJfl~n1Tr~~'"l:::crt!nrJ1 complex partial seizures

5.1.1 Simple partial seizure 6m:tru:::'fI101r{n'"l:::~U'fI~nuM1bmU~'1l'fl.:i~J.J'fl"'~bn(?]mrin b'li'W n1rin~bnl7l"l1nt'lJ.J'fl~~,)'W occipital ~t1'JtI'fl1"1 L-a'WLbt'l~'J1U n1rin"l1nt'lJ.J'fl~&'l'JU motor cortex 'fI1"1iJ'fl1n1Tbn~~ bLfl:::/~1'ilnT:::l?Jn".lI'fl~&'l'J'W"lI'1I_'i1~n1t1R1\'!MNif1J.J &'l')'Wmiin~ LnC?i'"l1nt'lJ.J'il~&'l'J'W sensory cortex ~t1')tI"I:::iJA'J1J.Jt ~n~Ln(i)~'Wb'1l~ L-n'W tJ,)17I b~tI,)"lJ'fl~&'l'J'W"lI'fl~i1~n1w~hUMNif1J.JbilwKnl biluRU

5.1.2 Complex partial seizure ~1l'JtI'fi1'"l"l:::~b'\.nJ'fIfl'fltl U1~Af~'fI1"1~ L~i.j'fl'Wl~'JLbr;i"l:::'hJ

M'fIU~'W'fl~r;i'flri1b11J.J1eXLiI'WtJn~ ~1'fl'fl1"1'"l:::LbM~'V'lqRnnJ.Jl'h·'lltl7ltl1iJl~') ~..:jcrtJnrJ1 automatism b-nU lhtJ1ml3-jU "lJilu ~1viTI'l1 .. mtJflnl L~mtJ1mmtJ1J.JwtJ1n ~17I.n') ~C?i~11 bfiu ~..:j tt1'fln'flC?iL~mJ1 'fI1n1Tim~g;he~n"l:;U1'W1lJ bnu 2-3 'l...nVl '-1ft..:j"l1mr'W'"l:::bif1~ post-ictal phase tl7ltl~n'"l:::b~'fl~~lJ Kut'l'W tJ'JC?i?li'l!/':::~r'fl'W'fI'W~~u ~'Hn"l"l:;Ltiu 'fI~'W1'1....mfl1tl'W1Vln~~fl1tJi'J tlJ~ b~tll~ nA'J ~ bL~'J~ 0"1:::91 L '-1l'Jmmr~ bn 17I~'W1iJ1eX

5.2 Generalized seizures bnC?i'"l1nA'J1lJWl7ltJn~"lJ'fI~A~'W1yjYl1t'llJ'fI~'V'lf'fllJrl'W~'" 2 olr1..:jil'IAfl1t1'l1U(?] 1eXLbrl

5.2.1 Absence seizure &'l'J'Wll1'lJcilJbti'Wl'Wb~n mJ'l'fl'flmil'W

• Typical absence ~n'l'lU1UL;;n~i1vroo.J'W1mitlnA 'fl1miincl'J'W1~'lJ'W1'WtJr:;lJ1ru 5-1 0 ~'W1Vll'WU1'lntltl1"1

b~tl1'lJmtJ1n~'JJ.J I~btl

• Atypical absence ~n'V'lulubMn~fh~oo.J'W1n1iojf1 'fI1n1Timilu'W1'WnrJ1 Typical absence cl'J'Wll1'lJiJn~1J.Jb~'fI bn ~..:j~1'11 r;i,)fl su il 'J n b11 tI n1'J J.J eX'JtI bbfl :;~n '"l:::i1'fl1 n1Ti n~fl1tl'll UA~'J J.J eX'J tJ

,

5.2.2 Generalized tonic-clonic seizure ll'1nl:r~n~lJ ~'lll n'l~'}13-J"'~~ LL~'dijn1~lnr"]lItl~

, " ..

5.2.3 Generalized clonic seizure bil'Wn1TinV1fjn~1J.JbU'fl'l1..:jA'JnT:::l?Jmtl'W~~'\.1'J:;

5.2.4 Generalized tonic seizure bti'Wn1rin~i1n~1lJb~tlbn~..:j~..:j~') 'fI1'"l~11-M~J.Jf'l..:jllru:::in

J~ e- J' I Ji!:' v!J (V s..- 1.> J' 1"

5.2.5 Atonic seizure ltiUn1nn'l'llJnfl1J.Jl'W'fIiI'fIUbtJf'ltlVl-ll'l,) ~tl'JtlJ.Jn'"l:;f'l~fl~bbfl'J~n"lI'W ~

11'WV1~~1~l1u¥~nrJ1'-1lJ(?]~~

"

Q: ~ J~ 'i.o..t v V 'V .d ?J

5.2.6 Myoclonic seizure bUUn1r'llnVllJnfl1J.JL'W'flm:::f;,lnflfl1tJt'l:::"J.:i J.Jn nT:;f;,lnVlbb'lJ'W~'fI_'°n1'"

t< 'i,.-..:J 'i-" .... j.o

tl1"1 '"l ~nmll nA1..:j b~ tI,)l1ftl Lti'W-n'J..:j K'W11~ n A f_, bWi1iJ btiU~..:j'\.1 ,):::'fl1 mrn i:;M n LL~fl :::A14'W1Ub V1 tJ~ b~tl') 'i 'W1 ~9..:j liJYi''WT

. ."

~n':h'\.1J.Jl'lt'l~

• 1l1n1'3vti..:!-nn (Post-ictal symptoms) 'fl1n1rin"llul'l complex partial bbfl::: generalized seizures ~nlJ

'fI1n1T'-1~~in'W1'W~fl1t1'W1V1'"l'W~..:j~fl1tJi'JtlJ_' 1~bbri tJ,)l'l?lrB~ ~lJ~~U Kut'l'W bL"lJ'W'lJ1'1l'flUbLN ~i'flil'fl1mi'l'l1~ilim M1J.Jm1'Wu1~A'W~ii'fl1n1TLL"lI'W"lJ1'1ltlULbNL'UYl1:::i'hw (Todd's paralysis) '1I')tJtJ~~rJ1mTinJ'Wi~J.JA'Wr.nn'i'1~'tl_'J11'W l'lNif1lJ

• 41U1UjO)f..:!"ll1l..:!1l1m'3-nnbbg;j~1"l113-J~"lI1l~1l1n1'3-nn iJA'J1~~1fi''1!lum~,)1..:jbbt:.Jum~fn'l!/'1~thtl

2

• 1'111:lJL~'UtI'J!lif'"l~u'UVi'fl1~bij'U'6'l1bVlfPI"l.l'fl~'fl1m~-rn (Acute symptomatic seizure, provoked

• •

seizure) L'1lU n1~~IP1L~'a1U~lJ'tl~ T.J1J1imt'J'Vl1~~lJ'tl~~::tJ:::l'il.tJ'lJ~«'W l~;;)\H:l'tlm~'tlIP1~lJ'tl~~::tJ::LiitJ1J~«'W zn

bl'tl%1 n'!H:l'tl6 ~1'tlr1'l1:lJtli1ltlfl~'Vl1~L:lJiIll11Jiln djtJ~u

• b~A'l.h:::~1Pi'J b~Avn{j'6'l:lJ'fl~1.t.!'fl~1?1 ,.h:::1&i'fl~LVlI?J'YI'1~'6'l3J'fl~ LL~~tl~~.wlb~A'&u.J-nnt'IJA'iI'fl'UA-r1

b~'tlm~lb~~'1l'tl"'l~r1%1:lJ-Hfl (idiopathic, cryptogenic, symptomatic epilepsy) ffl'l'tl~,h~L"llU

• Febrile convulsion

• Mental retardation and delayed development

• Congenital cerebral anomaly b"llU Tuberous sclerosis

• CNS infection, severe head injury, brain tumor, AVM, craniotomy, cerebrovascular diseases

• Perinatal insults L"ll'W birth asphyxia, birth trauma, cerebral palsy

• tl'a'::.J;j'Vl1~~1t.!~ui"L~Lb'&l::i..:ll'l3J (Psychosocial history): ilr1'l1:lJ~lf'oi'l,ltum~'J'NLbeJun1~ffl'jjlbb%1::n1~ ~urlrl:lJ~~~.rn~1u~tl'JtJl~A%1:lJ-Hfl 1WibLr1 nr.;i1?1~u~:::~1itJ fl1~~fl'jj1 'tl1~~ fl1~'li1Jnl , IA~nm'V'l A'Jl:lJtlt?ltiflAYm

" " "1

'El1~mwib~::1~A~1?1 biltJ~u rns fPI'1'J ~';h..:l rna

1. fl1'1t1l'1'J~.;h..:l fl1!1-k'J 1 tl L Y1'flVl1f'1'J13J ~ lPlti fl ~VI~'fl b'a'P1Vi'fl1'"l L i1'1J'~1 b VlfPI"l.I'fl"''fl1fl1'a'~n

1.1 Vital signs: 1.1.1 Fever

1.1.2 Atrial fibrillation

1 .1.3 Hypertensive crisis

1.2 Head

1.2.1 Contour: asymmetries, surgical scar, evidence of injury

1.2.2 Trans illumination ~f6fr'jj::L~'tl'i-ll cerebral malformation lUL~fl'I'llm

1.2.3 Head circumference

1.2.4 Auscultation

1.3 Dermatologic abnormalities ffl'J'Elth~b'1ltJ

1.3.1 Axillary freckling, Cafe-au-Iait spots ltJ neurofibromatosis 1.3.2 Port wine stain 1'W Sturge-Weber syndrome

1.3.3 Facial sebaceous adenoma, ash leaf spots, Shagreen patch tu Tuberous sclerosis 1.3.4 Spider nevi, palmar erythema 1'W chronic liver disease

1.3.5 Pallor, ecchymoses and hematomas, pruritus, excoriations, poor skin turgor, dry mucous membranes 1u chronic renal failure

1.3.6 Signs of needle marks in intravenous drug abuse

1.4 Anemia, jaundice. petechia! hemorrhage

1.5 Cardiovascular system: Mitral stenosis, Aortic stenosis

1.6 Auscultation of carotid artery

3

1.7 Hepato-splenomegaly

1.8 Asymmetries of face. hands and feet

1.9 Other abnormal physical examination related to acquired metabolic disorders

2. 01'a&l'i1'"lil .. m'1!1'Vl1~'i:::tJtJtI'i:::'6'l'1'VI ~ ~'elVl1 (ph~L Vlu~v1~ ~t1 n ~"lI'el~'6'l'a.J'el~:a~'el1'"l L t1U'6'l''1L VliPl

i.~~n(?)'el'1m'iin

2.1 Higher cortical function: language, memory, concentration, abstract thinking. neglect

2.2 Papilledema
2.3 Visual field
2.4 Smelling
2.5 Hearing
2.6 Lobe signs: 2.6.1 Frontal lobe releasing signs

2.6.2 Parietal lobe signs: apraxia, double stimulation test. two point discrimination test

2.6.3 Temporal lobe Signs: memory, receptive aphasia

2.7 Motor power and long tract signs

2.8 Sensation: proprioceptive sense, joint position sense 2.9 Gait and coordination

2.10 Meningeal irritation signs: stiffness of neck a.~d Kernig's sign

4

I

..:::II

tJVlVl 2

n1~4" Ul~1 u 'UntJ~~bJ1'V1~'f)~ b~f)~3-J~n bb~~n~3-J'f)1n1~i'n

q

F1'l14'~~1LL'Wm..J1~t.fI'VJ'1ltl'lhfH'll-Jin ~1LL'Wnrl1l-Jin1!tru~"lJtl-.1tl1n1f'nn( Seizure type) LL~~Pl,)1l-Jf.j~tJn~ 'lJ'fl'lf1~'Wl'rHh0ll-Jtl-.1 (International league against epilepsy (ILAE) classification U 1981) b'WU 1989 1~ ~'m'Wmi'J'Wh-Pl~l-Jin( EpilepsY)LL~~n~l-J'fl1n1rin (Epileptic syndrome) t~tJtiHrtll;!&'l~'W1 ~'Jl-JnlJin1!tru~ tlln11in~'JtJ l~LLri tl1tJ~~l-JLnAtlln1fin ~1L'V1l'J"lJtl'ltl1nl~in tJ1~-m'VI1-1-W'W!ln11l-J e.J~n1trl1,)'"lf1~'Wfll-Jtl'l n11 rltllJfl'Wtl..:JllItlnl1fn1!t1 LL&'l~ ~tJ1Mru1tPl (ILAE classification iJ 1989)

tlln1tin«i1u'Wnrl13-J ILAE classification t/ 19811~\i'J'IJ 3 tJ1~1Jl'VJ1~qj1161lL1i

1. Partial seizures

2. Generalized seizures

3. Unclassified seizures Lu'Wtl1n11in~u..:JhJfl1mtbl~1LL'Wnl~-)1LtI'W partial ~1tl

generalized seizure

l1f1&'ll-J-nn 41~~'WMn3-J International Classification of Epilepsies, Epileptic Syndromes and Related Seizures Disorder t/19s9161btll..! 3 tJt~IJl'VIbl1qj1161LLri

1. Localization-related (focal, local, partial) epilepsies

2. Generalized epilepsies

3. Undetermined epilepsies

4. Special syndromes

~..:J 1 'WLLIlI&'l::::tJ t:::: 1Jl'Yl"lltl..:J hf1&'ll-Jin&i'-.1 mh'J fllmtblq1 LL'\..! n 1911 l-J a1 L "'1P!"lI'el{J'il1n1-a-i n LL'll~\'lm fiamvll 'U

lI11iN l~LtI'W 3 tJt:::t.fI'VJ &i'..:JQ

1. Idiopathic (Primary) LtI'Wn~l-Jtt~fll-Jin~fj~nm(.Ojm~1nPl'Jll-Jf.jAtJn~'Yl1..:J-W'W!lnttl-J

2. Symptomatic btl'Wn~l-Jttf1fll-Jin~LnA'"l1n'Y'ltJ1fifl.rn'Y'lb'Wfll-Jtl'l

3. Cryptogenic LtI'Wn~lJt1Pl&'ll-J-nn~t.h'"l!::Ln~~1n'Y'ltJ1fiflm'Y'l1'Wfll-Jtl..:J bLfiu..:JRt':llilh,J'Y'IlJin1!tru:::"lItl..:J'Y'IU1fi flfl1'Y'1&i''lnf11'J61':ltJ'l'VJtJ1n1tbUif'"l''lUU

1.1 Idiopathic (with age-related onset)

- Benign childhood epilepsy with centro-temporal spikes

- Childhood epilepsy with occipital paroxysms

- Primary reading epilepsy

®'W1.:lvl1 International Classification of Epilepsies and Epileptic Syndromes (Commission on Classification and Terminology of the ILAE. 1989)

~--------------------------------------------------------------------.---

1.

Localization-related (focal, local, partial) epilepsies and syndromes

5

1.2 Symwomatic
- Chronic progressive epilepsia partial is continua of childhood (Kojewnikov's
syndrome)
- Syndromes characterized by seizure with specific modes of precipitation (l.e.
reflex epilepsy)
- Temporal lobe epilepsy (amygdalo-hippocampal, lateral)
- Frontal lobe epilepsies (supplementary motor, cingulate, anterior frontopolar,
orbitofrontal, dorsolateral, opercular, motor cortex)
- Parietal lobe epilepsies
- Occipital lobe epilepsies
1.3 C[ygtogenic

2. Generalized epilepsies and syndromes
-
2.1 Idiopathic (with age-related onset)
- Benign neonatal familial convulsions
- Benign neonatal convulsions
- Benign myoclonic epilepsy in infancy
- Childhood absence epilepsy
- Juvenile absence epilepsy (pyknolepsy)
- Juvenile absence epilepsy
- Epilepsy with grand mal seizures (generalized tonic-clonic seizures) on
awakening
- Other generalized idiopathic epilepsies not defined above
- Epilepsies with seizures precipitated by specific modes of activation
2.2 C[yptogenic or symptomatic
- West syndrome (infantile spasms, Blitz-Nick-Salaarn Krampfe)
- Lennox-Gastaut syndrome
- Epilepsy with myoclonic-astatic seizures
- Epilepsy with myoclonic absences
2.3 fuillJptomatic
2.3.1 Non-specific cause
Early myoclonic encephalopathy
Early infantile epileptic encephalopathy with suppression-burst
Other symptomatic generalized epilepsies not defined above
2.3.2 Specific syndromes
Epileptic seizures complicating disease states 6

3. Epilepsies and syndromes undetermined whether focal or generalized
3.1 With both generalized and focal ~eizures
- Neonatal seizures
" Severe myoclonic in infancy
" Epilepsy with continuous spike-wave activity during slow-wave sleep
- Acquired epileptic aphasia (t.andau-Kleffner syndrome)
" Other undetermined epilepsies not defined above
3.2 Without uneguivocal generaliz!:ld or fQCgl feg!ure~

4. Special syndromes
4.1 Situation-related seizures
- Febrile convulsions
- Isolated seizures or isolated status epilepticus
" Seizures occurring only with acute metabolic or toxic event 1iU~"lJ'el~hAfl3-l,rn ( 11I1'il{!~1)

1. Localization-related (focal, local, partial) epilepsies and syndromes

Lth.m ~lJ'lJ1)\1 tT~f'll-Ji n~ bnc?l"lln ~'lltJ~t>lUn ~'lJ'El~PI~'Ulyjvh~tJfl~ L '!lV'll :::~'lJfl~t'l)Jfl~

1.1. Idiopathic (with age related onset) Lu'UhPl:~ltJin~'V'j1Jlc1ll'UL~n~fl~OOJ'Ulnlntf'l:::nlTtnj'l"l'VlI'l

T:::1J1JUT:::tl1'V1Un~ l~Lbri

1.1.1 Benign childhood epilepsies with centro-temporal spikes dj'WhA~l-Jin~'V'j1Jlc1llw'li'l~'Ellf,! 3-15 tI flln1T-nmrn"l:::dj'WmTm:::~nvilfl "Jj1'lJ'El~Lu"nJ'Hb~:::1.hn 1J1'lAf'l~lh~ 1J 1"'1'"1 :::fl1JlnlTAftltJ~li m·i~1J1J '1 b9tJ'U 'en rn rin1J1"l~ n~ntJ LlJ'Wbb1JU bn~~n T:::~ n~'l A'l1Jl l1' n'"l:::bn(Ol~'W1 'W'lJru:::'W1J'W ",61J 'fl1n11im1m:::1lJt'WtbNbtfl:::bn(Ol1lJti'fltJ ~'l'W1tm.J1lJ~1J~nlm1Tfm~nbbfl:::"l:::vn~1~b1)o.'IVl6'lt'ih~1'tJt'W n11W1j'l"l PI~ 'W MV;J1 ii tJ1J'l"l:::'li 'l u L'Wn 1 j'l-W"l '!t~

1.1.2 Childhood epilepsy with occipital paroxysm

dlwtrRfllJin~'I'I1Jl~'W'li'l~'1.lltJ H 4 il t~tJ0i'l'Wl",qj1J~L'W'li'l~'1.l1tJ 4"8 il ~t.l'ltJ1J1"lfl'fnmTU'l(;)~T~:::btUu1tJ bn1Wi'ltJ~f'ltJ 'fl1mrinl1'n.,:::~tJ"'l1nPl'l1tJ~c?lUn~'lJ'1.l.:mlmEl~b~'W b'li'W b~'Wml'lnT:::'V'j11J b~'W"c?l(t'1l'lLbt'l~ ",1'flm1b~'W

generalized tonic-clonic ",1'11 complex partial seizure n1TWlT'l"'lA~'WlyjY11iij.J'fl~":::'V'j1Jin~ru::: unilateral ~or' bilateral posterior spike-wave ~b~'Woic?lL'W'lJru:::1.J'fl'W'!!Ii'lJ mj'V'jtJ1nTrulTA~mmbfl:::l1'n":::'!!I1tJ1Jlb'1.l~1'W'li'l..j1'tJt'W

1.2. Symptomatic epilepsy

1.2.1 Frontal lobe epilepsy

bUHtH'I~j.Jin~flA~'Wlyjvht'ltJ'fl~~~c?ll.ln~"1n'V'jtJ1fit'lJl1'r'1'lJ'D~&U.J'D~~'J'W frontal lobe 'fl1nlTinl1'n.,:::tUWLb1J1J simple '!!It'D complex partial seizure ~..j'fll.,.,:::~nfl1l-.Jmllt.JLtJ'Wn1jim~..jm'l (secondary generalization) tc?ltJ~ :i':::tI:::b'J~1'lJ'1.l~n11ofl'n'Jj-W(fl complex partial seizure b'W frontal lobe epilepsy ":::A'El'Wif1'l~'W :i':::""~1'ln1:i'in~th~ 'fl1"'"l:::n'1.l"ln1T'1ltJ'lJA'l11.lm (hyperkinetic movement) n1nU~~tAAtJ'l(vocalization) ~T1!t~if'Wlt1~"l'WL(Ol~h'W",n~

