Seizure and epilepsy

• Seizure-paroxysmal event due to abnormal

excessive or synchronous neuronal activity in
the brain
• Epilepsy-condition in which a person has
recurrent(two or more) seizures due to a
chronic, underlying process
Focal seizures
(Can be further described as having motor, sensory, autonomic, cognitive, or other
features)
Generalized seizures
Absence
Typical
Atypical
Tonic clonic
Clonic
Tonic
Atonic
Myoclonic
May be focal, generalized, or unclear
Epileptic spasms
• Focal seizures originate within networks
limited to one cerebral hemisphere.usually
associated with structural brain anomaly
• Focal seizure are with dyscognitive features or
without .can also become generalised
• Generalized seizures arise within and rapidly
engage networks distributed across both
cerebral hemispheres. Originate from cellular
structural,biochemical anomalies
• Absence seizure-sudden, brief lapses of
consciousness without loss of postural control.
lasts for only seconds, consciousness returns as
suddenly as it was lost, and there is no postictal
confusion.
• Commonest seizure of childhood
• Accompanied by subtle bilateral motor signs such
as rapid blinking of the eyelids, chewing
movements, or small-amplitude, clonic
movements of the hands
• Generalised tonic-clonic convulsion-commonest
seizure
• common seizure type resulting from metabolic
derangements
• Sudden but some patients describe vague premonitory
symptoms in the hours leading up to the seizure
• Initial phase is tonic contraction of muscles throughout
the body
• After 10–20 seconds, clonic phase, produced by the
superimposition of periods of muscle relaxation on the
tonic muscle contraction occurs
• periods of relaxation progressively increase until the
end of the ictal phase, which usually lasts no more than
1 minute
• Post ictal state of unresponsiveness, muscular
flaccidity, and excessive salivation that can cause
stridorous breathing and partial airway obstruction
follows. Bladder or bowel incontinence may occur at
this point.
• Consciousness is regained slowly,confusion may occur
• headache, fatigue, and muscle ache that can last for
many hours follows
• Atonic seizures - characterized by sudden loss
of postural muscle tone lasting 1–2 seconds
• Myoclonic seizure-Myoclonus is a sudden and
brief muscle contraction that may involve one
part of the body or the entire body
 Risk factors
• Trauma
• Alcohol withdrawal
• Illicit drug use
• Idiopathic
• Cerebrovascular disease
• Brain tumor
• Metabolic disorders (uremia, hepatic failure, electrolyte
abnormalities, hypoglycemia, hyperglycemia)
• Alzheimer's disease and other degenerative CNS diseases
• Idiopathic
• Childhood onset-developmental,asphxia etc
 diagnosis
• focus on the symptoms before, during, and after the
episode in order to differentiate a seizure from other
paroxysmal events eg sncope,TIA,migraine,acute
psychosis,psychogenic,panic
attacks,hypoglycemea,alcohol black outs,
• History of epileptogenic factors such as prior head
trauma, stroke, tumor, or CNS infection
• Precipitating factors such as sleep deprivation, systemic
diseases, electrolyte or metabolic derangements, acute
infection, drugs that lower the seizure threshold eg
antipsychotic,some antibiotics,alcohol,illict drugs etc
• EEGs
• Neuroimaging preferentially MRI seizure
protocol for all new seizures
• In acute onset CT scan brain to diagnose
CVAs,brain injury etc
 treatment
• All patients with recurrent seizures
• Patients with seizure and structural cause eg
trauma,
• If reversible cause eg hypoglycemea may not
need treatment
• Index seizure-treatment is controversial but high
risk of recurrence includ an abnormal neurologic
examination, seizures presenting as status
epilepticus, postictal Todd's paralysis, a strong
family history of seizures, or an abnormal EEG
 Drugs therapy
• Mode of action is by blocking the initiation or
spread of seizures.
• This occurs through a variety of mechanisms
that modify the activity of ion channels or
neurotransmitters
– inhibition of Na+-dependent action potentials in a
frequency-dependent manner eg
phentoi,carbamazepine,lamotrigine,topiramate
– inhibition of voltage-gated Ca2+ channels
(phenytoin, gabapentin, pregabalin
 Drugs -MOA
– attenuation of glutamate activity (lamotrigine,
topiramate