7

~1'fl'fl1.,.,::ljn1mflM~~~~n:i'~l-l~'i~1bMtJllJic;l') b..n'W bipedal automatism, sexual automatism ~t1'"ltJ'fll"'l.,::ftl-llM

I "" W ~

U'flm11lj'fl1nWDn'llUMLn~~(tonic seizure) vit'flm~in.y;ljnftll-lLU'fl'el'fl'WbtJ~m1~c;l'"l (atonic seizure) 'fl1m~oDn"'l::

LnM1A'u'fltJ'lIru.:;",IKu ffl1l-l"'IK~n1~in~t1'ltJ'fl1"'l"'l::lj post-ictal aphasia ",1'fl Todd's paralysis n1i('l:l''"l'''lA~'Wlyjfl1 ~l-J'fl~'lIru.::oDn'fl1"'lhJ~UA,)1l-lWMtJn~i~lb'~'W",1'flnnu(?lU~M'ltJ artifact "'l1nn1HA~'fl'Wl~') mi('l:l',)"'l MRI brain 'fl1"'l

'U

"'l:::i'ltJ :l'::bU"ll'W1 'Wn1 :l'",1:l''fltJ hA~ LU 'Wfl 1 b"'(;)'lI'fl~ n l:l'oD n m nh c;lMfmt"l 1 'WntJ~hJ fIl'flU ~'W'fl-ltol'fltJ 1n'WoD n 1M e.JflUiltJ

n~1~1.htJn~l-l temporal lobe epilepsy

1.2.2 Temporal lobe epilepsy

bu'WhA~l-lin~ljA~'Wlyjfl1fll-l'fl~~W!i1tJn~"'l1n~81iMl~'lJ'fl~fll-l'fl~~'"l'W temporal lobe ~t1')tJJTn"'l:::~l-llj'e11n1iin 1'W"D'l,,'J'ltJtU !f'tltJ~::: 30 'lJ'tl-l~tbtJ'tl1"'lljtJ:l':::1fi febrile seizure1'W'lmfin bMm'il~1::: complex febrile seizure

v ~

'e11n1:l'inljlff~~ simple bLfl::: complex partial seizure Lbfl:::'fl1"'lijnfl1l-lLU'Wn"!:l'oDnr1,,'Jc;l') (secondary

generalization) J11tJ"'IK~m:l'oDn~t1'ltJJTn"'l:::i'l'fl1n1f~Ufl'W'fl~f::tJ:::",ii~

Simple partial sensory seizure ",1'flbTtJnQ1'fl'ln1n11 (aura) ~~UU'fltJ l~bbri epigastric sensation, autonomic symptoms, psychic symptoms (b..n'W A'"l1l-li~nnIK'"l deja vu, jamais vu), olfactory/gustatory symptoms ",1'fl visual phenomenon

Complex partial seizure ~~UU'fltJlffbbri 'fl1mj'1t11",!h~ mJJ'flfl'fltl JTn"'l:::fJ automatisms ( b'li'W roalimentary. bimanual, gestural) 1'l:!-l~'ltJ

1.2.3 Parietal lobe epilepsy

bUU b:rAfll-loD n~lj A~'Wl yjfl'l'l1l-l'fl~~WMtJn~"'l1 n~81fi'l1J11~'lI'fl~~l-l'fl~~'J'W parietal lobe 'fl1 n'lfi n'fJ1"'l ~l-l ~')tI'fl1 rnr U1b..n'W 'fl1mj''lI1~~'"l'Wl(?l'lh'W~n~''lI'fl~h~mtJ Lbkl('l1l-lm~')tI'fl1n1fimbUU complex partial seizure ",1'fl

generalized tonic-clonic seizure

1.2.4 Occipital lobe epilepsy

L1j'Wb:rA~l-lin~ljA~'WlyJfl1fll-l'fl-l~WMtJn~"'lln~81fi'i'1J11'V'l"ll'fl'lfll-l'fl'l~'lU occipital lobe 'fl1n1rin'fll"'l~l-lA''ltJ-enn1j' U1 L'li'W visual hallucination ~1'fl visual illusion ~'I'fl1"'lbll'WLLUU positive (b'li'W n1n~'WLL'i'1'1~tp}1'11) ",1'fl negative phenomenon (n1j'l-l'fl'lhib~'W'fl:::h"'1'flrlM~1'l1U'V11tJi'lAi) ti1tK ",6'1"'l1mr'WJTn"'l::~M('I1l-l~')tJ'fl1n1:l'oDmLUU complex partial seizure ",1'fl generalized tonlc-clonic seizure n1:l'(>l~'"l"'lA~'WlvJ"hfll-l'fl~L!i1m'il'V'l1::"lIru.:::n1rin 'fll"'l"'l:::'V'lU epileptiform discharge "'lln occipital lobe

2. Generalized epilepsies and syndromes

2.1. Idiopathic

2.1.1 Benign neonatal familial convulsions

2.1.2 Benign neonatal convulsions

2.1.3 Benign myoclonic epilepsy in infancy

2.1.4 Childhood absence epilepsy

t:rAfll-linl'Wnfil-ln~nM1'Wb~n'fl1tJ 4·10 titMtJ"'l:::'V'l'IJU'fltllu'll'l'l'fl1t1 5·7 U L~n"'l:::iJmj'~[IJ..J'W1n1j'

.. ,

tJn~ "lIO.J:::nlTinL~nq:::iJ'fl1n1n"'JJ'flfl'fltJL~~::'tn"l"l:::iJwmj':::~rUbU'W~:::tI:::L,)fl1i'W1 4·20 ;;;m.y; ~6~imrnhH1 'fl1n1:l'o&'u~'W W'ln''lln'W1'W'fl1'''l9::i1 automatism 1'Jl-lc;1')t) illn1TinJTn"'l:::LnMl~UiltJ (l-llnnQ11 0 ?lf~6'W) n'lj'(>lf')"'l

8

l:'aJ'fl~'"l::;'I"lUin'lfru:::L'U'I"l'l:::A'fI 3 Hz generalized spike and wave complexes mt'l"lmntru1tfl~Lb~:::'fl'ln1tin'fl1'"l 'l.ntJhJl~L'fl~lti-ldh~"ll'N1'm~u

" .

2.1.1. Juvenile absence epilepsy ~t1')mrnf<il::;~l-J~t:nm:i'intu'll,)~'fl'l£j 7 -16 iJLL~:::'I"lul~

U'fltJlu'll,)-l'fl'lf,! 10-12 11 in'lfru:::mn1tim:::flA'ltJ childhood absence epilepsy 'fl1n1:i'in'fl1"l"l:::~t1U(;jgil'fl~

and wave complexes

Awakening

2.1.2. Epilepsy with grand mal seizures (generalized tonic-clonic seizures) on

'fI'ln1timrmil-Jlu'll,)~'fl'ltJ 20 1IltT'fllu1'tJm",nJ(;j'flU~U 'I"lU1UL'I"lm'ltJ1~tJ'fltJn1'llrl}lm:::~n'ltin

II "I; <1J 'IJ

bL1J1JLn~-lnt:::fJmr-lA,) (generalized tonic-clonic seizure) ~-lJJmnt'11u'll,)~~uU'flUbLA'tl'l'"l"l:::bnWltu-rl')~~4')~u'flU "'T'B~nn~:::~W"l'lnn1~'fl AU'flU"'T'fIm~~l-J LL'Elf'ln'fle1'Eli n1tl?lr')"l fl~u'lyjvh~l-J'tl~'"l:::'I'Iuin'lfru:::LtltJ generalized spikes and waves complex

2.2. Cryptogenic or symptomatic

2.2.1. West syndrome (infantile spasms, Blitz-Nick-Salaam Krarnpfe) n11im:::b1l-Jbnt'1 tW"lJ'lU1IbLtn tiJ)tmu1&1UtH.J'll'l~'fl'ltJ 3-5 bM'flW l1'1n1:i'in'"l:::dJuin'lfru::: spasm "lI'El-:Jii'lUfl'El ~r'lf:::bLfI:::~'lA,) ~lhtJ tn'"l"l:::~~oo.Jmn11tlmJnM ",1'B:wmental retardationf')U&l')tJ West syndrome 'fl'l'"lLnA"l'ln~'lbtH'.l",ftltJ'Eltll-lL-rlu metabolic disorder, cortical dys-genesis. degenerative, neuro-cutaneous syndrome ltTmnA"l1n acquired lesions L-rlU anoxia, infections, tumors, trauma, hemorrhage bLft:::lh:::l-J'lrur'fltlgil::: 40-50 dJU cryptogenic ms 1?I:i''l'"lfl~ulyjvh~l-J'fl-llu~tl')tJn~l-Jn9:::'I''luin'lfru:::fl,)'ll-Jtlt'1unML'U'I'I'l:::lStJn1'l hyps-arrhythmia A'fl:win'lfru:::ti:Jw disorganized pattern, bilateral asynchrony with high voltage slow wave LLfI::: multi-focal epileptiform

discharges

'I"ltnn:l'ru1tflhj~

2.2.2. Lennox-Gastaut syndrome 'fI'ln1ri'mimnt'11w'll,)~'fl'ltJ 1-10 tl tJthtlJJn9::::W

, "

~{?~U'ln1ttlWltJnMltT'BiJ~M'l1ryry'l L~'fll-Jf'l~ 5n'lfru:::'B'ln1rin"l:::~mnmLU1J t'llu atypical absence, generalized tonic clonic seizure, atonic seizure (drop attack), focal motor seizure bilwilu n1tmt'l"lfl~wlyjYh~u'fl~"l:::'I"l1J in'lfru:::L'U'I'I'l:::M'fl 1-2.5 Hz slow spike and slow wave complexes tU"lIru:::~ult1'B "run of rapid spikes" lu"lIru:::

U'Bu",5u

2.2.3. Epilepsy with myoclonic-astatic seizures LnMlu~thm~n9wn~'fl'l~ 9 "lJ')U 'flln11

-nn'"l:::ut:::n'elU&l1tJ myoclonic jerk LL~::: astatic seizure (drop attack) n1~(.Y1~,)9fl~wlyjvh~u'fl~9:::'I"lu5n'jj'ru::: generalized spikes and slow wave LLf'l:::'B1"l:W photosensitive response

2.2.4. Epilepsy with myoclonic absences JJm:::LnAlu1'm~n~t1'.ltJ9:::ilinmt-nmLu1J absence f'll-Jnu myoclonic jerk

2.3. Symptomatic

2.3.1. Early myoclonic encephalopathy ~t1'ltJtun~l.Inihnn1~in~iULLN n1:i'in~l.ILn~

~'lLLtIi'll')~'fl'1~ 1-3 L~tJU tmJ~tl')tJ"l:::~'fl'lm:l'-nnLLUu myoclonus (fragmentary or partial erranc), massive body myoclonus bbfl::: tonic spasms m1f11,)9fl~ulyjYh~j.J'fl~"l:::'I'Iu§n'lfrw:::L'1l.'I"l'l:::A'B repetitive generalized bursts of high voltage slow wave with spikes U1UVlfl'ltJ1t.I1Yl'l1iunu bursts suppression ~tl')tJ"l:::ilfl,)1l-JWC'ltJnWi'V11'1 'l1l-J'El..:! LLf'l:::~M'l1ryry'l m1'1"ltnmru1rfl hj~

9

3. Epilepsies and syndromes un-determined whether focal or generalized

3.1. With both generalized and focal seizures

3.1.1. Neonatal seizures

3.1.2 Severe myoclonic in infancy

3.1 .3 Epilepsy'Nlth conbnua..JS spike-v'vave actMtyduring 9oN-wave sleep

3.1.4. Acquired epileptic aphasia (Landau-Ktettner syndrome)

~u1Kl'Wbfln'£l1~1 4-8 11 t(mJ~u'1u'"l:::i1n'1~~1f1'E1tJ'lJ'£l-l~W-.Juln1~'Vll-lm~YlC'lbbi1:::il1111 '£l1n1~-nn

,;!" "

"'I:::i16nl1ru:::b1J'WbbUU myoclonic jerking bbi1::: brief absence-like mj'Mj''1'''1f1~'W1yHh~}'/'£l-lq:::~u6n1!!"ru::: spikes U1b'1ru left temporal lobe

4. Special syndromes

4.1. Situation-related seizures

4.1.1. Febrile seizures

4.1.2. Seizures occurring only with acute metabolic or toxic event

10

.q

'UVlVl 3

u U1'V11~n1i~u ~UbirJb UeJ{h!lbirJ'cUJi'n

cu

lumr';'HJ.<:jitJ'fllOlT-nnttil:::mT"httumJT:::bl1l'1'llil-llrf'lm.,J-nn il1MmJT:::1m.tbil:::n11(ilj'':l<:jil-l0l8tUu~hf'T0J bdil-l'"llniltl1-lmru~e'1th8~1l~ltln11nr'llblJ:::-nnhn#i ~'hil1"hji1e'1b~U~~1tl0l1nr~1"'h..h:::1ili1~~h'iil'lh:::nil1Jfi'lJOlT

'\I':' 'lJ '1.

-nnbuub~tWe)1n1tLLf'lrl-l'llil-lf'l,}1~~l7Itln~'lIil-lfWil-l~-lffil-lmf'l1blt(.'J r;-l,rU~-llJf'l'Jl~~1LtluAil-l~tl;r'W1tf'l#i,)tJ1fi~

b mJ1:::f'l~ t'i11JOlmtl '(1 e..Jil m1~tlAu mil-l~"1 fblJ1 i'J~ n'lJil1 n1t1'l1-l AilUn#i':l8 L~~il A'J1~d.:j~b1Jlumt~'lJ;rulj'A~uil~ntlil1n1j'1'I1..:jA~Un'llil..:j~tJ'JtJbtlu~~n ~tJ')tJ~-nnAf-lbLmA,)11M'lJn1j' ri..:jIllT')"HYiil~lf'llblt(.'J bdil-l<:j1nmj'-nflf'lf-lbbmil1"btluilln1nbM..:jblltJ'lJ'I'H~'U'llil-lhf'l (acute symptomatic seizure) ~-l~ 1 dJUMil\l1 ~mj'fmn b'i:!'W'l:::~ bi-l ~lU 1 urij'ru~tl t::::-wihJ-nA L <:jU~ 1 LfltJ bUU hl"lil~-nn~'lJiilUlt1il 11.J l~~il WijilU

~

bil".J-nnA1-lbbTn

rl?l"tl';l~~'H;fI;um'i~'lJA'Wt'Jf'l fli'el

1) b~il'liltJn1T1U~itJilln1ri'mbil::::hf'lil~-nn

2) bYiil'llltJ~1bbUn'llUrI'llil-lil'ln1ri'mbil:::'iiUrl'llil-llj'l"lil~-nn (seizure type and epileptic syndrome) t'J~ D~n1j''lJiln'1r1n1bUA'lIil'.mlt-nn (seizure focus)

,

d .dI !V IV

3) L'Wilf'lUAUt.11f'llLlt(.'J'lIil\lil1mrnn

4) b~il~r1(il1~mtW1bUuhl"lbbil::::Wiln1tfntn

n1';1~'lJA'IJ~1bb'Wmtl'W 3 'l.l'i~bIlVlliuri

1) n1TlIIT,)<:jl'l1-lt\il-ltlBtlAmt biu mt~bl"ln:::'!fb~ilrl Lbfl:::~'l1'l1trUlt~-l

2) n1tlllt')<:jmtJm'W'lIil~f'l~il\llAtJf-l~'il'VltJ1 b'li'W CT, MRI

3) n1tlllt'J<:jmj'l11~lU'llil-lf'l~il-l b'llU EEG, SPECT, PET '1il"1 nl'iUl';l'l"lVl1~tr'el-ltlDU;m'i

nl1ri-l1llj',)"l f'T i?lnTiI-l'VI1.:j,xil-ltlB'IJ'imj'~ltlftl ~lbtJ~iJilln1t-nn 1i?1tJ~,) 1tltlj':::nil'IJ~')tJ CBC, blood sugar, serum electrolytes, BUN, creatinine bLil:::: calcium lUtll-lntruil19i'l-lIllj',)"l serum magnesium bbfl::: toxicology screening ~hei8l'm~ilmhlllj',)91111~bLMn:Hil ~thtJ~~J.J~nLtI'Wtlj':::~l hJiflnM'JLu'Wtlnmbilm'Jfll'W,),W 'IJ~..jmj'in t.11illJlj'f') m')::::nAtln~~'W 1 i')~#i')tJ b'llU hl"lMU lrfl1~ hflL~'ElA trfl~:::Lr-l m':l:::.lJiJ~~n'Wun'{'liil\l Luuffu f'l')j'vhlnlJ1t'i-lI?l:i',)"lAl7lntil~ 1u1'l1-l(llNnU'Ih~ e'1tJ')tJhli'ltmin~1lJl#i~J.J~nbtl'Wtlj':::~1 iln1~~u~~~'IJ~-l

" ,

mj'-nn LLfl:::llJlJtlj':::-wit.11ilillmj'1'I1-lA~Un~U~~-l~tJ~1iJli'I'J1~~i?ltln~'Vl1-l metabolism bb'(1::: toxicology ill<:jllJ~1

LU'Wth'il-lI.'1-l1llj'')9 f'T i?lntil-l11711

ms 1?l';l1 "I J11"l1 iu'VI;.::I

"

.e.,.. Qo..::!l..:!.l <V

~.:j ~ W11':l:::: (II i?I b 'I!illt rsrn j'1) n b f'ltl'llil..j~ ~il.:j

~-l ~tJm,)::::L~iI i?lilil n 1 u'llil-l b~il~~f'l~il-l

II

bwWin~fJ1~mtln~'l 1 tJ ~nHiVif1l~U'1EJ~ immunocompromised ~~'l~'lWI~'lI'f)-:)m:ii"nhM1J f1'l~Yi"l'l~ru'l 11l~'1ColJlhiu~5-:) L~'f)-:)Col'ln'f)'ln'l~"Vl'l-:)f1f'iilmrnlJ.JfML"lWbU:i'::tI:;ltm'll'f)-:)n'l~~Ml~'f)'lI'f)-:):i':::1JU1h::~'lVl

n'l';J!?1'a'dCol Fl~'Ul ,..jYh~1-liN (Electroencephalography, EEG)

tl~::bU'll,r'1J'f)-:)n'l:i'l7l:i''lColFl~'I.llyh'h~:w'f)-:) lJiwi

1) ~,r1J ~'\{'I.ln'l :i''5ilCol,ruhf1~'U.Jfn 1d'f)~1JFl'1'l:we1 M'!Jn ~'1J'f)-:)f1~'I.lll'l~ 'l~3.J'f)-:)~Y'l1Jb'l.l~1J'JUbrA'M./in

(epileptiform discharges)

2) ~'llb'l.ln'jjilM'lI'f)-:)n'lrln (seizure type) bb~::n~3.Jb~fll."13.Jfn (epileptic syndrome)

3) U'f)n~'lbbVlu-:),~n'llv'~n'l~in (seizure focus)

Fl 'l11-11 '1 11 ~ :::Fl'l1 1-141 b 'W1:::"ll'fl-!l EEG (sensitivity 11 ~::: specificity)

, ..-

n'l~l7lf'1"lfl~'I.l1l'l~1~:W'f)-:)bfitNf1f-:)1~mm'f)n1~Y'l1J epileptiform discharges tJ~::3.J'lru r'f)U~:: 50 (l'l.l

1ciinmfJn'lMflJf1'1'l3.J~M'!Jn~1~tJ'EltJO"j'l)mnl?lf'1Col 3-4 Plf-:) "l::m'f)n'lfl'V'lUA'113.JtilPlUn~rM~::: 80-90 n1fl?lf'J"I3.J'ln

" . "

n1'lt1"1::1Jil.h:::btl"ll,rbYi:W~'Ubi'ltJ-1b~nUfJtJ b'l.lf1'1.l'!Jntl'f)'l"l'V'lU epileptiform discharge l&i:YelU~::: 1.8 - 4 (specificity

l.h::::Wlrur'f)tI~::: 96 b11."1::: sensitivity '!Jf:::W1rur'llUI."1:: 50) mn~:Wn'lm~::~'I.ll'1.l"JIru::mm1M1'1"l (activation procedure)

.

b'll'l.l eye closure, hyperventilation, photic stimulation, sleep deprivation, sleep recording rnn-w:w specific

electrodes 1t.!~11mti-:)'~h""ti' b'll'l.l zygomatic lead. foramen ovate lead n'ln~m::U::b'11."111'1.lm111l1'1"111~:::n'l~ ci1um'V'li)~t'f)'lIrunhn'l111l:i''1'''lPl~'UlvJvh~:Wil..j (prolonged video-monitored EEG recording) "l::b~3.Jf1'1'l3.J1'1b'U m:i'I?l:i''l''l'V'l1JA'1'l:wti~'!Jntlmn;'U A'11~-:)I1l:i''l'''lA~'UlvJfh~3.Jil-:)~5..jn'l1inhj'U'l'U tMtJ1>tl'V'l'l:::b'l.l'll'J-l 24 -B''1b:W-:)blTn

~ ~""'t - .1 "'" .\'

VI~..jm1'lln "'l:::W 'f)n'l~'V'l1Jf1'1'l:Wj:..JlPllJntm.J'ln'JJ'I.l

n1'al?l'a'1'"l n1t1m'W"ll'fl~'ll:W'fl-:) 1lPltl~~M'VI!J1

"llPlU'J:::~-:) rlb~'f)~'I.l~'l~'l bVll>l"JI'f)..j'f)'l n11fnlt1eJ t1Pl~tlin M RI "l:::nfm:wl '1 bb~::A'n3.J~'ll'V'l'l:: bum 'JM1'1"l ~'I.l:W1n

, .

n~'l CT scan blPltJ1'UY'l'l:::teltlb'JPl~n'll'U'l(?lb~nU'l..j'llv'lPl 1J'l-:)~'lbtVIU-:) b"ll'l.l mesial temporal sclerosis, cortical dysplasia, tumor bU temporal lobe bb~:: posterior fossa A'l1lJd-:)~'J'Ut'l.lm1i'1-:)(9l1'1"11iiYi"'l'l'Jru'l~lhmTIuntru.hJ

-n'ellj.,'JiL t.!n1i'li,m:J'l"l

1. 1J.JVl:i'11J~'lbVl~'1l'f)-:)n1~in

2. hPlI."13.Jin'jju~ partial onset

3. 'll'ln1'Jfmj3.Jb'l.l'rtJ~m\l

4. bulJU'1tJ~n A'J'llJe1lPlUn Wi'Vl'l-:)~::1J'lJ'!J 1::~'l'Vl~iJ..'llJ.JVl n'lJ ~'l b VlI?l

~ ,

5. hAgwin~ltil'l'f)1J~'U'f)-:)wi'f)n'l~fnti'1 (intractable epilepsy)

6. A~'1"lU:i'::bij'Ub~'El b(?i1U:Wn1~r.J'l f9i lPl

i'fl;i"ll'fl..'ln1'a'li~A'a'1'"l CT scan

2. f1Pl'l~nn1'lbb~::'J'1lPlbr'1n11

4. ilPl'1'l3.Jl'11'1.ln1~l>l~'J"Im'J:::1~'f)lPlil'f)m~tlUY'l~'I.l

-n'el;i"ll'fl..'ln1';Jgj..'ll?l'a'1'"l MRI

2. 1?l1'1"1'\.t'l1'EluhPll'1.l~'lb1'Vlti..'l temporal lobe

12

..d

tJVIVI 4

n1'i1il~'ii'!Ju!ln b'ifl~:JJ~n~1nll1'l~~'U ~

~1'i1-3-¥l 2 n*"l'enm'ibV~::;1I101'i~~~W1-3"l111-3hFl'Gl~"lln

(Main categories of episodic symptoms that may caused by epilepsy)

• Loss of awareness

• Generalized convulsive movements

• Drop attacks

• Transient focal motor attacks

• Transient focal sensory attacks

• Facial muscle and eye movements

• Psychic experiences

• Aggressive or vocal outbursts

• Episodic phenomena in sleep

• Prolonged confusional state

tl1n1111l1-31 ~-3nci1~tl')"nJ1"l1 n br1~'W11~ ~'IiJr1'l1l-!~1 ~tlUMtl-3 uu ntl 1 n11F.:j ~U n M1Il1-31 ~U 1. 'el1m'ibU'W'Gl~ (Syncope)

btl 'Wfl') ~ :::~l'ltJ tJ 'B u bnJri"l1 n bfltl Jri 1u bitJ'If1 aJtl-31lJ l'ltl ejlJ~tJ~ n iJtl 1 fl11"JJ ru:::'Gl n~ 'WU'W'B th'l1~ Jrib ht-'lTtlU'W

~ ,

'W')'W11~m'il'V'l1:::1'W.rm::;~iJn11'lJtJ1tJi7l'l'lJtl'l'lMl'fl~bfltl~~~'Wtl'Gl1tJ (peripheral vasodilatation) i'JaJ~'ltJ ~'ll'W tl~1u~

'fl1n1f1Ttl'W r1~1aJbr11tJ~V11'1tl,)1l-!nr A'l1m~Ulh~ mfH~btl'Glntl~'B6~Ttln111-ntJ1~iJ~V1jf'lJtntJtH'I'tlM~~'B~~'l'U Ufl1tJ 1~tJ~lJ~tJ~niJ'B1n1f~'Ib?ltJ'W WU1n~ b9K'W m''tl~b(?ln (autonomic symptoms) ,hmri'BUm1mJ(1Jf1~ 1'U'!J1-3

, ,

f1tJ'tl1"1iJtl1mftn1-'Inf:::(;m'lJru:::Ylt-1aJM~M (convulsive syncope) m1i)u"lim~tJn"l1n'fnm1'in #j',wnn.'1Yl 3

13

..; n~"a7UlOllltJtt8n"a2::VI~1~'tI1n1"ati),.J~:lJbb~:::mn1'i-nn
m'i1~'Vl 3
Features Syncope Seizure
Relation to posture Common No
Time of day Diurnal Diurnal or nocturnal
Skin color Pallor Cyanosis or normal
Aura or premonitory symptoms Long Brief
Convulsion Rare Common
Injury Rare Common(with convulsive seizures)
Urinary incontinence Rare Common
Post- ictal confusion Rare Common
Post-ictal headache No Common
Focal neurological signs No Occasional
Cardiovascular signs Common No
Abnormal EEG Rare Common ~ "I "I a . ... 1" ....::"1

2. 111'J2::n~tJVl1tJ blOl btJb~n (Breath holding spell) bn~b'ilYn~ 'WbM'tl'ltJ 6 b~'tl'WtN 5 u

~'lbb'Wmu'W 2 th~IJlVl WI~n

2.1. Cyanotic breath holding spell

bii~b~-eJb~nrlmi~1"l~1'flbn~l'l'la.m6~r1n~~1'fln'fl'ln.Jrw1m'j) b~md'fl~bttmn bbf:ltni'WmtJ1"l"l'WWI'lb;JtJ'l

" " .

Lnf~ 'fl1"lil'tl1mrn:i':::~n~'ltJ U'l~f1'W'tl'l9'1..jj.j~Ii'1~~'lfli ~~~9'lmr'W9tn~iJa.J'lmtJ1"ltJn~

2.2. Pallid breath holding spell ~mnA~'Wb~iH~nb~fiJfI'J'la.JL~iJtJ'lti1'flth'lb~tJiJ'V'1~'W ~1'flrlfi19L~n

~n"l:::baJr'tl~bttbLri9:::~idnti1 ni'W~'ltJ19 Lbf:l:::W1'l'fi'fl'Wti~ LrtJnhjwaiJli'1t.!'tl~ 'fl'l9iJ,r'l1"l~~~bt1ft.!t.!'lt.!'laJ~~'W1Vi (mn bn'W 8 ~t.!'lVi9:::il'fl'ln15'tnf~n:i':::"ln1~) "l'lmr'W"l:::n6iJa.J'lbU'lnJn&1

3. 111'J~t~'tIA'1.Ub~tJ~'6'l:IJll-31aJ'W'tI-t'J"lItu~(Transient ischemic attack or TIA)

~ ,

~ll'ltJ~na.J'lJl'ltJ inm5'tL'lIt.!'lI'l'ei'fl'WbbN ~1'fl'l!1 ~~b~tJt.!il1:n~·::: fb'W1~qjil'tl'ln1nut.!i'W1 bLriba.Jbn'W 24 i'lla.J~ ~t1'ltJ

~niJif"l4'tJb~tJ~'lI'fl~'i::r~mfl'flAb~'flAli'1lJ'fl'l1'la.JJl'JtJ~lhtJn~j..!~a.J'lJl'JtJ'tl'lm:i''l!'lLut.!~n1 ~'lbU'W~'a~bbtJn"l'ln'a'ln'lrin 4. 111'Jt,r'J"l.9tl[ilunii (Cardiac disorders)

[l1'J:::~Atln~'lI'tl\l,r'J19 iJt.Jfl1ttL~'fl[ilhJb~'1J~Ii'1j..!'tl'l'laJb.wtl'l'V'1'fl bti'fl~"l'lniJn1mJ~t1'Lmtlfl'l'll'fl~ cardiac output 'tl19 1'h1~eYl.htJbU'l.Jmm~'a'a'l"lbnA'a'lm:i''li'mr'lrl'l1Jl b'llW1'l'J:::,r'l19b~'WtlAt.lnM (arrhythmia, transient complete

"

heart block prolonged OT interval), valvular heart diseases bU'W~'l.J m:rlil:r'l911~n1t1'lJ'a'l:i':::iJ1J,r'l1"l'tlth~

fl:::b~tlA m:i'lil:i''l9rlbli'lli L"l1'W EKG monitoring bbfl::: echocardiography ~'la.J'l:i'r1'll'ltl1'Wm:i'7119itlbJl

5. Transient global amnesia

~ll'l tliJ'fl'lfi1:r~ry bfltJ fl'l1a.J9'l1l'Wii cl'lt.!hqj bU'l.J'l.J1t.!~fl'ltl~'llj..!~ ~1'1l bUWJt.! lC'ltJ1aJ'Y'liJ A'l'l~f1 A1JnmVl'l~ :r:::iJiJ

,II j.o'

t.I:i':::fl'lVl"eH.h~~'l.J1'la.J~7tJMia.J'il1mrt:1~n'V'1tJ1'l.Jfl'l.JIi'1~'a'l~lbbfl:::~n111bnA-n'l m:i'A:r'l"lflfl'Wb~Vhli'1l.J'tl'l1~t.Jflt.ln~ ~'tl~

. " ~

bLtln"l'ln"el1n'lrimuAnon-convulsive n1:i'A:r'l9fl~'Wfla.J'fl~~n'V'11J epileptiform discharge

14

6. n1'~U1iP1~'i~:m1J'uhnn"'1'U (Migraine) lJl-l"i!il.~'fI1"L.t'l~'l'fl1m1iPl~1U'fI1n11in L'liU

Classical migraine ~lhtJJYm:;:il'fl1n11e:imJn11il'l1-l1:;:lJUlh:;:~1l'lbn~~'UiPl1a..J~'JtJ'fI1n1nb~~:i'Jj:::"L'ti'W b~'W"l~bb~-l ~~1-l ~1'f1bb~'l~U'J1lJ(SCintillation) b{hJbb~-l~bthJbA'W1(fortification spectra) ~1'f1iP11Y1i1 M1JY') M1a..J'el-lltli~bil.Yn:;:~ (scotoma) ~-l'fl1 rn1b~~1~Wi'fl-l uu nvm 'fI1 n110DnbblJlJ partial seizure b~U~nljru:;:n1n.J'fI-l b~'Wbb~-ll'U~lbu b:i'iPl~a..J inJYn"ltbU'Wu1'b'1ruiPINMl1'l(centrally localized)'l'W'lIru:;:~~t.l'JU migraine "l:::b~Ubb~-lu1'mlJ1f)lJl(peripherally localized) lhilll1:;:1MiPl1'fllJMf'1bU'W migraine "l:;:'li'Ju~Uu~t2u'lwm1'lil."lt[umm:i'll'J~r1:i'lj:;:bbulJla..JLnm

7. Physiologic or nocturnal myoclonus

'fl1n1:i'bb~A\I~'fIbb"llU~1m!1n:r:;:liJn"llru:;:blPl~a..J~~lJ bbr;l"l:;:ltlbnA'lIru:;:mu ~1I'1U"l:;:ltlihl1n1nn~-l~Allnm~1'f1~Ug>1w"m.J l.J1 1"ol~'Ug>1l-J'fI"llnA

8. Movement disorders

~1I'1u~m~,)U'fI1n1niPl~'fIul~1wAlln~ 'el1"l&l'fl'lbbUn"l1n'fl1n11in 8.1 Hemi-facial spasm

8.2 Tics

8.3 Tourette's syndrome

8.4 Tonic spasms of multiple sclerosis 8.5 Subcortical myoclonus

'fi1 rn 1l'l1-l iPliiun b ~tJ"'fIth-l b~mf)1"l bbuntJ1nr~1 nm n11in M'fI-l'fl1~U nl1-nnll :i':;:1AbAU~:::; b:aU A bb~:;:~-l bnA

6 nljru:::n11bM ~'fIU 1 W}~e:i All n Wi ~'1 a..J ~ '1U th'u 'l ~ rY bb~ '1 n 1 nl"ol ~'fIU 1",'J ~All n AJY n"l :;:YllJ~'Jl.J nmn n11~Ul~ bUU

~n1.:tru:::b'UYI1:;:"lI'f1-lhm . .,1'f1illl1:;:1M'VI1-l~U~n:r1l.J~"l:::'li'Ju'l'Un1:i''lU''l'Yltl

9. Metabolic disorders iPl,)1l.JwA1inWil'l1-lba..JA1lJ'fIiin~ft1u"i!ut'lil'fl1m:i'I"ol~1tlim'li'U

9.1 m'l;:;'th~n~i.'LHll'fliPIe.JiPlun9i( Hypoglycemia I hyperglycemia) 'fI1"l"'1'l~bn(PJ'e:nn1:i'~u~u~T'fIm..JAg>1WilJi-rh:i':;:(?}lJJ1M1~~1~1I')uJYnil autonomic symptoms Ula..J1ri'elU lCi1bbri l~n ih 'l"liu b~1'flUMn ?-lb'lUU ~i.htJ~

9.2 Hypokalemia I hyperkalemia

" , ..

'fI1"ll11b'!.\bnA 'ellm1n~1a..JbU'fl'!i'flU~bN (Periodic paralysis ) t~UVi'flln1:i'''l:;:ri'eltJ1bUUmn~u bb~:::f)1"l'el~U1UbtiU

~'1bl.J-l~~'fI1''UJl1'J:;:e'fl1''lYlU~'1l.JnlJbtAI'h\l1 L'liU hyperthyroidism, hyper-aldosteronism ,renal tubular acidosis. bUUflU

9.3 Hyponatremia I hypernatremia "'1 'l'!.\ ilnlnll~£JUbbll~\I:r:::(?}UA'11a..Jl0lmlJf

9.4 Hypocalcemia I hypomagnesemia 'fll"la..J1Ci1'1U'fl1n1:i' tetany (peripheral twitching) ~-l1"ol~1U

simple motor seizure 1~

10. Psychogenic disorders

10.1 Pseudoseizure ~1.huJYnl.J1Ci1')tJ'1l1n112 6n1.:tru:;:A'fl

• 'fl1n1nn~"n:r:::"Jn (attacks involving motor phenomena)

• 'fI1n1m'fluU'l1tlAfllJg>1'W'fI-l (attacks of lying motionless)

ill"ol'11a..Jbb~nc;h-l"l1n'el1m1inA'fI 6nljru:::'filn1:i'ifm:;:rifl£Jl~U'U. rel1mntlu1mul, f11n1nnl.m:r:::rjnbb(;jft:;:l"olf'l'fl1"l ltl mtJ'fl'Wnu (non-stereotyped). ~1I')tl'tl1"l"ldl'el1 n1nn~\llCi1u1Ul bAU ltl J:JfI 1 rn tM'J b~m, JYn ltlilKu(PJn u~1'el rns

15

1J1~~~1J~n~~'W'1lrutm~1n~~I:'l::;arn1ti~'fi')n'l~~1J~'WlH:r,.'jinrl'1).m1.m~M~'l"li'1,.'jmu'VI'1,.'j~t1J1J'I.h::;~'1'11~~l:'ltn'l~M~'l"l f'l~'W1~';h~~'el,.'jhJ'V'j1Jf'l'l'1~1.lMt.lnA1~1~1~f1Jt'1UI:'l:;L~UALL'W'l'l1'1,.'jn'lj~il9'i1'tJutJnronnrel1n1t-nn ~,.'j1'Wt'm'1,.'j~ 4

~ ..c:IIo.Q..... • cv
(1)1'i'N'YI 4 n1'i'J'WIOl-UtiLt!Jn Pseudo-seizure r.nnilln1'i'iln

Epileptic attack Pseudo-seizure
Stereotypy of attack Usually stereotyped May be variable
Diurnal variation Nocturnal or daytime Daytime
Injury Can occur with tonic-clonic seizures Rare
Tongue biting Can occur with Rare
tonic-clonic seizures
Urinary incontinence Frequent Rare
Motor activity Automatisms or coordinated Prolonged, uncoordinated.tonic-
clonic pelvic thrusting
Post-ictal confusion Common Rare
Relation to medication Usually related Unrelated to changes
Inter-ictal EEG Frequently abnormal Normal
Ictal-EEG Abnormal Normal
Presence of secondary gain Uncommon Common
Psychiatric disturbance Uncommon Common 10.2 Hyperventilation syndrome

~'el1mjklAC)J~'il 1-1'elU1-11t11"l LT'l LLj,.'j "Jj1rl1~!l'il L~1 il'il9Wnf-l l~nmtJt9hJ~~ nt::;'lUMt'l1t1 ~,.'jL~tJ'W~5''M':: 1-1U1!lMdhun.)1u1Jl~j1mh'W1~qj~thtJ6~i~nlA''Jr:~1mjnfuimt'Jn1jru1~ LL(;]'el1"l1tiH'fl~rl'elU~'W'il,.'j(;]'il~,.'jLL'lA~'8).j 1 0.3 Panic attacks

'1lru:;Ln~fl1n1t~lhtJarn"l::;i1'il1~).jnrn«'l.W:i1~'lrln. 1"li'W. mtJ19-nmLt'lt'81"li1 hyperventilation i'l~~'ltJ mrnr

Ln M 1~411L~tI~U1,.'jf'lf'i'81"l1tiilil"lr.rtJnt::;:~u1~ L9'W ~thtJ6,.'j~ n 1A''l Ct1'1l rutLn (Pl'ell ms complex partial seizure

10.4 Psychosis

'elln1j~1r-1t1!~fii''el~LLtJn''l1n'81mj"Jln"JjilA complex partial At) hallucinations LLt'l:: delusions ~'i'f11n1j1u

. .

psychosis arn9::il6n'l!trutiu-n'el'W ~lLil'WL1'fl,.'jj1'l(;]flLU'el'i LLt'l::;LtlUj::;tJtL'Jt'l1'W'1'Wn~1. ~tJt:ltJarn"ltilfl1n1t~'J1A

j:;LL'J,.'j~i'flilfl1j).jnmAt.lnWiL~'WfA'8~Wlt'l'el~mn

11. Sleep disorder

11.1. Narcolepsy

~u 'ltJ'el19"l ::;il'el1 mt~'J'iU'el'W11'WVh1'W1A L"ltJ1aJ ~1).j1jmtr1J1~ Vi 11 ~\ii A m j~1.h,ii~ n~1'eli a.Jfl~ 'fl1n1j'eh1ULLN~,.'jIA''JLnA~'W LnA~'W'lIru:;'fl1ja.JnrLtl~tI'WLLtJt'l,.'j L..n'W 'lIuiu. bMfi1-1r'elt'ln19 (cataplexy)

16

11.2. Non-REM parasomnias (Night terrors and sleep walking)

~n'l"l'!.JtuL~n lL~:;:il1IOjj'jUj':::.wi·el')n1j'~,mkdhJA:r'flUl'lf'l b~~~L~nlOj:::j'j'fl1n1r~:::Ll.J'fl1 mut'um1tl~11\.~1Jmu tl1n1j' IOj:::Ln~1U'Ji1~ slow-wave sleep b~~ ~n"ItlrhJ'WTw~fl'1~U'1Vl bbMhhnu 411bl.J-:J j'jiflOj4'8inin'l~wi 1'l1'1l.JL1'l1~~ ~1tln11 uJ~tl'Wm(llU~U'fl'W n~l.Jtl'1n11~~Mh1I'l'JnLtlnlOj'1n partial seizure L"lIU nocturnal frontal lobe epilepsy

11.3, Obstructive sleep apnea

~tl'lmrnii'8'1n'11~IN~1tl~~1Jmnlub'Jil'1nfl'1.,'j1u. ii~tj~~'1~1IOjbuu<d'l~1 1:;:wi'1~n'1:rutl'W~~'!.JU%'l:;:'allOjiimr n1:::~1Jn:r:::rl'18'lJru:;:'W'a'W~~1J~~fl~'1811'!.J nocturnal epilepsy lJl

11.4. Restless leg syndrome

~tl'J8ii rmfufl'J'1l.J!~ ne:i AU nUl~'lJTvh 1 ,x~'fl.,'j1l6'!.J'lJ'1",1'a Lfl~'flul ~'ltl~M%'ltl~ b'J%'l'1 'lJru:;:,i-:J~1'flutlU'W'1'W1 th'Wlm\!

...! ~ • ..- .t '1

tl'1mr"'l:::b1l.JM-lLbM'J8Ml'1~fl'W1I'W U

17

I .c:I!II

tJ'Vl'Vl 5

I V

n1'ifn ~1bb sem '3 (P)'iiJ~ b vhJ b ~ all'U erih tI~ n fl f~ usn

<u

n'1rinA¥~um1'W~~"nrmo~ ~th8ilmrnnLU'WA¥~mn1'W'liIjWlt(rl8~§n~ru:::lIil~n1rnnil')r.;"'l:::LU'WLLtJtJ1(r1ri L~ il1"'liln1rinA¥~ b~8':lvf;'ilVi~,)8 A¥~ 1 'W'rl')~ L,)~,) L~mn'W~tJ,)8~ ') bU'W~il~IjU"'l.[8 uun trAr.;1 nm,):::A518-TI n~'W1 ~~ LA' n~1,)lJ') U 5':1 1 'WtJl'l~ 4 bri'fl LLt,nr.;~1 LU'Wil1mrinr.;1~ A':Ir"'l:::~'fl~Vi1~1 LVi"J"ll'fl~ rn nn t~8mr~tJl'1'WWll:W~ n~l,) Wl'WtJl'l~ 3

~1bv!91",in"lJ'fl':1n1~i'nl"l.f,:m~n~1LL'WnLA'Lil'W 2 n~:wiK~d (LLeJWliJ~ 2)

. . "

1. Provoked seizure: Vim80~n1nn~bn(rl"'l')nih4'w;h~1 ~ileJm111'\ seizure threshold 1I'fl~~lh8~(rI~~.r':lAn':l LA'wi

alcohol Vi1il drug withdrawal

~1LVi"J'VI1-lL:W()lltJ'fl~n L-n'W hypoglycemia, hyperglycemia, hyponatremia, hypocalcemia tJ1n~:w benzodiazepine LL~:::WUL~~~(rI L-n'W amphetamine, CNS stimulant

Eclampsia

nlrtJl~L'~tJlI'e1~~r~:::

n1rAAl~il1'W~:Wil~tL~:::L~'fl~:W~l.I'fl.:j

in~ru:::n1rinJYnr.;:::LU'WLL1J1J generalized tonic clonic seizure LLft:::'i:'e1n1~'lIil.m1nnAn'uin41 1'W~tl':l8n~l.Inr.;:::~1 nlVi~m~8~if"'l4'8iK-lmil'J.jh~~'WLA'

" .

2. Unprovoked seizure: Vi:W180~ 'fllmrin~LnA;'Wt~8hJilil ... 4'8im11mL~tI':I.jf'fl.:j ~~n1rin1'Wn~l.Idci'J'WVI~.:j"'l:::

'i.-t;l to- 'i-o'

LU'Wn1rinAf.:jLlrn1l'fl~~tl':ltJVlLiJ'W'h-A~l-Jin t'fln1~n1nn~nWnnil1'W~thtJt1iltlr:::mruf'e18~::: 50

mm8n~1.htl~~~'fl~n~l.Id 'fl1~tJtlr:::t)ALL~:::n1rMr'J"'lr,)~n1tJLil'WViin n1rMr'J"'lL~:WLA:W'VIl~"'tl~tlDu'1in1r L~'flVilA':Il~,m(rltlnA'Vll~L:WWlltJtl~n'fll"'l'lh81'Wn1rljilr.;.[m-n'W n1rmr':l"'Vll~ltYl~ (Toxicology screening) L"il'Wtll

, '" ii' I

Vi1'fl~1nt1~~AVlilmH,iil seizure threshold n1rt'lr':l'9'1l1111~'WVifr~mrut1~~8n1tA(rIL~'El1'WL~tlt!:W~l-J'fl~ (tJl'l1l3)

m~9li'J'"I b ~ l.I b~hJ 'VI1\1,x'fl \ltl D'IJ"i mi-&q,,,,fu ~tb~ un "provoked seizu re

1. n1i(;1'3':l'"lA~'W1'V'1'rh~l.I'fl\l (EEG): nl~tJ epileptiform discharge "'lnn1t9lr,)'9A~ulv.jfh~l.Iil~ t'Elmt1L~tJ-l ritlnl'j'in~lMn~1~tJ,)8~ijA~u1vHht1:W'tl-ltlnA '9:::ijeJ~ri'fln1t~~i'lu1 ... 1umn'jl-l8lriuin

" ~

2. Neuroimaging: ~tl':l8n~lJ~ijnltimLtJtJ focal Vi1tl9l~':I ... il~n1tJr:::tJtJtl~:::~1'V1VitJA,)1lJ~~tln~ JYnijt11m9l'lJ-eJ~

~ . .

n1tin"'1mtltltrA1u~l.I'fl-lL'1i'W ~-dtl~tln, bK'WL~tl~~~tln[ji, n"lrAA~~il ~~~lblWl1Jl~tlfh.:j~lbilwli'fl\lLA'f1Jn1rfntll

ilth~Yi''Wvi':l.:jVi n1~M11"l'VIl~f~~~il"'liti bA'LLrl CT scan Vi1tl MRI 1.i~ijA,)ll.1~lLil'W1Un1tWl5',)"llt,)~81fi~.f1')~1'W

18

n'aruV1!l.:ihit?i''ij.:it'i.:iI>i'ij€th~t~'ijYhn1'i~'3·l~t~3-H~3J 31~.:iW'ijlt1d 1. ~tb~31n1'3<i'mt'lJ'lJ generalized tonic clonic seizure U'iilt31n1'3~'3'l"'l

~1.:in1~"lJ'ij.:i'32::'lJ'lJtI'3tm1'Y1t1n~ bb~l'IU~1mrfl~~l1J13..1~lJrJtJb~tJhJM'el-3~3..ItJ1nufn 'M1'el~lu~'1oiJ'elmj'w"l1ml1~3..I

~ . ~

tJ'lnufn 'lI'el-3'lJ'VI~ bwib~'ell~~~1I'1tJi1'el1mtfni1bn~~u'M1'elilmntl~tJubbtlt'l-3'l1M'fllmt'M1'eln11At')r.ti1-3n1tJl'Il-3 t:;'lJ'lJtlt:;~1l'1 ~':lrW~11ru1~-3~'el~1I'JtJb~'eln1rl1Jr':lr.tb~l-IL~a.J~'elhJ

~ ... 'I oC:II <:0..00 ,t..c::IiI.q Q tI ""

2. ~u·nJ3.J'ij1n1'i"lfmb'lJ'lJ partial l'l'i.:Jwm VI'a'ij3Jl'l'l13J~W1 nGl"lJ'ij.:in'l'iGl'a"J"'I

i1.:in'ltJ'at'lJ'lJtI'atm1'Y1'i1-3biiVl"'l1n'i'ij!lt'3l'lVl~'ij'V'lmfimm'V'lbrhV1m3J'ij-3'i1.:icl'tl"J~bl'l!lli-r1Jn1'31ih~~3J1ri'ijtl ~-3n~':l1a.J~~t1nmril-3nri1':lM'El-3hJLuua.J1n~u (Non-proqressive brain lesion) n11~~l1J1a.Jfm~n~1I'1tJA'J:i'l11

~

'eltl1-3~'elbrl'El-3bbt'l:::~~1b~HtI mn~1I'JtJiJ'el1mrfni1~A'J1JfJa.JhJ1Ji'M1'eliln1rbtl~£JUmJMn'El-3'El1n11'M1'Elm1l1Jt'1~i1-1

n'ltJ'VI1-3tt'lJ'lJ'I.Jr:::1.'I1l'1 9-3A'l1Wr.tltru1cl-1M'el~tl'ltlb~'elm1l1J1':lr.tb~a.JbAa.J~'el1tJ

~

~ ... '~ G.doClrl Q.I lJ. I il ...

3. ~u':lm(iln'YI3J'ij1m'i"llmb'lJ'lJ partial l'l'i.:ibb'an bb'iil~(il'a'l"'l'i1.:in1!l nOl

4. n1'aW"'l1'aN1t~3Jmnu<i'nLu~tl'ltJV131n1'i<i'nl'l.f.:ibb'in

OJ

'M~nn1nia.J£J1nufn MMVlr.t1rru1n-3t.lt::;btJ1ju~1Ji1un1r~'J1Jf.la.Jn1rlnb(iltJbmtJ'lJbYltl'lJn1Jb'flml.'llun1r

~ .4, <v Q.,o ~ t a.".e- q d Q,.../' I IttJ.t

n1'a'V'l"'l1'iN1b'i3JmOtl"l!MI-3bbl1Jn1'i"llnl'l'i'lbb'a03JO'aNVI'IUI'ij L u

~tl'JtJ~iJn1rimb'lJ'lJ focal ~i1~1b'MMa.Jl'"llntiltlb1~'lUi'la.J'El-3

~ .

~lI'JtI~~'lJ epileptiform discharge 'lUn1rl1J1'1r.tA~u1l'l-Wli'la.J'El1

~1I'1tJ~31A'11a.Jb~tl1~-3~'el~'lJ1ib'l.1~'j,11'el-BUMntlr.tlnn1rfn ~1I':ltl~ilt.l1::;1m'll'el-1t1A'j,11'El~'Jla.J~(iltln~l'Il-3~a.J'el-l b'llU iJtlr:::1mn11~~b~'el'lu~a.J'El~, mril1'eltl brA'lUi'l3..l'el-3r.tlnn111J1t7lb~'lJ'1'I1-3~t1:.t::: bUUMU

~lI'l£J~iJn1rlmb'lJ'lJstatus epilepticus

~

~ U':ltl ~iltl1:;tJM~\..!fim1a.J"l1 n b r~ t'la.Jin

~ ,

n11fmj-l~1I'Jtl1unn1hr'fl-3 provoked seizure tiubiiu~mmm'llu~4'tI~iJ~fl~'fl seizure threshold bilu

", ,

'M5n 1U'lJl1n1ru'fll~H'tI1nu-nnlu'lh-3f,{u1 'lIru:::Ylvhmtfm:l'11l1'l:::'M1renj"l~tJYlvhl-MbnWln11inlu~tl'J£J

u'flm'ln~~U'1tJ~nrltJ~'J1''"l:;M'fl-31MlJ~1bLu:::tnb~tI':ln'lJn11t.l3a.J~tI'l1J1fl"lJru:;~~U':ltllnWl'fl1n'lrfn, ms t.lll'lJ~l1JUb~'el'Mftnt~£J-3U"l4'tI~iJ~~t'l(il seizure threshold lb~:::oiJ'E}~'Jt1:::1'-31umrvi1n"l1'l1J1t.l1:;~'l1'ul~'fl'j,1ftm~tJ-3

,

oflUl1Jtlt1Yl'fl1r.tbnf71'"l1nmrln

19

~ UVlVl 6

• • !I.'

u 'lJ1'V11-:Jn1'ai'n~1bb~~n1'aL91'a'l~b ~3J b~3Jb 'lJrrthtlV1iJtl1n1'acin~1

<U

n1~in~1~hJili1'"1~8im.l1 (Recurrent unprovoked seizure) 'Vn.n8n,m1nn~Lni?l;'W~1 ti?l8hJi1th~8in thll'fl~n1rinfJth~ii?lb'"l'W b'li'W fl1'J~lii~~ mrWii?lb~~1'W~)JfJ~ mLb~~~1rb~'l"iMi?l mJ1ib'l.w1'Vl1~gW'fl~LiI'W~'W

~ , ,

n1i~'"l1iru1b~3J!l1nu-nn (bbtJU,nijVl4)

..

F11~~'"I1rru1b~)J81n'Win;'WfllJtJ'"I4'tJtt~18'1.h~F1'l~ L"ll'W tfJF11t'lb~tJ~1'WF11nni?lF11nnAf~~fJhj 'il1tl LM'Ii

,

J1'W~'IJfJ~AUHi Lb~tf,Jflmt'VllJ'IJ'fl~F11rLnl11n1rinA¥~!ii'elhl ti?lm~')'bJA'lr~)Jmn'Wimrl'ai1 un-provoke seizure )J1n

<-

n~1 1 flf~ tlm~'UJl1')~inu1~tlr~lJl'Vl L'Ii'W mrin"1!tl.i?l benign rolandic epilepsy (benign childhood epilepsy

with centro-temporal spike, BECT). Childhood epilepsy with occipital paroxysms ~il'fl1mrimni?li'WhhJ'el8 LW:;:F11rimtl.i?l-d~m~mtlL'fI~1co'lL~'ab~nb.jh~.r8t'W

'VI';nmib~)JtnnU-dn bV"'::i1!.1~:aiitJ[il"ll'fl~mnu-nn"liu~u;h~ "1 ('l.JVlvi 9)

20

• .c:iI

1JVIVI 7

u 'lJ'dv)1~n1'a@l bb'Cl ~t1'd!lb'afl'Cl :J.Ji'n~u(?l taJ ~'fl'lJ~'lJ'fl~ rP1'fln1'a~n'l!t1

cu cu

ertl'JtJ~1~fun'l:rfm~1~'JtJtl1nU'nnVltlltJ']jUAbb~'J6"A'JlJfl~'flln1:roll'nhi1&l 'fll~~~dlw.l:rflt'l~oll'n~fnMl

~ .

tJlnVl1'fl'i::rflt'l~oll'n']jUA1~M'fllJ~U'fl"M'flm:rTnM1

hjO)fl~i'nv1~n'l!Y1tnn (Difficult-to-treat epilepsy) VlmtJn.."l ~lhtJ~Tnl3''lmU1UbbMtJ.."lfl'JlJfJ~'fl'ln1:i'in 1~1&lbri'fl.."l"lln~lbVl(;]Ul.."ltJf~n1f VI'lnbbm"lJ1&l'fltl'l.."lnnL'i'fl.."lertl')tJn%'l~d"l::;fl'Jufl~'fllm:rin1&i'

.q 0;" q;... oQ,

a,)b'VItJJ[ih~ "l&1~n~1,) l~bul

1. ~il~~~tJ!9l~1btl'lJ'fl1n1~..nn nril'JA'fl~'fllmrr:JAtJn~d:lu~n 1 bbt'l::;1&lTum:rfnMlbbuu1:rfltllJin~lUlu 1Ami '1l'lm:i'btiutl~, n'lm'flUmAtJn~, TIA, migraine, psychogenic problem, hyperventilation syndrome btiUL'iU

2. ;ja,)b'VItJJ1'3'A"uJi'nv1~~3j1rPi'~mt') 1Abbri b~!l.."liln~~'1l.."ll'ltJlfi1U~~'fl"1ru'i::rfl~~!l.."l btiUMU

3. jjif~~t1n'3'~rK'lJtl11~bfl!9l'fl')m'a..nn b'lfU m:i''1lAU'1lU fl'J'l~bflrtJA n1:i'~lJ~f'l VI~!lbfliil.."l~~ ~~bb'flt'ln'1lD'1lt'l i4

. .

"'1" FI "

:r:::CiJ ~ '11 LlJUMU

4. €ihtl-rU'u'at:mu!nhiaal"lba3.J'fl bba~laJ~nrK'fl~JhtJ~'l bVl~Ml.."l 1 b'llU ftlJfUtJ:r:::'VlltJtJl bnlJtnl3''ltnhiQn M!l..'lVl'll ~tn b~'fllJtJf::;~'Vlfiml'l ~'0'pjUfl ~~1~QnM'1l.."lYil1 ~Vf!l bbm~ bfl i.."l iPITA lun1rTutJf:::vI1UtJ1

5. hJl~..rtJm~'!.l..rutl1nui'n'fl!h~b'VIm~~UJ n1:rfnMl~t1'ltJM!l"l,)l.."lbbf.JUn1:rTm~nc!l'JtJtJlnuimtlufltJUfflt'l 'fl"Y'l

~ .

WriNb"ll:::t&A~~~lJtJ'l.-n 'Wtr:;~mnmnVl1il 'b.J

Refractory epilepsy ('i::rflt'l~i n~1aJ l?I'flU~U'fl"M'fl mftnl3''l) VlmtJ 'O.."l ~t1'JtJ lfflfmoll' n~1c!lftJm:rTnM1A'JtJtJ'l Vl1'fln'lfTmn~U1b'llUn'l:rr.httiATnM1bb~'J6"l1aJ~1~'l:rflfl'JtJ~l-Jn'lfin1Gl luif"l,,rutJ.."l1aJ~~1~lnMfl'Jll-J~lV1TtJhflf'l~ in~1aJM'flUf'lU!l"M'flmfTnMl~1AflJmftJ'fll-lftJd:lu~lnf'l lutJ'Vl;1"l:::n~h'Jn"lb'Ul'l1:::1:rflf'llJin']ji).M1~M!llJ~u'fl"M'1ln'lf fnMl&l'ltJtJ1 medical refractory epilepsy (Lbf.JWJn~ 5) ~"lU~~VI~'ltJfl,,~t1'JtJ~1GlflJtJ1nuin~UjlU 1Glbbri CBZ.PHT,VPAPB uuu monotherapy 'flth.."lii'1ltJ 2 'llUA Vlffi HtJ1nuini')~nu~'fl"!K'J'fltil..'lii'fltJVln\j~ 1U'1lU'lAbLf'l~ b'Jf'l'l~ bWJ1~~l-J bbihtJ.."l fl')U fJlJ'flln'l foll' n hi1&l ~tl')tJn~lJd~~ iPI'Jf 1ATUtJ'l nui ntu1 t.t~ b'llU Topi ram ate, Neurontin tth.!.~UVl~'flTmt1&i''ltJn1f~htti~M'fltJ

n1'3'fm~'lcl'tl'JtI~'J~a1nui'ni'l.{l'VI"'; (Novel antiepileptic drugs)

tJ'lnui'ntulV1aJ 1&i'!Jnl:i'WW-JU'l '1ru~lJ&i"lJ'fl.:ltJ11~"tJ ilu ltJ:r~UU'fl'tJVl1'fl1aJ"u bt'ltJ

!J:i'~tJ:::6'lt'l1~.."l~(;]tJ'l') ~ linear pharmacokinetic correlation b6~:::1aJ~~'Vl'ifuu~.."lt.l1'fln:r:::~un1rYi'l\jlU'1l'fl.:l liver enzyme Yi'l1,xfl!l'ln1:i"irl.."lb~tJ4Ut'l:::tJnmtJ1f~VI'i'l.."ltJ'l ii'fltJn~1tJ1n'WinmMi3'lU

tJ:r:::~'VlfiJl~'l'l'lJ'iI.."ltJ1nuin']jil~1V1aJ1MlJn'l:i'~n'tniubb:rn l~'flfl')lJ~~bfl~~in~hl(;]'flu~U'1l4A!ln1:rfnMl Gl'ltJtJ1 lA'tll-ul'l'l:::1u partial lbf'l::: secondary generalized seizure ~'!'JuW''tltJ1ATlJn1:r~nM'l1'W idiopathic generalized seizure "lIUAM'l.:l 1 lAtJl-nbtl'WtJ'lb~1lJ (Add-on) ntJtJ1nUin']jUAmM1j'lU~~t1'JtJ1&lTlJ'fl~ri'flU gj,)U 1 WL~ fl'J'llJtl~'fl Mn u b ri'fl.:l"'lln btlUtJ11 VlaJ~ n1:r~ nMl n.:l f.Jtl~:::tJ:::tJl'J"lJ'1l.."ltJ'lnuin6.:11~ b-WtJ"ll'l'fl b6t'l~i'ln1 :r~nMI n~ f.Jt'l M'fIYI'l:rnlufl:rf.nii'fltJ ~"l~U~~1~b6u~'\h1m.nbtiu (first line drug) b6t'l::;1'W~t1'JtJ~~.:Ifl:rf.n tJliult.l3J'VlnwI'J6.:1!Jf'lfll

. "

21

-H'flti~~1'Wm'j1im1V1~1!?1'bbri

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dJI

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n1~b~1.Jntl')!l'Wintul~lJil~~nn'lt#l~e

1. nfl3Jer{i'J!J partial bb'lU~ generalized tonic-clonic seizure m~lfl!?1'fhl Gabapentin (GBP), Topiramate

• OJ

(TPM), Vigabatrin (VGB), Tiagabine (TGB), Levetiracetam (LEV). Oxcarbamazepine (OXC)

2. nfl3Jertl'J!J infantile spasms tI'l~lfl~ ~il VGB. TPM

· ...

3. n~3J€t1'J!J Lennox-Gastaut Syndrome m~H1~ ~il Lamotrigine (LTG). TPM, Felbamate (FBM)

Lbfl::; Zonisamide (ZNS)

4. mn'W-nnr;l'J1.vraJmiWI'W monotherapy l!?1'bbri LTG, GBP, TPM, OXC 'Wilmru~hwl'MqJHLi}w add-on

"

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.,j J~I ~" ,

5. !J1'1'1'fl'flnq'l'1fiblJU broad spectrum bMbbn LTG, TPM, FBM, ZNS, LEV

.,j I"lrum).Jllil"ll'fl~!J1n'W-nni'W1V1aJ
~1'j1~'V1 5
• •
Dosage Therapeutic Half life Doses TimelO
mnuin adult Children ranqe'" (hours) Given RI?3Ch Steady
(mg/d) (mg/kg/d) (ug/ml) per day Slate (days)
GBP 900-3600 - - 5-7 3-4 1-2
VGB 1000-3000 80-100 - 5_i2) 2-4 1-2
TGB" 32-56 - - 4-9 2-4 1-2
LEV 1000-3000 - - 7 2 2
OXC(3) 600-1200 - - oxe 2 2-3 2-5
MHO 10-25
FBM" 1200-3600 45-80 30-100 20 3-4 4
TPM 300-600 - - 18-23 1-2 5
LTG 100-20d4) - - 10-50 2 2-10
200-40d5) -
ZNS· 200-600 7-30 5-70 1-2 2-15 22

(1 ) (2) (3) (4) (5)

nlr~T:::~utl'1tU~~'E)~'lI'fl~tJ1nuintu'l'l..nJhiiijS)'Jl~~ldjUtl'w):::il linear pharmacokinetic

""'IlL ill J'cv""

tJ1'~:::m)'lllfitJ1'Jn'Jl plasma half life tWT1:::'lIUnU'el~TlnlT re-synthesis 'lI'il~ GABA-transaminase

active metabolite ri'el 1 O-monohydroxy metabolite (MHO)

{hH' LTG :h~nu VGP

{hH' LTG h~n1J enzyme inducer

[Ill';11~Vl6 '£:nm'3il~tA£J~yjVl'IJU'fl!J"lI'fl~ !Jlnu-rn~u1Vl:iJ
Dose-related I diosyn crati c/metabol ic Teratogenic
FBM anorexia, insomnia, agitation weight loss, headache unknown
aplastic anemia, hepatitis
LTG dizziness, drowsiness, ataxia rash (10%), headache unknown
TPM anorexia, drowsiness, ataxia, weight loss, renal stone unknown
psychomotor slowing. speech disorder.
cognitive impairement
GBP dizziness. drowsiness weight gain unknown
VGB dizziness, drowsiness confusion. mood change, unknown
psychosis, visual field defect
TGB dizziness. drowsiness Asthenia unknown
axe dizziness,drowsiness. nystagmus, ataxia headache. hyponatremia unknown
ZNS Anorexia, drowsiness. Impaired Rash renal stone unknown
concentration
LEV Drowsiness asthenia, headache unknown 23

I

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tJVlVl 8

~ • ~ d

1l1'J~"l!n{Pl'£lm'£l'l (Status Epilepticus) tumm.:l

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2. ~'l..h£Jil'fl1m~intt~1t1Af'lfi~l1itlfl'Wbn'W 30 'W1Vl t~U~:;tt~1'1n1~imLI1i~:::l"lf'l~'il'JtlUJ1~uA'Wflfid:I'WtJnM

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n'lbU!1l

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m'i~lbb'Wn"llil!Ol

n1~inf?i'fl bOfl'lm.J..:! LtI'W

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2. Nonconvulsive status epilepticus Convulsive status epilepticus ~lu'Wmtl'W

.?I ." ..

1. Generalized convulsive status epilepticus 'fll"'UlJ'W generalized tonic-clonic tt~tltonic tt~'fl clonic

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2) Generalized non-convulsive status epilepticus b'llU absence status epilepticus

owmn'aN1'iFl

Jl'l'J:;infflflbOfl..:!1lil!>l generalized convulsive 'U1'WLn"W 1 i'J'i:~N il-5W1~"Wl1U~'1 n11'1'W1Mru1~i"ol;"Wnu

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2. m'l:::f'l~'iI'IU'J~

3. m'l:::J1W11al'WL~'fl17l~1

24

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2. ~~b~'fl~Wl:i''l''l1l1:i':::~lJ glucose, electrolytes, calcium, magnesium bbf1:::R:i''l''l'l!UbiiCilb~'1lA(Y1''11:rru1btJtJ:r1tJ 1 ) f1'lnn'Ub~iJ~U1-l~'l'WH~111f'UIl1~'l1il1l1&'l1rY11!J" b~1:::b~f1 :i':::~'U'lIiJ-ltnn'Win btf1:::'flt.h-l~t.!~'fl11il"l:::~ii·m.J..'j~t'W1811«-l 3. f1'J:rttX~1r glucose, maintenance fluid bLf1::;~R1ijtJii ~-l.n

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4. t1:i'::;biJ'W~t1'lu'flth"r'lAb~'ln-llliJA'lI'e1-l'fl1n1:rimbf1:::~1bl1ll1

v ,

5. ttXtJ1n'l.,l'nn~'e1'fln~'Vltb~'l1.~bbrl Diazepam 'lIU1A 0.2 :J.Jn.!nn. lIr'fl 10 un. ltJ011'lJ'Vl1"1If1'flCilb~'1lA~111r'1lttX'Vl1-l

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, <-

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rJ'l1ll~tJlf1~(>] lI~-l"l1n1Ji'tJ1bb~'l 20-30 W1Yl ti..:!~-l~'e11mrin~nm91trtl1~11'W'lItJ1A 5-10 ~n.lnn. ('lIW1!ilU1r'l:J.J b~ll~ 30 unznn.) lI1nti~1lJlItj!ilin ~'lrltrtJ1 phenobarbital lIrtlbu~tJwli!81~H~1l1f1J'1l1mrinm'flbti'fl"hi 1l1'fl1J~'W'fl..'jMiJfi1rfn'l11 (~r1Ufl:::b~tJ~(i]1llii"li 6)

25

Stage of status

General measures AED treatment

Premonitory (0-10 minutes)

'lh~b~umnh~'lu"lJ'iI~r::'l.J'l.Jhh'H~8'1.m~::;n1rVl1ul"l Diazepam (i.v. bolus or p.r.) (cardio-respiratory function) bU!1l'VI'Nb~hm1tll"l 'hX Midazolam (i.rn.Lv.bolus.p.r.) 'iI'elnon b"lU lh:::bi.lun1rin

Early

(0-30 minutes)

A!1lM13J ~'lJ'1!1ru~~ bbt'l:::mnn

Emergency investigations btJVlVll:'lfJVlb~'ili?l~1 b'"l1::: b~'ili?lt'l..:jMr'J91,x 50 %glucose (50 rnl) Lbt'l:::~M1~U iJ 1 Vl1'eJ~M1iluih'l3J· fmn[11':l~ acidosis cl'iA'il1tJtY..:jVl'il~ l.hm·l,xn (t'l1tJ..:jin)

Diazepam(Lv.bolus)

Phenytoin (i.v. loading) Vl1fJ

Phenobarbitone (i.v. loading )

Establ ished ~UVl1fl1 b VI [>J bbl:'l~fmj'1m'J Ub'VImofifJUfJ1'"l1 ,xtn·jhm.w3J mtJ..:jin'il~1-iJ1~3J (Phenytoin

(30-60 minutes) !'l'J13J&i'uVl1n~'ldJu VlW Phenobarbitone) "lIU1V1fl~mi..:j"lJ'fl..:jflf-lbbffi

tY..:j'hMtJVlin~'ilntn~mlWiVld..:j Phenobarbitone (Lv.loading ) VlffiPhenytoin (Lv. loading)

Refractory (>60minutes)

EEG monitoring Monitoring seizure EEG and Thiopentone (i.v.bolus & int) cerebral function Intracranial pressure monitoring if Propofol (Lv.bolus & int) appropriate

bW1Ai?lM13J~'lJ'lJ'lru. EEG, Ai?lffl'l3Jn1rimb~:::n"m1'l..:j'lU Second-line:

'lI'i1..:jr:::'l.J'l.JtJr~fl1'V1b~1~i?l(fJ13Jfl'J'l3J~ulun:::1m'mMrl!t::: Pentobaubitone (i.v, bolus & int)

11'1fl1tnm Isoflurane (inhalation)

i.v.=intravenous,p.r.=per rectum,i.m.=intramuscular,inf=infusion,EEG=electroencephalography

~lPl1iluiJr'Jw 'llll!1l~i?lbiJ1b~U (VhtJi?lVlI1un1r MIMS Thailand 1/2002)

1. BECOLIM 1 oo" Iml (Atlantic lab) Vit.B, 100 mg, Vit. B2 2 mg, Vlt B6 10 mg. IMIIV niacinamide 100 mg,d

pantothenol 1 mg. (1M/IV)

2. STAMINA®/ml (S.charoen Bhaesaj) 1 00 ml Vii. B1 2.5 mg. Vit. 82 2mg. Vit. B1 2 mg niacinamicie 25 mg, dextrose monobydrate 5 g. (IV)

3. B.100 complexl(TP Drug) Vit 8. 100 mg, Vit. 82 0.5 mg, Vit 86 1 mg. nicotinamide 100 mg, (IMflV)

5.2 nrruhiiJVl1'flll..lM'il'l.JflU'1l..:jIPl'il phenytoin 'il'l"l1,x phenobarbital 'lIU1i?l 20 3Jn.lnn. ~fl3JluJ1bn~'1l1,x'VI1..:j VI~fJi?lb~'ili?l~'l ~'J8!'l'l'l3Jb~'lhhnu 100 3Jn.lt,l"ll1 (lur::VI~1..:jU~'fl..:j.w91rru.1tii?lM'l3Jn1rVl1819 fI1"l~fJ..:jtdvi'el·lhtJ

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~ ,

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~ ~

26

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f11~!>lillb"ll'a fl'1bVl(;J'Vll-3Ll-JAl nrsn f11~ iJlnJtJ1bbf'1~~'1~'f'jtl' f11nJ1il1b"l1J'VlV'l~tl'~ b U!>lU

9. rl'l~b~'1~:::-r-1bbftnbnt"IJ!11'l:;bb'Vl~n.jj'aU~ill"lbnill~'W1Jlbbri metabolic acidosis, electrolyte imbalance, hypoxia !11':l:;~l-J'fl-1U'll-l ililill'1lm~u'"l'1n1~~16n bUl.lA'W

1500 l-ln.i'rl.l

Diazepam

o.s un.mn.

~:;i 'l n '1 sn ill m ~lI'1tJl(~ fl':l1l-l c.oll.l b~ilillj;'j1 fl'l~ht Phenytoin loading w1il

Lorazepam

0.05-0.1 l-Jn.lnn.

~~ojf'1-3 b~tJ':lbllrr'al.l diazepam hiiJ 'lI'1tJl'Wil~:;: b'Vl Pll'VltJ

Phenytoin

20 un.znn.

2 l-Jn.l'W'1i1

10 un.

.

rl'd'l~~'WLfi'el~rn1.Arrhythmjas if,

l,xbhi:J~l-llJln1Jnormal salinebvh t!''Wr111,xl~'Wb~'fl C1i'1lm~1J

Fosphenytoin

15-20l-ln.lnn.

1500 l-l n .Il''W

Mil-1iillA'J'1l-lc.ol'Wb~'aillbbf'1:;: ECG n ~g'lm~'fl'W phenytoin ,bLP1hlAiltJ r111,xA'l'1l-lc.ol'W~'1 ~rHojf'1n~1l-J1Jl

l~iJ'1i'1l~f'1lJlnfj'al'Wb~n l~m'W il~:;b'VlM1-ml

20 un.nn.

50 l-Jn.l'W1Vl

3 l-Jn.lnn.lmVi

nillf11mltJl'"lbbg'l:;:A'l1l-l~'Wb~'aill~1 cl1H1'll-lnu diazepam

Phenobarbital

27

1"'b'ir1t.!tl'el(91b~'flC'l~1-if1 1 'lI'W1(91 20 l-ln.lnn. Ji''JtI~,)1l-lb~'l 25-50 l-ln.l'W1Vl (b~'fl"l1~~'ltl ~1ttl~fl1t1 normal saline)

Phenytoin

10 sm. b.fi'1t.!tl'el!?lb~'fl(91~1LLfl~~11in'VY11l1Ji'mr~ 15 'W1Vl ih~~il'el1n1t-nnLPl'elb~'el~1l(91LojJ'l 'VYfl'elC'lb~'elC'l~1Ji'')tI'lI'W'l(91U'eltln~1 2-5 l-ln.!'W'lVl

Diazepam

Phenobarbitone

Propofol'

initial 1-3 mg/kg iv bolus followed by infusion 2-10 mg/kg/hr

Midazolam*

initial 0.05-0.2 mg/kg iv bolus followed by infusion 2-40mcg/kg/min

Thiopentone'

initial 5-15 mg/kg iv bolus followed by infusion 0.5-10 mg/kg/hr

i.v.=intravenous * infusion until burst suppression in EEG

28

d tJ'Vl'Vl 9

V I I Jt

mtHmn'Wim1-.lt~nbt~::;rJ1~q,ir1'Jtnfl'l1~t'i'1lbil'1l-lbb~t&'lihb&'ll.J'1liJ'l-1«nbC'ltl~-.lb"llt.J~-.lU

1, ~~~nl"l!'.JbVla.Jl::;'i.UJrl'1J"l!ijlPt"ll·£Winmi-rn(~ln-.l~ 8)bC'ltlL~'1lnn~l.JtllV1«nri'1l'W~"l::;Hn~l.JtI'l~'1l-.l,\"Ti'1ltllb~1l.J 2. t~a.J~t.llil'l~mn'IJ-nn"llijl?lb~m (monotherapy) L'Wtl::;iJ'l-1in~1'W~1"ltr1'l1Jfll.J'1l1mtin1~~n~lmt1oDtll~~1t1

~ ,

"JjUC'l'W~'1ll.Jn'W (poly therapy) ~-.lg-.liJ'1l1n1~1f1..:1L~t1-.lbL~tt.JBMtJ1:i'twh-.l81 (drug interaction) U'el'~m~l ~thtl

t'llm:i'C1n'WtI'ln'Win1~pl'1lLrltl-.lLLflt&'lJ1b&'ll.J'1l~n':l1 bLr1t~1f11f1nn~1 LtI'Wmllht~6C'l th::;a.Jlru~tltlflt 70-80 "lItl-.l~

~ ~

"JjUlPt"ll1l-.ltl1m~in tI1~b~'1lnl-D

tI1'l-1in tll:i''1l-.lLLr1ttl1L~1a.J

Absence

Valproic acid

Clonazepam Acetazolamide

Myoclonic, atonic, tonic

Valproic acid

Clonazepam Nitrazepam

Generalized tonic clonic

Valproic acid Phenytoin Carbamazepine Phenobarbital

Clonazepam Clobazarn

Partial

Carbamazepine Clonazepam

Phenytoin Clobazam

Valproic acid Phenobarbital

Infantile spasms

ACTH Prednisolone Vigabatrin Valproic acid

Nitrazepam

Clonazepam Clobazam

1f1-.lLfltl-.l (maximal tolerated dose) "lI'W1lPt'll'1l-ltlln'W1nm!?l:i'j1'WLL&'lC'l-.ll'WWl1:i'1~~ 11

~'i:i'::~nL~a.J'1l~1 m:i'!?l'1l1Jfl'W'1l-.l'll'1l-.l~tl'ltllLplfltr1U~'EltJ1n'Winut'ir1t"JjUC'l9tLb!?lnpl1-.ln'Wl.J1n ~-.lfl'l:i'tJf1J tl1"l'W1~"lIt.l1C'l~bVll.J1tfll.J~1~f1J~1.hmtl'Wr1'W 111J 1'WrJ1'l-1q,i~tl1n1.Jincl'l'Wl~rYfI'Jt~l.J~'ltl"llU1C'lU'1ltl 1 LLfltA'eltl 1 b~l.J'1lth-.l1fl1 b~'1l'l-1finb~m'1l1n1:i'~hl~-.ltJ:i'tfl~A91ntll1'Wnn)J~~t1'JtlllJ1~ihl1m:i'imJ'fltlVl1tlbtl'Wmrinffl'1lb~'1l~ 1;Jnfl'Jll.J~1bil'Wllftl-.ll,x loading Lbfl::;1;JfI'J:i'1,x~l.htlihl1m:i'inVlfl-.lbVlii'fl'1ltlbAtl1~tl11'W'lImrP1~1;J&'l-.l'W'1l (sub-

~ " "

29

~1I')tlhndlihl1m1-nmJ'eltJ"'i~'lItu'Wn1~nt?i'elbtiil-l status epileptlcus hJiJfl,)13-J"hbut.u1f'El-llt\' loading blm:hjfl'd~ 1 'IX ~1I')tll:l'el1 n11-n nll~-l m~'el'El~LcPltl1dlU11 'W'1J'W1cPl~1lJm-lW8 (su b-therapeutic dose) bu'Wm~1'W1'W

.col i'fl3Ja'l'l1\1Ltl«"ll"~f'l1~1PI4''U1\1'f1211\1 LL~::;"IIU16'1mi"ll'fl\l!J1nui'n3.J11P1'i:S'lU
1PI'l'i1..:1'1'1 11
~ ~
'lI'W"lcPl Therapeutic iPl'l"i1\1~i)Ul ("Jl3-J.) ...
1:::tJ:::b'd~1'Vl n111'd:JJ
~1'W,)'W .. nlJ
range {l-l
1:JJLAmf3-J1 "
tnn'Win ejlm1J '" Af-l Steady state Protein
bcPln
3-Jn.lrl'W 3-Jn.lnn./rl'W 3-J~. ejlllcY '" ~lt\'li'W (rl'W) l'Wb~'1lC1l
bcPln
(%)
Acetazolamide 10-30 2
Carbarnazepine 400-1,SOO 10-25 4-12 5-24 5-25 2-4 3-6 70-S0
Clonazepam 1-10 0.025-0.1 6.3-56.S" 20-60 22-23 2-4 6-10 75
Nitrazepam 0.25-1 2-4
Phenobarbital 60-240 4-S 15-40 50-160 30-70 1-2 >20 40-60
Phenytoin 150-600 5-15 10-20 9-140 1-2 6-8 90
Sodium valproate 500-3,000 15-40 50-100 9-21 8-12 2-4 2-4 80-94
"m'il!li::;i'U!l13rnhiiiFl'l'UJVI:JJ'l~ b'W'i1:::bflUl receptor tolerance
, 4. 'U~VI'l'1mnui'nIPl13JFlru.~:JJ~'I'I1\1btl«"ll1'Vlm (t>l111-lYl 11)

4.1 A1fli\l~Ul (half life, T 'h ) tJ'l~i1 T 'h 6'W 1dlbbri carbamazepine. sodium valproate fl'dtl,xrl'W

~::: 2-3 flf~ ~1 T 'h 'W1'W~"Hbt?i 24 i,)Lm~'WhJ 1dlbbri phenytoin, phenobarbital ~1:1J11tllmMu~::: 1 Af-ll'W ~llcY

n1n"l1:::t:::Ji'1JtJ11'Ub~'1lcPl f1'd1n1:::Vi'lb~m.J1l:i-l steady state bb~'d n11~"I:::tl1:::bi1'W~1t11n'Win'1rui?l1t\''llui?lllli\l1~f1JtJ~m'elhJ ~1bu'WWf'1l-l1,xtl1nuin'llui?l,rul'W'lI'W1cPl~Lllm:::

,

~ 3-J btlUt:::tJ:::b 'd~1 Vi'W'l'Wb Y1tJ\I'V'j'el

5. n'l'ib~'fIn1i preparation "II'fI\I!J1 bbA~:::'llUM du tJ1bijM ~1 bbfltl1~ ll1'elm'lfUC1lb~tJ'dnUbbtA~1-llJ1';'VlWf'el-l~'li1-l n-1 bioavailability ~'f)19"1:::bbt>lnM1-1nu1dlmn n1ntl~tJ'W'lfUM'lJ'el..:i preparation 'lJ'el-ltJ'l"Jltii?lbMtI')nu1'W~1I,)tJ~fl'dlJ A3-Jn11-nn1(?)'bb~,) '1l1"19:::n~lJA,)lJfl3-Jil1n11in 1lJ1dlll1'1l bnC1ltJ~ih\l bAti-lmn~unr.i1b~3-J Ji'\I,r'Wb~ilHU1 preparation

. .

~ , v ~

'lfili?llC1l bb~,) f1,)lJ A3-J1(?)' fl'd 1"1::: 0WllilC1l bbft:::'1J'W 1 cPluu1 ~ 1lJfl'd n tl~tI'wn5lJ1tl3-J1 Y1-l ilf,')n~ '1l m'1 fl1 C1 nrf1tl1:::~'Vl flJlTI"j

. ..

Iii. ~

6. n1'itpl'1'd"'i~i'Umn-".!-rn"l:u~~'fIl9l 1'11 bilfli1.jf'1l1J-1~ (Ul'l11-ll112) Therapeutic range ((;I'l11...'JVj 11) ll)J1tJ~...'J

1::: Ji'lJ u 1~-l L~'1l ~ 1 n~ 11::: Ji'lJe1ti ~13-J1 sn ~,}lJ fjlJ'ell m j'-nn ten bb~:::fl 'lm\l n~ 1e9 :::1'l11 ~ bn C1l'el1 n11if 1-1 ~A twa'W1ti ~\I '!.h::fl-l01

30

..I i~u~~~~~nl~~~~~~~~uElnuinluL;~~
~1~1~'V1 12
1. l~'ll'I.J5'~llJUMA'J1l-J~3J1l@'lltUn15'ftJ'l.J5'~Y11Ut!1"ll'll~e11J'Jt!
~ ~
2. 1 ~'fl1 if'I.J1~n'fltJnU'fl1n11Y11~ A~lJfl':hlh.bt! luuvhj''''l1 ntJ"l~1'll hi 1Mt! t'il'W1 ::::t~'ll1iftn:hl-Jnu
~
~~ 1 tJ'1lijM ~fJ~Y111U~'lil1...rw'tt"'l1 n tJ'l'1lUM 1M
3. 1-if'I.J1~nfJtJrltJ'fIlmn~fJ'l.J5'::::llJUrJ1t11nui'nuUA'JUA~'ll1n1si'nhMi
,
4. 'I.J 1::::lnU~tl'JtJ~'ll1"'lln M'l.Jn mm n:~~1..,tJ1
5. t~1~1~t?itJtI1nui'n1um'J~Vlijn1:n'I.J~tJUlttJ~N1::::t?i'lJ1'I.J1~ulUl~fJM t'du burn n11~~An.n hfl
riu hAll91 1ilu~u
6. 1 ~'ll~15'::::t?itJtJ1 nuin~ A'J'lJr)l-.f n1~in 1JllUll~tJ fl fl~
, t!1rluimn'fltJ'I1mUMlJ dose-response relationship uu~m'~Wi''lJtl1~~~~ 'I.J~~~'Vlfirn'lf'jlun1~u'fl~n'W 'fIlm~in~~~ rh~1l'Jt!u~ijfJ1n15'in~1 fl'Jn~~'lIu1M~'fI~tJl"'lul~1::::Wi''lJtnlu upper level ~1fJ sub-toxic levellu

"

therapeutic range 'lI'f1~t!lnuinu'W

Therapeutic range iJA'J1~bt(;lm;h~rlumnlulbr4~::::A'W ~t1'JtJ~ih::::Wi''lJtJ1~..,nrJl5'::::t?i'lJ upper limit 'lI'f1~ therapeutic range ~f1nb'1"'l1nAtm~~",~~ 'lll"'lhiil'll1n1nilu'Yib' lL~::::hi~1lil'WI$1'll"'M'1I'W1MtJ1tNrhtJ1A'JUfJ~ 'fl1n1~inl~~ 'lIru::::b~tl'Jnuwtl'JtJ~th::::Wi'tJtn~lnrJl lower limit 'lI'eN therapeutic range 'll1"'l~1l-J1nlA'J'lJAm}1n15'

~ ,

in 1~ llif'J tMtJ 1~~1 bijU~'ll'" l~ ~tJ1 nl5'fn'ttlA'WEl1 A'tJ'fIl n'l5'Y11..,AftUn dj'W~« n 1MtJ M"'l1 n'fll n11in lb~::::b~'l M'fIl n11

v ~

LiluY1'tt"'l1nm Ll~::::1"yA'Jl:W~1f1 flJntJ ~'l5'::::#itJtJ11 'Wl~'fIM lilu~'ll'"

n1~.r M5'::::i1'lJtJ'lnuin 1 Ulft'll M 'W'fInr,nn"'l::::'lI'JtJl Un'l~'l.Jf'lJ~U1rJ'lI'ENtI111~'JU~'lI'JtJ'lJ'fIn ~~ A'J1l-J~~'l b~~'fI t 'W m~f'lJ'I.J~::::YI1utJ1 (compliance) 'lI'll~~t1'JtJ 'l.Jn~"'l::::.rMbilu total level ~\J"l::::5''Jl-J~..:!fl'Jutl'lnuin~~r.rtJn'lJb'I.J~~u lb~::::tJ1~bUutl~~::::1'Wnnn~ilmn'I.J~t1uLl'I.J~~~::::i1tJb'I.J1~'WlulftfJM ~1'f1tJnmtJ15':::~~l..:!tI1 (drug interaction) ~lnMn11 tbtl~4tJ1'I.J1~U ~1lil'W~fJ4t"'l1:::~l (free drug level) mn"'ll::::~15'::::iI'lJA'J5'Vill,r(;l'flm-n1ri'll'WnutJ'lrl'flbtm (trough level)

7. t1~~biiutli:::~'V1fim'Vl"l.l~~E1 (efficacy) mi~~'lJWu~..:!~~tI1 'l.J1:::llJ'Wl&l"'lln

7.1 41'W'J'WAf":!'lJ'll~'fI'ln1jin~~M~~ bi?)tJmjUul1n~'l'W'J'WAf~'lI'f1~m1in~41'W'l.JnYi'W (seizure calendar) 'fl'l"'l~'lbLunmj~'l'm.J~'WfJ..:!l&lWi'..:!~

(1) hiil'll1msi'm~~fJ'fI~~mM (seizure free)

(2) 'fl1n15'in~~U:W1n (marked improvement) ~'U'fl1mrin~M~'_'~1nn~1~'fltJ~~ 50 'lI'f1..:!~dJ'W'fltJ~~

'I!

,

'fl~W~btm

(4) 'fl1n1nn1lJLtJ~tJ'Wbb'I.J~..:!~'fl'fl1n11im'I.J~tJl.m'I.J~~1lJbnU¥'fltJ~~ 25 (same)

c..'.d. X..c:'J..:::rI 4'~ .v

(5) fJ1mj'1lm~~:wln'1l'WA'fl:W'fllmr"1lm'W:wmnn'l11'fltJ~:: 25 (worse)

? .:- 1.1 .'1 ~ "" 1 ,"" ~ "" .. ~ "",! I'

bMtJ'Vl'J lJlu1~~'ltJ'lI'fl..:!mjm'tt1 A'll ~3-J'fl'lmj']jm~tJ (seizure free) m'fl~'U1n15''1lnV1'l1Umn bMtJ"'l~

~tJ181~A'J'lJ~:W'fl'ln1si'nltY1.&lb1'J~qM ~t1'JtI~imJ1u1'W"l~n1'flm~mtJ (remission) ~M~'_'

31

fm.ntJ1tJLVI~'1l b~tJ'1'fl,)n'lnlm~~u'JtJ~n (aura) ll'flUn'1l1n'll'fnl'thih.!1iI,)l-Jl-J1

·h..!nnU~L'M~ilb.y:jtJ'1 aura ~hin'flln1~'Vl'I'1 motor 3fn1~ilrl'J,)l-J~1LUUM'1l'1A'lUI'.ll-Jl,xlntJ~l-Jfl b~l'1!: aura ~n~~1~~'1ltJliI'1lU~U'fl'l~'fltJ1nufn

7.3 n1l'tJ~:::LiJUbfltJ~'J},J (global assessment) bUUn1:i'~lh:::i1Yl~~~ (effectiveness) ~'1l'ltJ1 l':::wh'1n1:i' A'JUPl},J'1l1mj'fnnU'1l1mj"ih..:!L~tJ..:!~LnM~U~'flPlblUl')'jI'j'1l:)MLL~!:i'ltn'J!:'Vll'l~1iI~'lA:J..l (psychosocial) ~il'l~lhtJ ;'1

. , "

, ..

'llfltn

Acetazolamide

..

~U Stevens - Johnson syndrome,

SIADH, aplastic anemia ~u5m~lJ

Carbamazepine

,

".. 0

Ll-JflL~'fI(9l"ll1'lM1

Clonazepam

'fi'flUL'V'I~tJ J'l'l hypotonia'V'l~tinm .. mJ~tJU nfln1l'mtJl~(ti11.jftJ1~fl) mJ~'lJ1~1tJLL~:::L~l-J'M!:l-J1n

n')'Jh'J~lt.llqj - J'J'1~l-J 'fi'llUL~~tJ sickness

\!Pl~nll1~btJ~tJumJ~'l Ll"1rB'"

Nitrazepam

.d

~U Stevens-Johnson Syndrome, serum

Phenobarbital

Phenytoin

fJl1m!:"JnNystagmus b~tJU~:i'ti'::: biitUl1'V'1 mu Stevens-Johnson syndrome ~lJ

im~u btA"H'1Itm~1 choreo-athetaosis 1-ii

.n'll'lJ ~l-J bti'Ub"D A~u1~ 'll1L~tJU L'M~'fln

'x U'Jl-J VlU1M1'MtJ1lJ hersutism i1'JL-Wl-J"lIU

... ,

r;I'fIl-JoW1 L'M~'fl'1 btPl'YI'J 11..1 L~U'I..lj'!:~1'Vl.a rusu

megaloblastic anemia (tolatedeficiency)

Sodium Valproate

Hyperammonemia

8. L~1~'il1m1'·h.!lL~tI'l"ll'il..:jtJ1 (adverse reaction) (M1l'1'1~ 13) 'fl,)n1:i'-ii1'lLfitJ'l~'fI'lmnufn 'El1'ibbU'1il'fln1cJtLUu 3 'I..l:i':::I.f1'Vl ~fl

n. 'll1n1nuu-wti' (toxicity) Lnfl~'l..!1'l..!~t1'JtJ'I'lnAUmn1cJtfutJ11U"lI'U1fl~~'lLn'l..!11..l 'fl1"HLfJlnfJl1'1nuluJOl'J1l-J 1'J"lI'll'1n1nnfl'El1n11' 'lI1n11'''l!:'M1tJ1'1..l19i'Lri'1l~fltJ1~'l LLi1:::hlnl"1'J1:J..l~1LU'UMiI'lL1..l~tJ'U"lln(9ltJ1nufnti11"1'JtJ~3..l1#i'

~. '1l1n1l'LbYl (idiosyncrasy) bnfl~ulu~t1'JtJU1-lA'W ~'1hj~1mj'nA1flml'n11#i' l!mn~Hri'fl~3..l1-iftJ1hJ'U1U Lri'fl Lnfl~ULL~'J~"l LUUA'1l'l"HJfl LL~!:hl Pl'Jl'AiI'l HtJ1t!u~ n

A. i1"ln'll'if1'1Lfimr;lilYl1mbUAl':i'.r1 (teratogenicity) LnM1Wil.uml'fl1~1-iftJ1 'Mr'fliltn'J!:'lI1flfl11' t'l'h~1?l (~ t"~·'1l..:]j;.Ji1'll'1l'1tJ1nufnM'1lYl1tnb'WAl'j'rl)

32

9. 'j'~-r-1UDMtJl'j'~""~I~tll (drug interaction) brlill-ntJ'1nu-nni'J:iJnu:iJ'1nn~1 1 'liil(?l;u1t.J "';~i1i'J:iJntJm~uil1!;j 'I'l'11~f1'JW;J:iJil1n'1rinhJt~ ~1mn~i11n1nU'W~tt ("l1n~~ 11)

10. U'<ij{!Iv1rK'el-1l·'i1il-1t)-1 fhHtnnu-nn~-lM~~1mmt~:iJbb~'J i1'1n1j'-nnV~A"l~lbUUil£l

"

n. 'fl1mj'tJ(?lUnA~btl'W~n 1 Paroxysmal disorder ~u 1 ~i)u"litJfwd1btluhf1f.'l:iJin "JJ. ilgl1bVl"lhf1f'Win~u"lijl~fntt'1

1'1. i1ur,I';i"tJMtJfful~bii~i11n11in

,

"l. iiUtJ1'Wfl~1bfl:iJiI

.1..1... ....:y_ ..I ..... 1 ... ~ ,\... "I ....... .,""

11. m'j'b1J~tlU"lf1J(P'I"lI'el-1!11n1J"Om3,J'el'j''lJ1J'j':::'¥111JtJ1U?1:iJ ~3J (?leJ~ ~1Jm'j'A'J'lJf'l3Jil1n1'a"lfn Ltfltf1M!;j!::blJf.'ltJ'W

'1iil~"JJMU1nuinf1'Jmn:.yh~~-1!;j1n~e.Jfl'lJiI\ltJ1nuintf"'l,1Ju~u1~ftJn1nJj'tbij\Jl..JIl'1'flb.wtNU~'J n11~"'l1nU1 bu~mJmnuinilu~nr1l-1e

........

11.1 Yl"l1j'ru1~1~1J'JtJil~nk1'rut'fl1n1rlmi"lftun'1iu~ 'liilMl"'buuif'1!u11Un1j'f1'JtJ~}J'fl1n11 inmnY1~'"

1 ~ L~i1 nm nuin~ M (1I~1"ltgl1m1(l f1'JtJ9'.ll.J'fl1 n11i n~ LUUU '1!Vl1~u1M'~~~'" b nil-1"l1n 1 U'lJ 1-1 n nUU6'1"l1 n bjl.Jn1'l fntt1 M''J mJI nU'nn'1iU(11 usn 1M'1ttJtuQ'Iil1 n'ij'i n'lJiI~ ~1J'JtJil1!;j!;jtuJ~tJUltl LL'lJtJ Iil li1l ~tJ1 nuin~ Q n b~i1n 1 uf1f'l

1 ' v "" ..:.r '" "" 1 1...... ...

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34

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4. 'flln1~oinbtl'W'fl'ln1nL~rP1'1f'1f'lbbm"1l'fl'l~thUb1S"l&'l~oinbi?ltJn1ibtltJil~4'un~~~tJ'enn1~in~bnrP1~'lnloifbtltJilry'M1~ 'VOJ1JltJ'fltlt tJb;; n ~ln n11Mm.:n 1 tJf11'1U 1~m~'I'IU~ln'1{lliin11¥'fltl~~ 2-5 ltJn~~u1r"lf1"lftJri'fl'W1''!.lb1m.J

~141ri't'lA'l1~

'fl1n1~in~bni?l~'lnl.jJ (Febrile seizure) bncnltJb;;nun~'fl1'IJ~'Ibbfi 6 b~tltJn'l 5 tJ bb~~~'fl'lllJ1Jlbn9l~1nn11 ~t'lb~tl'lJ'fl-1~~UUU1~~1~n~'l'l 'M1'fl~1nfl'l1~e1i?ltln~'lJ'fl'l~~"Jmn~'flbbili?l 1 'M1'fl~1b'MfIJ~tJ~';h1~Lnw1.nn11oinlA bb~~~niltl'ln1~oimnM~'!.lmulu 24 -K';lblJ..:!bbm'llfNloif ~'lbbun'fl'flnlJld~ltJ simple febrile seizure unn'flwJl'ltl in'ttru!:"1I'fI'Itl1mnnd'J'WbbuU generalized seizures (generalize tonic-clonic 'M1'f1 generalized tonic) 'fl1mnn ~lncn~'!.lbtltJ"J!'l'litJllJbn'W 15 tJ1V1 (fl'J'Wl'Mqjhlbn'W 5 mVl) llJnA';l'llJe1cntln~"1I'fI'Im~M1'J'9l'l1\1~~uutl~~~1~'Mi'l

~ v I I

tl1 n11in bb~~llJ n'fl1n1 ~oi n~11 tJn1rt ~U1hu Af'l b~tI'J ntJ 'fI1 m~oin~tJlt'l'W'fl n mil'fl'91 nVi nii'l';lWl bb~';l 1,x4' t'l btltJ

complex febrile seizure ~'IilA';l'l~'M~'ltlfl~'fI'Uf'1~~n'l'fl1n'l~oini';l~n'I.J1i bMtJ~'tl1m~imr'W'fl1'9 biit'lb1t'l'l1~~'J..I1'fl

.fJI oQ.o' .J..c::t I"'" ~ Q, .. I ~ " I 1,,;;9 .q. X cv

blJtJ'fl'ln1~'linm.J~~tI!:L'J~'ltJ'ltJn'l1 15 tJTV1 ~P1'J1lJtJ au n M~~UUlJ ~~~1~mntltJ'M~'fI in t'l'lJtJA1lJmJ')1t1'J..1~'I'fI1 rnr

in 'M1'f1 btltJtl1mrin~ bn t'l~'l1 'Wmn~'Uu'JtJ~n1iJi';llJJl'Jtll tJflf'l b~tJ'Jn'W

'V'I!I1Hn1dll1l

il~"lutJetl\lll.llMM~tlmltJ'fltJb~tJ'lnun'(11nb1t'l'l'l~ ltJmnilM'fl1m~-nn"l'lnl.jJl,tJb;;nuf1M n.jJ'fll;l'(1UtJtltJ~1 il fl'J'llJ b~tJ'Jojf'fl'l nu~tJ~n~~lJ ~\leb;; n~ bil A 1 tJfl~'flU fl f';l~ihJ~~rWin'fl'ln'l~in~'ln 1if 9~m 'fl m~oi n-nn 1iJlJ'lnn~1 b;;n~llJntJn:1Afl~'fluPlf'J bbfl~'I'ItJ~1m~~Ul'l'fll?ll'l1\1~tJ~m1~btl'WbbU'I.J mulfifactorial ~1tl autosomal dominant 'V'I!I1n-aru1'aA

.aMnM1tJ~bni1l~'lnf11~oj'n'9'lnl.jJu'fltJ~'ln bb'(1::hJ';hl~'Lnt'l~~'fI\lflf1'l~'M1'1lb~tJ cognitive function 111tJ'Mi'l 9'lnin n\lbb~'9tblltJ febrile status epilepticus ~'J1~~1m1nltJf11~irtJtJ'I'IqMmn.Jbb~tb"lf1iilq)q!'l (IQ) llJbbflnf11'1 ~'lnb;;n~hibAtJ)j'el'ln'l~in~'lnl.jJ:I-J1ri'fltJ bb~~~c;J.JtJ1m~'Il'fl'l6~nnllJbw1nf11'1"l'ln~'!!'tl'l~1l.lil'fl'lf1'lrlm1nlojf 'fl'lm~oj'n~1nl.jJ6nl?l~11Jl tJ~~lJ'lrur'eltJ~~ 30-40 "1I'fI'Ib~n~inr,l'ln1ifAf,mm bb'(1!:tJ~tlJ1ru1'tltJ~!: 10 b'Vi'l t!tJ~"I~tnM'fl'lf1'lrln~16ntJ 3 flf'l il~4'tJb~u..:!~'I'IU~1b~tJ'l.jJ'fl'lnumnnM'1l1m1in~'l"l1nl.jJ~~'wiq)~'1l m~il1.!Afl'(1 1nMt'l\tJ9'l~'flUflf'ln'1l1mrlm1nl.jJ bb~~nin'91n1iJ~f\lbbmri'fltJ'fl1~ 18 b~iltJ ~\lfl'l1~b~tI'I'Il'fl~n'')1in~'l 'fl1~b~l-J

38

mn~U~-1~'tlU~::: 50 iJ'fl'ln1rimnC1llt5-1"'l1ndJJmfl.ur::u::~5uJ..l1n L1iU inmulu1'ltJJ-1bbrfi'lJ'fl-1Hf q::bn~ifi~'l1~ tJ'fluntJICf'l'fl'lmrl~u'fl~u'lU U'flnq'ine Cf'liJ'fl'lmr-nn~11i~-113JJJ'ln ",l'fliJ1-ihJ'flu 1 lt5-1qln~iJ'fl'lmrinr.nnHi flf-1Lbrfi n"'l:::lJb'tln'lflb~U-1(;)'tlmrLnC1l-nn~'lJJ'ln~u nn'lr~ntl''l'Vw1'lnltr'''l{tJb~tJ-1lt~'lmJr::n'lrq:::~-1iJl'fln1flfl-1~q:::

~

i.o I ~ i-' !I

bnC1l'fl'lnlrin~'l b~nm3JiJtrq{matJ-1"'l:::lJb'fln1flin~ILV1tJ-1~'tltJf'l::: 1 0-15 b'l'h,xu

Complex febrile seizure 13J~11,xLnC1lmrini'lJJ'lnntJ'l simple febrile seizure LLil:::nlr~LnC1l febrile status epiJepticus lub~n~t1nm~ri'tlu~q:::LnC1l'fl'lmr-nmlnl-irfi13Jl~~'llt-1'bnC1l iJfl'lIJJbatJ-1~"'I:::LnC1lin"nn1-irb~JJ~U

"" !:'II 'i' "" .... .,j." .... ., .,

n1'iLn~U1J\H'it'liUJ'2inlllt1U~-1V1:IJ'ellm'i"lln"lln b"ll

b~mJnM~int;nn 1.jJiJtlr:::mru~tltJfl::: 3 "I :::bn C1l bUU lrPlflJJinmumr-1 0lt'1J~ bUU lrPl~JJi ntlr:::mrur'fltJ il::: 15 bflUin"l'lnHimri'flu mr~ntl'lfl'J'Wllt0J13J~lJtJ'lmr~bnC1lin"l'ln11iAf-1b~tJ'J "'l:::vhlt-1'lJbtlnlflbUULrflf'lJJin mnntJlfl'WtlnM

tr"'l{ u b~ tJ-1'lJ'tl-1n1 nn C1l bUU lrPl~JJi runn n1'ltln m mriJtlr:::tWi flr'tllJ A1'J bUU LrAt'lJJi nmriJ PI'JIJJ 'tlC1ltlnm 'Jj'el-1r:::lJlJtlr:::fll'Ylri'flU'I11tl'l1~-l bniJlfltl'lmrim'lnHi bbf'l:::b~n~iJ'fnmrin~-14'!?i'el~lun~JJ complex febrile seizure

I 'i.o ~ I

mrVliJ'tlln1rin"'l'lnHf~11 ltf'lltJ 1 A1-1a.nri'fluiJ1tln'lflbatJ-11umnnC1lbuuLrAf'lJJinmnntJ'lfl'WtlnMbYltJ-1bRnutltJ

"

bvh,xu

"_'1..1... .... .,....e

m'imL~~N1J'dtlVl:IJ'ellm'i"llnlOlln L"lIt'l'i.:lLL'in

.. ..

'tl'lnirint;nnlo}jPlf .. mm~-1~LUULblJlJ simple febrile seizure Lb~::: complex febrile seizure lunrru~bctiniJ

'tl'lmrintl~

1. l,rmrfntl''lbdtl-1rifm'lluL~tJ'lnlJn1rin~bnC1l~'J 111.1 AMg\lm~'fl~'l~fC1l'fl'tln"l1n(i('Jb~n4''UUtlU~:::bbfl\l1W1rtl'::: ~'lb~'f)13J1t-1' ~15mfll-l'l1:::bo}jlt1'fliJl bb~:::~'YlI\lL~ultltJlt-1'~l!?itJ13JM'el\ll.jj1'fl~liJl 1 -TiJltllnlt1'tllt-1'tJI'Vll\llhn lub'J~'l b~tJ'Jnu1'IJb-n!?l(i('Jb~flVl'llmif~IJl~\ltC1lmi'J tlJltJmrH'~hll'IJ~'ltlr:::t1l lunrru~~nntJ'linUIU (b'llmiiu 5 U1Vl) L(9l1tJJJtJ1 diazepam b~'fln;.r'IJ'tl1n1rinlC1ltJlt-1''Yll\1ltfltl!?ib~'elflil'l 'I11tlltt'Yl'l-1'Yl'J'lf",,xn 'lJU'l!?i 0.2 ~flflnfwnn. (;)'el t'lf\l (1tt~'l1~'tln 6-8 1'J1JJ\I n'l9'lbU'W)

2. b~flm,j!?iin1'Uintlr:::tWib~JJbAJJ bbfl:::CIlr'l"t1r:::bilui'l\lmtJ~-1n'IJ'IJ,f'l1t1 Lb~:::r:::'U'lJtlr:::fll'Ylb~'flfl'lm"J'lJ'el\l1if

3. bbU:::t111t-1'Mr'J"'lljbPlfl:::'lfJ'lbiu",5~'tlnr'ltJ lub~m~n ('el'l~~'lntJ'l 18 b~'1IU lh13JiJif'el,x'lJJ) bYlt1::'1Ilmmfl!?i~ ~"I :::tJ\I'IJ'eIfiO\lmrA IJl L~'fl'lJ'f)\I r::'U'lJUr:::flI'Vl L 'Wt:::tJ :::Ufn'll'el\l l~ n b~ n~j.J'l &i"JtJ'tl'l mrimrU'IJ'el n l~tJ1n ~'lltr'U b~ n~ 'fl'lf,lJJ'lnntJ'l 18 b~'tlU bbil:::~(9lr'J"'ltlr:::b~'Wbtg\'JJul"'ltJ'l 13JiJ'el'ln1m~cn~tJ'lbiiC1l"'l'lnmr~!?il~'el'JjMr:::'Uutlf::fll'Yl 'el1"1Yi"'l'lfn.mUur'ltJ 11.tl~\llunrru;1fl'Jt"'l:::M'tlo.liJn1nJr:::l~'W~t1'JtJ~I'eltll\11nt\<n!?i rh6\1fl\lnlo}j'el~ i'JJJnuiJ'el'ln1t

.. d %.' d ... j' u 1'" ... '" l' 1" il .,.

ltrfl'tl1n1rLlfll1l\l'Vlfl\lo-lU'J1 "'l:::JJn1fCllcnb'lf'el'lJ'el\lr:::'IJ'U t:::fll'Vl C1lbLn 'el1n1r'll~ 'tl1t"ltJu JJc:JiJlUJJ \I'eltb\l JJbflU(9l1JJ n(9l

iJ'fl1mrin~1 lt1tl-nn'W'lUbnU 5 U1Vl ~r'J"Iil\1n'ltJiJfl'JIJJf.jC1ltJn~'lJ'el\lr::'IJ'lJtlt:::~1'Vl ~'lluuwr'el-ll1'lmr~f'J"I

... .- ~ 1 %. ~ 'i' "..! 1 '1'-'.,. '" '" ~ d " I .,. .r ~ , 'JLflr'l:::ltU1 'lJo-IU'I1il-1 bC1lmr'J 'll\l JJ C1lLnIn"11ntJ'llJ'el'lmr'llfi'lll, 'I1r'el'fl'ln1f'Vl'l\lr:::'IJ'lJlJr:::fl'l'YlLnlJl'lJU b'l1JJ

4. n1tb"'l'l:::t~'ellJlb~'fl'l1'lfl'J1JJr:lC1lun~'Vl'l\l metabolic (electrolytes, calclurn.uaz magnesium) ~'Jr~lt'U~'l::lur'lu ~iJ'el'ln1rin~lbbil:::iJPI'l'lJJr:l!?iun~'lJ'tl@'lfr'IJ¥flti

~

5. u\l13J9'lbUU~"l:::&f'fl\lVl'lmr(9lr'J"'lb~mMJJ'Yl'l-1t-1'tl-1t1lNiimt~u 1 1'll'W fl~u1yHhfllJ'el\l (EEG) ",1'elnlrm'l"'l'Vl'l\l r\l~Ij'Vlm'lJ'el\lfllJ'el\ll'll'W x-ray skull ll~::: CT scan l'W~thtJ~lUU simple febrile seizure bb~::: complex febrile seizure ~iJtlln1timv1t.m:::tJ:::L'Jfl'lku 1 Lbt'l:::13JiJfl'JIJJf.jC1ltlnM'Yl'l\lr:::'U'lJUr:::fl1'Vlb*JJ~U

39

6. (;Ii',)'9ltft~fm~1~,)b'M~~l'111t\tn~il'flln'1i'H

7. ~llfl1m~1fl1t1'M6-l'fl1nwnnl~~1bilU~'fl'l1tX£J')nuim~~b1B~ ~blfltlth1tXtl101r~-l~n Ji'JtJn1i'1U1n1!J'1~lb'M~ 1tXtJl fl ~ HI boii~rff'J bbfl~1tXJ,)tlti1'llfltl'l'V'jtl~J1 b~~'fl

" J' e-

8. m i'~ bbflUtl-lnU 1~1M tn I?li n~l lhilHhii I?l'll U~ n 1UM1'l Mtl hi

8.1 f1j'tl4'f)iiU1tl1tX~tlnMi''fl'lf1J'Vli',)U~1'fl1n1i'in'''l1nHl 1WJl'J-lb')ftl~\J 1 .,~1;Jri'fl1tXbnl?liul?1i'1tlfJ1'fli'~UU

tl1~~1'V1

8.2 'fIfiu')tl1tX~tlnfli''fl-l~M,)1~~u19 1Un1i'~bbftb~'fl-l~U~~n~'fl'l tfl~'fl1n1i''liJMf-lfil'fl1tl 'fltil1tXii1;r~p

SI I J I • ... i-'

rff-l bbfJ1 bhn.htlblPlllltXtI1fll?l 'liJ mrmi lPl rff')~ A 1;r d'l'fl 'liJiibbU'J tU~"1~~-l~1n M'Ji'~~Ul1 tX bYitJ-l'V'jil rff-llbMi'~tl~btm 'V'j1'fl)'!

nUU1 ~Mn 1tl'V'ju bb'V'j'V16b~tl (;I1'J"1 1n1!J'1~1 t 'M~'lI'fl4H

8.3 ~tl'ltlfiU1111tX~tlnMi''fl4b~h1''1 ~4M'J1~~1~'1JUfl~~lmm 1tXn1i''ll'Jm'M~'il bdil-l~'lJ1~~nA'fl4 tl1bMn tnl?ln'illn1rim')n1;r~-l((;I')~.jj'f) 1) ri'flU~"1~1uti1~nmY"lUtb'V'j'V16

.... ·1 <>I"" ... ., ... • &:.

m'1,!!bbfll~i'u'J!lVl3.I'fl'1m'1"i1n"'lln b"ll3.l1nm1 1 fl'1~

Simple febrile seizure c:Jbbftb"Jiul~mnu~iltlln1i'oDn"11nl;rMf'lbbm tJm~ub1il-lmi'!fIi''J''1Jl1'l1i'lJ'M64 bbft~ !fIi''J''b~'£1lP1'M'1M'Jl).1WlP1tln1B'V114 metabolics fJ11'l 1 M'Ji'''1~Vi1b1!.·rn~1ui'ltl~n;]tl1.i'l~

Complex febrile seizure lPllt'iU'll'lJ b~tl')nunu'fl1n1i'in"1nHMf-lbbm tJm~'W~lhtJ"'I~lMUn1i'I?1i''J''1Mm'lJ

" v

~weJ41Ylyh

1) tilMmu1YlYh~).Itl'lwlP1tln?ioDlPlb"1U ~.nJ4~~1~i1'Jtlt.l1"1~bil'lJti'Mft).linblPltJm.jjdjuih~tJm:;~u fl'Ji'q~ Yl91i'ru.11t¥n1 i'fn1!J'lbbUU b1Mft).l-nn

2) tf1f1~u'lYlvh~).I'il-ltln?i M,)i'1tXbYitJ4~lbbU~U1b~'£1U'fl'lnUtllmi'in~1 b'llub~mnu simple febrile

seizure

VI 3.11 mVlOJ

1. M'J1bUUM'J1).1b;]lhn4;rtl1Ift~rm~il-l n4e.J~'lI'fl'ln1ioDn~bnlPl91n1;] rff'lmh'Jbd'fl4~ubbri~tJnMi''fl'lbil'W'M6n

'oJ " ..

2, mi'1-ntJ1UMnU'fl1n1rimtluflf4fll'1'lb"llu Diazepam lu'll'J-lil'l~'W Vl6491nlJiilfiu1tJttX~tlnfli''fl4'V1nU;r'f1J;jft

!fI1).1~Mh')1u;r'fl 1 'ilti1-ltJn~'fl'lbb~'J bbM~tlnfli''fl'l5'lM'l'lRnn-l'Jmbft~nM'Jl).11;J~u191Un1i'c:JwCl b~ilbnlPliltl'lmi'oDn

~ . "

;u bnN~1"'1~niJ1mrinulUbt~'Jl'111tXbnlPliie.Jm~tlfJ1tl~).I'fl-l ('lIU11?l diazepam 0.2 i1fl~nfwnn/Mf'l 'l.tX"rJn 6 'M~'il 8

1'lblJ'l1u"ll'J'l 241,)b~'lbbm'll'fl'lHibYi1t!U)

3. 't~bbU::;ti11~1,'n phenobarbital bbft~ sodium valproate lumi'fn1!J'1l~'flu'il-lnU'f)1n1~oDn~1~lni?l"'11n'H b'V'ji'1::; ;]ilJ;jfl'V11-l~'hl1n1~lJibl~ 1YI'l~'l £J'l.,r4~il4'llUI?l ~'llbJ!'£11"'1"'1:;~I?l'f)"1 n'lrin~1"11n'loir'lJi tbr>l'l;Jn W~ 1'Wn1~il'fl-ln'lJ\~1tX bnl?l

.. ..

btiU l~fI~).Iin 1'Wf1 "1 lIVi 64 'tJi U'iln"'11mrUe.Jfl;]1-l bAtJ4'l1'fl4£JT~14~il4 'fl1"'1l'11b tX tn i?ln e.J~ b~tJ fJ1'fl b~nmnn11

40

d tJVlVl 12

Infantile spasms & West syndrome

Infantile spasms ttK'lt West syndrome dj'W~n'd'rut'tl1mrin bbK'lt n~tl'a'1n1j'in~bn~b'QvntL'Wb~n ~-:)hJ ri'fltl~'fl'Uf'l'W"1NA'fln1j'fn'd'1 m~tl1n'"ltiJf'l'J'1tlr:J~tlni!i'1J'emt'U'UtJrt~TVlt'WbbN(?l'1tltl'1

'1~'I.J'1 Ul :)\,un

r.;'U1~';j'VltJ'11'WR'1~tlr.;b'VlPll'\.!'.rl'J-:)b'Jfl'1 15 t1~e.h'Wmhjilmj'btl~m.mtlK'l~ LLfltil~mn'1tru 2.9 - 4.5 11 00,000 '1J'fl-:)'Vmmn~iJ~~ 1'Wtlttb'VlM1VltJiJj''1tl .. :n'Wn1j'~n'd''11'W referral center ~'I.J~'1fl~lhmu'W1'eltlK'lt 4.9 '1J'i.l~ ~'ll'JtlltflK'ltJin ~~~~h'W1",'l,i'1J'el~~'ll'JtJA'i.l41'W'J'Wj'tld1~ r'i.ltlK'ltSO - 77 '"ltb~tlfl'fl'1n'1j'inrt"'~1~ 3 - 7 b~'fl'W LLA riil1'"l'"ltdtliJ'i.l'1n1j''''~-:)bnUl '"l'W~~ 5 tI 1'W'1JrutnU~hH:Hf'i.l(?lml-lbLU'Wil'W~-:)n1j'1oD'fl1tlmn~~~~bn~'fl'1n1t1'W",~n

, ,

bnru"lfn1j'~ihitJ

i mIW~'il'1 01'1 usemsu 'l411l..:!

'i.l1n1rinLLUU infantile spasms 'fl1'"l'"ltbn(Oll~ 3 XtlbLUU A'tl bLUU-:)tlWl'J (flexion) LLU1JL"'Utl~M'J (extension) ",1tl LbU'Ur.J~tlt..l~1'W (mixed flexion and extension) ~-l1'W~U':ltJfh'W111qj'"lt'tl'Ul'WXtlLL'I.J'Ul1i-lmnn~'1 pJbL'UU~U 'i.l1n1rin~Ln~'"ltLu'W,~ 1 'i.l1"l'"ltiln1j'~-:)L~tl-:)r'el-l~'1tlj.J'Jfl1tl",~·.m'1rin ",1tl'fl1'"l"'ltil'i.l1n1rLn;-:) mUtJPlLL~':lLnUl'fl'1mrnrtl?Jmil'\.!'JlM 1 ~'1tltl'1 t'WU'1~flf~'i.l1"l'"ltfltl'1n1t(?l'1A''1..:!ln~~'WYl¥iltl 1t1uil'el'1n'1j'mtl?jn -crn~rut'i.l1mrin'fl1'"l'"ltLn~~1'UYl1tri':l'W'1Jtl~i'1-ln1tl "'Ttl'fl'1"'l"ltflmrnj'tl?Jn1'W~n~rut~laJ~tltl'1(?lr (asymmetry) LnUl~'W1J1 ~4tl'1~9t'johl,xLnM'J1tlX'U~'Wt1'I.J'i.l'1n1rin'lliJPI~'W 11J1

~'1",f'U West syndrome ,r'Wr.rUlbil'Un*J'tnmrin~ilil4~thtn'fl'I.J 3 urtn1tl'Wn1r1,xmj''lur.;itJ l~Llri 1. il~n~rut'fl'1n1j'imL'UU infantile spasms

3. (?lr'J'"lYlW'l~'W~ml-l~LU'WLL'I.J'U hypsarhythmia

~-l fl~'W~tltl41LUU hypsarrhythmia ~Yl'U1J1uj't:j,nrurtltlK'lt 40-70 '1Jil-l~lhtl1'Wn~tlnl~tltl1nYl'U1'l.!'1I'l4'fl'1~ 3 L~'i.l'W ~~ 2 tI LL~'fI1"l'"l:::Yl'U1J1~-lbLALbrmn~'"l'Wn-l'i.l1tl 5 tI ~n~ru:::fl':l'1tJr:J~uni!i'llil4 EEG '"l:::il background tU'W

,

continuous slow wave ~flfl'J'1tl~-l'llil-lfl~'W (amplitude) 'lIU'1~1"''l,itl1n AtlUrttJ'lru 500 microvolt bLt'lt~ui'JtJ nu spike ~il-crn~rutLbflt'll'W'1~~laJm.l'U'fI'W ilmntJ~tJ'WLLtlfl-ll'l.H1-l 'll'W1P1fl'l1tJ~4'l1'fl~ spikes bbfltM'11L"'U-l~LnUl 'lItl-l spike 'fl~~K'l'fl~l'lfl'1 mh':lAtltl1r.;'"l:::~'U!tl'WL'UYl'1t~ (focal spike) Lb~'JLtl~tl'WbLtlfl-llULil'WLLUU"'K'l1tlM1LmU..:! (multi-focal spikes) ",1'fl bU'WLL'Uui'lltl (generalized) lP1tJ~'l'Wmmb~'J'1Jru:::~~lhtlil EEG Lil'W hypsarrhythmia

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2. n1ftJT:::Liju~tl':lUb~'flb.jf1fun11eJ1MM1TAftl-loft'nfl'Jf~"11fru1't1uYi~~lhtlVifUn1f~U'"litJ~1'fl~1'Wn~l-l~lhtllTfi

fll-lin~1~~tl1J~U'1l~~'fln1ffntt1~1t1tJ1 L~'1lL~~t1ln1f'l1'Wn11fntt1 bb~::fti?1~mb'VltnoN'flu

3. n1nJ1::Liju~lhtl L ~'fl b;hfu rnseh iAfntt1 hflftl-l-Dn ~~"1::1 ~.jftla,j~~~1 Mry'Vl1~n1m ~'Vl6bLriflru:::1,i iPlft1 n5''Vl1~ n1nL~1'l6~fntt1 Hl'Wn1f'SbiPlT1:::tf iJil~ul"l ~1lJnU ~1J'JtlLbft::~tJnfl1tl-l ri'1l'l;I'Vhfi1ffnH1tAtJmf~hmM ~1nr.Jft '"l1nfi1TtJr::ln'Wfl1mTrl1J'ilnu1b1ru"1l'fl~fll-l'1l-l~bllU'1(P)fhtUAn1rin (Epileptogenic zone) 1~ n1TI?iAt'll-l'fl.H~'lU

"

1J 1-b':lndl'fl'fln"1::'t111 U~lhtl U1 tI"11 n'fl1n11in 'fl tl1~ fl17T

45

~ ~ ,

4. i'WVlil'Wll ~ ::'ilfi rnnl n: lfi'Wet l.htJ '"l::ili 'WVliltm~t'ilfim:i'~1lV'l1t m :i'~1 b u'Wmntl'W:i'ttJ t blfltJ 13-:W"l1 n'ilfi Non-i nvasive

~

ttJcl'ilfi Invasive lvl'el'lhif'el:wm .. d:ilfln:::,r bb~n~iln'.jfim:i'frrtt1bVl:W1tfl:W~fllfll1.~\bri~t1')tJ

'iJ 'I\.t II 'lJ

n1~A!9lb~'fmeftl'ulv1m'11~~'lJm'i'll'i~lii'W

....

1. b:i'f1~:w1n~llJlIl'el1.H'Ij'W'el-lmn'W'nn (Medically Intractable Epilepsy) ('lJVl~ 7)

2. ~U')tlL:i'A~:wonn~fllm:i'tlfmj-11cll~')tJ'.jBn1:i'ehf?i'ill (Surgically remediable syndromes)

i'iltJ-l~

1. ~tl'ltJ1Mf'IJn1:i''.jil''litJ~1lil'WL:i'A~:w"lln ~fl1j .. mtlfm~nl~~')tJ'.jfin1:i't-i1~ill l~bbri n~:W'e:nn1:i'#I-lM'ell1.Hi 1.1 Mesial temporal !obe epilepsy due to mesial temporal sclerosis

1.2 Lesion partial epilepsy either temporal or extra-temporal foci

1.3 Hemispheric epilepsy syndrome

1.4 Secondary generalized epilepsy in infant and children (Infantile spasm) 1.5 Secondary generalized epilepsy in older patient (palliative treatment)

2. ~U(ltJL:i'Aft:win ~'W'elmVl'n'el'"l1n~t1')tJnfi:wl'Wif'el 1

" " ,

2.1 Localization related epilepsy

2.1.1 'el1n1:i'onmniJl'"l1n "Jilln1luillonn bY1tJ-l"JMlAtJ'J (Seizures arise from a focal area of the brain)

2.1.2 fl:W'fl...'llug;h'W~rJ1Mlflil'fJn hJ1rXl11V1U1~~~1~ry bb~:::llJri'fll-NlnIflA,)'1:W ~ry L~tJVlt!1~ 'el~.h...'l11fl 'flU1...'l ~~...'l fl'1m~«...'l (Dispensable brain)

2.2 Generalized epilepsy ~ilb'1lm~HnM.u'WVlntJM'el~t1'JtJ~...'l b"IlU mrln"JlUill drop attacks

... ...

".tI'el'VI1:1-1

1. Severe psychiatric disorders

2. Profound developmental retardation

3. Progressive neurodegenerative diseases 4. Benign epileptic syndrome

... 1 ..r::.a.. ~ .. ~I d !l.I Q..o" I -Q.,<' 0 tCQ c:Ii !ZJ' ~ Q.f I '1 ... ,.3

msueeuru ~lJ'J!I b'V'l'el b ".tI1'i'IJ m.'i~n lPllfl fl1'W.:JU.:J".tIil'V'l'"l'1'inA1 lPl\ll?l'el b lJ'IJ

....

1. iI1n1:i'~MtJn~'lJ'fl-l~1.hmni?l"'l1n 'el1n1:i'"lln (Seizure type) Vl1'fl n~:W'1l1n1:i'~:W<Jln(Epileptic syndrome) 1aJlrX

, ,

"'"'I. ~ ~""'" 'it IV

in ill'"l1 nfl1 LVI!?l'1l'l!1Vl :W'1l1 n1:i'Aft 1 tJ"Jl n

2. if'1ll;l~l'Wn1:i':)u'"limd'1l.:JA'W U'Wtl'Wfl"lbVll?Jmrin '1l'1Vib'll'W n1:i'Ifl:i''J9A~'Wl'fHhfl:W'fl-l~')ltJ

3. ~u')tJ1M'lJtnn'W1n ~~mlf'1l.:J bVl:W1tfl:W nu 'flln1rin Vliil n~:W'f:nn1:i'~:W"lln bb~:::1~~illr.n:wdj'Wn:tJtb,)~1V1n.:J

4. ~U'Jmb~tAj''1l'IJAf') f'IJVl:i'T!Jbb'W,)Vl1\1n1:i'tJ:i'tbfi'W bb~tm:i'fmj-1~t1')tJb:i'A~:W"lln1lUIfl llJlIl'1lUt'l'W'1l\lM'ilm:i'tm~n~'JtltJ1 r;)~ili?l'"l'WtJfJ:wfun1j'fm~nM1:Wbb'W,)Vl'1.:JM.:Jnci1'J

1'Wettl';ltJb:i'A~:win~llJM'ilU~'WfJ-:i~'1ln'l:i'fmnM')tJtJl billtlb'fl.Vn::: ~ll'JtJ~'ilul'Wn-..i:w Partial Seizures ~-.1iJ

'jJ cu 'IJ"'q

bfJm~VI"ltl"ll1i?l iI1~b"Il'W Temporal lobe epilepsies nb'1ln1t'lVl1m'1lfl lJi1i?ltlm:i'~.h~c?itJ:i't:Wlruflltl~:: 90 tbftni-:iil n~:w~'W 1 ~1~tJf.'1'"l1nmr~1riM b"IlU Complex partial seizures of temporal origin or other focal seizures, generalized, atonic, akinetic, Or myoclonic seizures, and partial seizures with childhood hemiplegia.

46

"'... - 1 ... "0'1

LAi'fl~3J'fImiui:::L3J't.!tJu'Jl!I

..

1. n'11'oDmh::.w; n1t~t'l"'lhm1tJ~'J1tl btfl::: n1t~t'J"'lhm1t1l'11\1t:::Uutlt:::fnVl btlU~\I~~1ArylWF11t1,xn1t

~U"'l,rtl 'i:t~'Cl3.lin

2. n1tA1''J'''l~~u1't'J.yh~3.ltl\l

3. n1t~t'J"H~nofbt6~3.l'il\l

t.ll1n9:::4'PltFi~'il\liJ'ilF11t~UAUttluvr3.l'WIVl~1V1qj1A 2 ilreum ~tl'llU~ Invasive bbfl:::'lIU~ Non-invasive

Non-invasive Routine EEG

24-hour Video/EEG

CT MRI

Functional MRI

Neuropsychological testing

SPECT PET

Electrophysiology for diagnosis Electrophysiology for diagnosis Structural imaging for diagnosis Structural imaging for diagnosis For functional mapping

For diagnosis and mapping

Metabolic imaging for precise diagnosis Metabolic imaging for precise diagnosis

Invasive long-term video/ electrocorticographic For precise diagnosis and mapping monitoring*

Invasive

Wad a test

For functional mapping

For precise diagnosis and mapping For mapping

Epidural electrodes

Subdural strip/grid electrodes Intracerebral depth electrodes

Intraoperative Electrocorticogram (EcoG)* Cortical stimulation*

* Diagnostic surgical options

~UA'il'Wn1t1Jt::d1Ub~'flb-ii1fumtr.hi#(~fn'l!i"1ttPl'Cl3.lin (Pre-surgical evaluation)

!::- .c..!J..' ~ ~~ x 1-" ~ d ..::.. ~ 1I'..::t lJ oCt. ..... ...J(a.o' ....

"1lUAtlUn1ttlt::mu~ll'JtI l'l'3.l"'l'1mjjbU'il\lAUlbfl:::trlt'il~3.l'il'llU~ Non-invasive ntlU bb'Cl'J9\1 btl~ 'JfiWDU'lI'ilU

bb'Cl:::bM1'fl\lil'fl"JfU~ Invasive 3.l1n~U ~\I~b~'fl1t«Ji;J'flJ;J'Cl~thA'1Jbbfl::~1btlU3.l1~bR11:::tf ~UVl1urb'Jru'il'1l-.l&'l3.l'fl\l Vl1'fl

~ ~

l''fltlbA iUltlU~UbVI!PJ'iI'fl\lh~'Cl3.lin bL'Cl::~udu~1 &'l'13.l11'bli#(i1lUrb'Jru'il'fl\l&'l3.l'fl\l~'lui1'fltln1Ji'flth\ltlfl'fl(P)i1tl ,rU~flU

~\lnfii'1'J&'l'13.l'1tmbti\lbtlu 3 1'::tJ:::1~Ufi

d .1 ~

i:::tI::Vl 1 (Phase I) lJt::nflUi11'Jtl

;Jfl3.lfl'Vl'1\1Aflun91n n1l'imJt:::1fflLbtl::Al''J'''lt1\1n'1tJ

'iJ

n1l'm'J"'lb~nofbt6&'l3.l'fl\lJi'JEJPI~u1YHhtb3.hVlftn1yHh"Jfu(p)tlt:::~VlfiJ1TI~~\I [High resolution MRI (Magnetic Resonance Imaging)]

n11'A1''J9P1~u1't'Jrh~3.l'fl\l~fi3.l'1Al'j'1'W [Routine EEG (Electro-encephalography)]

47

n1:i'~:i',)"lPl~Ug1}.J'fJ~bbUU 24-hour video/EEG monitoring ~'1tJ scalp bb~::: special electrodes mnJt:::biJull?ltJliibbUU'VH,)g1'E1U'VI1-1 Neuropsychological

n1t~J',)"lg1}.J'fJ~J1'1tJ~B Ictal SPECT (single photon emission computer topography) '1:;tJ:;~ 2 (Phase II) Ih:::n'ElUWI'1tJ

mt~J''1''l~U1Villil~~}.Jil-1~'1tJ1jj Wada test

n1t~t'1"l~U1Villil~~}.J'El~~'1tJ1jj functional MRI

'a::tJ:;~ 3 (Phase III) ut:::nilU~'1tJ

v '" I , I

" ,""~ • I = ".' 1 "" ~" ""~ " d '" ~,,,,,

'1J'elU~'ll bumJ'ut:::b}.JU~u'1tJ Wt:::tJ:::'VI 3-b}.J'el'1J'ell;l~'VI bcPl"llnt:::tJ:::Yl1-U~:::-t:::tJ:;:'VI 2- b}.Jbl'ltJ~Y'l'el-bb~:::

~t'fl hJ~}.J<Wt.!:ifnun1t~t'1"lA~Ug1}.J'fl~bbUtJ Invasive long-term video/electrocorticographic monitoring WI'1tJ intracranial electrodes t~Lui special epidural electrode, subdural strip/grid electrodes ~1il depth electrode nlJ'mt'1"lPl~ug1}.J'el-11uJ':::"dl-le.JlroicPlJl')tJ1fi electrocorticography (ECOG)n1tmJ''1''l~Ul~'lI'1.l~g1}.J'el~luJ':;:~~1~e.J''W1A J1,)tJi)fi Cortical stimulation

• I ... "'.'1 "" ....... .... 'i' ....

bb'U "l'VI'Nm'1lJ'a::b}.J'U ~lJ'dti b'V'l'fl b"ll 1 '1'U mi'3'nNl ~ 'aAa}.J"lIn

~-1bLf.JUQiJbLM)~Vi 7 ~Ul ru

n '1 itl'3'::b3:i U ~tbtJ ~'l tI ~fi'Vl1~ Ka tJ n'1'1}.J

OJ

luntru~~'l.htJtJlftJn1n..h:::b3:iULd'el-1~Ut>ll}.Jt:;:tJ:::~ 1 c;l~~tJlLb~cPl~.jh\lJfu LLil'1Y'lU~l iJ,l'lnlbilr?l'nn ~t'fJ iJ

"ll'lfhbllM~u1~vh~~cPlun~ bUl'1}.J'1.l-1 LLM~-1hil'11mn)tJ'eln'll1lUb'll!?1l1il~"lcPl~urilbllI?lA~uh..JYh~Yhb~bncPlil1n1rnn

, ,

1c!1bLUuicPl n'1J'UuWnnlmJ~tJULbU~~'lI'1.l~A~u1yjf:h"11nLd1ll'1}.J'el~1I?ltJmNbUu1fin1nh:::dju~ni)ih.,rl~~"li'1tJb~}.J P1'11}.Jbb3JU!hlUn11'~uAu ~~~Bc;l'lmh'}d~lm1'''nt:::Yh1cPl'1l?ltJn11'r.JlroicPll~1tliJojf1l1i-3~!?11}.J~1J'1~bb~cPl~~ 16

I?Il'3'l~bb~IM~ 16 ';'fIti~'l~1V1i''U Invasive monitoring
Temporal lobe seizures Doubtful side
Normal MRI
Bilateral pathology
Discordant non-invasive testing
Extra-temporal seizures Definition of extent of epileptogenic area
Extra-operative cortical mapping
. bAt1l'liJ'tIn11'U1':::biJU'llllcPl Invasive long-term Electrocorticographic/ video monitoring iJiiil~l'Umt UU~ nrl~u1 yj Yf 1~}.J1l~'"l1 n b tl'fJ g1 }.JiI~1J1LA tl ~t-l U nfDl"11 nnre bb~1yjYf '1tun '1U"l1 nn11''1Juu~til n~ 1}.J btlfl (movement/muscle artifact) ~'du<il'fl~lnM A1l L~tJ~"l1ne.Jmb'VIm.rilU~i11"l"'l:::bncPl~U"'l1nm1'thWfcPlm1}.J!?111'1-1~ 17 ~1}.J1t(1Uuil n rl~ut yjYh"11 n bnil~}.Jil~ 1 UbbA~:::A}~ tc!11 uu'1t'l ru~ 111M b~i1 bmtllJ LVi uu l1u7:ififi~~}.J cPl1 bb~::: bA11l'liJ'tI

'3!i " "" ..J. I - 1 ,Ji. I "

1.'llJP'lU}.Jt1ronbll'l'l bPl~'1.l~n1~uJ':::b}.JU un~}.Juu~:;n'tllJ(?]'1tJ epidural electrodes. subdural strip/grid electrodes

bb~::: depth electrodes

48

J?l1';11.:1bbj;'H'){I£ 17 ~flbb'VIini'elu~lnfntracranial monitoring
Procedure Reported complications
Depth electrodes Hemorrhage
Infection-intracranial abscess
Malplacement
Subdural strips electrodes Hemorrhage
Infection-meningitis
Subdural grids electrodes Infection-bone flap
Raised intracranial pressure Intraoperative Electrocorticography (EcoG)

A~ul~~ 1~1.I'1l\1~ nU'Ulln Lrnu (>IN"llnth~l.I'El-1!11mHr-1 wmll ~ b~'fI~l.I~l.Ii1-1 LrnUb; bA1i1-1!lil~ilH1.u

r t.- I "

Vl'fl-1(M11rn 'M1i1 bb1JUYI~~bbU~-1~'Ub'El-1 bA1i1-1!lil"llUrnu~:::1l11.11UrnMrnnlJn:::L'M~n~r1j:::u1'b'mJ"lI'El1J craniotomy Lrnu11i

skull peg ~~rnn1Jlb~1:::b~n1 (small drill hole) n'uUwl1nAll'Wl~Yh~l.Ii1-1~ln electrodes 1W!UbblJU 16-channel bipolar ~f'Ell.ln1J referential recording tJr:::Lu"llu~in'll'fl-1 EcoG At) b~'fImii1bLWW-1~mfig;lfl1w (localize pathology) ~'Jtln1rUul1nA~ul~.y;h~l.I'El,.'j 1.I1·jhtJur:::n'!l1J;r'fll;l~~1~"lln preoperative imaging bb~::: ~tJ1fiM1~ 1:::w:h~th#f~ (visual inspection) ~1J~1 EcoG ~ll.1'lHl1J'!ln~lLbVlti..j'lJ'!l-l cortical dysplasia 1~'!lthm~w81bti'fl{l "lln~tI1fi~J11w"llilrnUllJ~lmrC1b~wl~~'JtlWl U'flm1n~ i11n1iin~Vllt1'lJ1'rdhrl.l'WwfinlJw~wtJ1fi~Jl1~~RNn'U W1bbVlU{l~#fA'fI'fln1tHin~'JtJ

Cortical stimulation

1wil"l"l'!Jw~fin1rmM1bbVlti-1n1ii,m1i'll'fl{l~1.I'El{l~bblJu81~M A'1l ~fin1mi:::~,U~'J~l.I'!l{lr:::VI~l{1n1r~"wiA

. .

(Corti cal sti mulatio n) b ti'fl {I"l 1 nw U~1 tlTt'Jru. 'lIfl{lfll.l'1l{l~YI1{1 rn tJ'jfl1 A b~ '1l~1 L UU 'U 1L ') rw~ i{l mrvi'l..']l URll.1 bbWUJJij~ nlV1U(?l m~flnM'1l{lbfll.l'1l1U A{ltJub~'1l~rnL'1ln1flbnAilruVl1bbl'lmo!'!lU~lnn1r~1(i](?l n1r~lMlbbVIti..']fll.l'M~'lI'1l{ln1r

~ w

held ~{I~fin1rnr:::~'WnilA'J111bbRnlkNn'!.nr{l~;'!.111lJ 1J1b'Jru.fll.l'1l..']~i{ln1r 1UVI1.J1~f9il{11 '!llt;b-nU m1ni:::~wu1b,)ru peri-Rolandic b~tl(?lmnflll'1lu1VI,)bbrl:::flJfl'J111T~n'lJfl-1bb"ll'W-'lJ1 L1fnr:::bbfll~Yh~il"llUli?l~l n~1~11ib~'1lmA1bL'\.Iti{l

~ ~

Visual areas.

'El U1{1trn(>lll.1L uil"l~'!Jum r11imru i::: Li1uYI1{1 MfltJ nnl.l i:lU'I'IU1'1'1flC'lfl{l m~'dur:::l.I1ru.¥i1 Ufl::; 10-20'll'f){I ~1u'JuwibUb~'f){I"l')nn1r~nlW1~lU neuroimaging ~L~oir'1ll.lfl~btl'Wtli::;LtJ'lI'l.nUn1rur::;LiJuwil'JtJritlue.hAM;j.J1n;u

~ ~ ~

n1';1~.h~1PI.rm~t1hl"lfl:IJin (Epilepsy Surgery)

~~~U~t~.:IAn1~~1~1PI.rn~1t~l"Iflllin

t ~'f)L ~~ihmntJ'"l1 nmrin'1lU1{1 tl1')mfl:::~ ll.11rfln~lJl.I1Lm~ (>IL t.l«~fl1I1~ L '\.I!l'ElUflWtl n M Vl1n~il'JtJtJl{1 r1tJ~Ur:::biju~b~'J~11lJfl1l.11ifl fn1j') 1 ,r'\.l1tJ'111 rnl~ n1r~1AC'I"l en r::;Yi 1 b~ilum '1'111)1 rnr LrnU*flM fl'J1 l-l1UtbN Lbfl::: f1'Jll.1~'lJtl{ln1rin b~'f)~AA'J111b~tJ~~1{11~bUUW~"llnn1i'nn

49

"1iUt'lnl'i~h~1Pl

n'1n.hl'i~fn11'lbT~t:u.Jinwn.JlTrl91bb'Wn (illj.J-rIfl~lh~~..:j~'lI'tl..:jfi1Tfn11'l1~ 2 lJr~Ul'Yl (I1l'lT'l..:jtb~IPl-1~ 18)

1. Resection / definite surgery n~j.Jdn1Tfnmb<fltJn'1Tr,hrl'1Pl 1JltJ~~mn b'tln'l~tt'ltl'1'ln'El'ln'lTin~1ltJ i1~ 90-95 'eJ'ln'1Ti'n'll'fl..:j~lhmrn'El~1'Wn~j.J Partial seizures ttr'fl n~j.J localization related epilepsy ~mfi~il'l~ tb~~~'fItJ1T~~~'lJtJtl8~~~1'Wn~j.Jd~'EI mesial temporal sclerosis ~..:jtJ~fi1~fn'l!t1bt'ltJn1T~hl'i1Pl ( anterior temporal lobectomy ~lfl amydalohippocampectomy) iJ1h~~YlfiJl'l~\1..:j~i?li..:j1'Wbb~b'flm~mtJimbftt~1'lj.Jt~tJ..:j"l'lnn'lH.h

2. Non-resection / palliative surgery n~'J.Ji!uJrVlJ.Jrfl'l/fNm5'thpf(fJt~iJfitJIn15"m1nt::'"I'lfl'lfiNfI~wlw WriWiJ.Jrfnl iU't!'itJlfJlnl tin ~.Jnl1U'fitJIfl')'lJ.JlW"N"fI::fl'J'lJ.J5'11iJ.JfJ'lm5'';n L~fJ LU'~ihf1fitJIillll tllifl.J'"IlntJfI lmm.uiJU'lfiJ1fJ'ln1ri'n l'liW Lwyihflrfifmtinu1J1J drop attacks mn1'l~.hl'it'l Corpus callosotomy ~l&J'lTnf11Pl

1 .Resection Idefinite surgery

a, Epileptic focus

1 .Anterior temporal lobectomy (A TL) 2.Amygdalohippocampectomy

3.Neocortical resections

Focal epilepsy secondary to foreign tissue lesions (e.g. cavernous, AVM, tumor)

2.Non-resectionl palliative surgery 2.1 Disconnection

a. Callosotomy

b. Hemispherectomy

c. Multiple subpial transection (MST)

2.2 Augmentation

a. Cerebral stimulation

b. Vagal nerve stimulation

~~ 'U'l'Vll..:j nlie.ll ~ IPlfn'tn b iA'Cl ~-nn

mnii'tln'llUt'ln'lHhrl' i?lfn1111T~f1l.Ji'n~'\J1;'IJ(il'll.JA 'l~bWW":) tbft~~n11ru~'lI'il":) Epileptogenic foci 1fI1l.J

,

lbtJWJilli 8

e.J'Clnliin'l¥!

tJftmHhl'i~fn'l!tlL~~ftj.Ji'n ((il'ln..:j~ 1 9) ~T1'IJT!)&J"IlnmnhT1'"ll"'lu~fntl1bTrt~mi'n 1 00-tt'l-i..:J-k1bftn1u-

~

u~j.J'lthu tJM1tl:.hAi?lfn11'l~;U'fltl'l..:j(f]mii'il-l ~'IJ"I'lm''ltJ..:JI'W''I'ln~u5fntl'lb~rt~&Ji'n(f]'l.:j1(ilfl'ili?l'"lU''lln n'ln~u'fl ntJ,nw1'W~tlr~"ll&JU'l'l..!'l'llIA

50

f1'J'l~~~~htun1j'fn1!t'l (cost effectiveness of surgery) ~rufl1l'1~'ijLPl"1l'fl~~lhtJtttr~n1j'~.h!?lt?l b'flm~mj'llj'::;n'fltJ 'fl1~l'I tb~::;mtllj''l~''l'lmJ~LL'Vlmoj['il'IJr,nn1mj'~11'it?l Llluth~''lJ

1Pl'l'31.:! V119 ~~m'i~h!Kl?l;n'hl11'3A~3J-nn (Worldwide, 1986-1990)*

Surgical Procedure No of Patients Outcome %
Free of Seizures+ Worthwhile No worthwhile
improvement++ improvement
Temporal-lobe
resection
ATl 3579 67.9 24.0 8.1
Amygdalohippo- 413 68.8 22.3 9.0
campectomy
Neocortical resection 805 45.1 35.2 19.8
lesionectomy 293 66.6 21.5 11.9
Hemispherectomy 190 67.4 21.1 11.6
Multilobar resection 166 45.2 35.5 19.3
Corpus callostomy 563 7.6 60.9 31.4 "Result reported for 100 epilepsy-surgery centers at the second International Palm Desert Conference in 1992. Data were obtained from Engel et al.

+The patients had to be free of disabling seizures for at least two years. Some patients may still have occasional auras. Patients take antiepileptlc medication for at least two years postoperatively and may elect to continue thereafter.

++ This was defined as more than a 90 percent reduction in the frequency of seizures. This category includes patients who may have had only one or two seizures since surgery.

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53

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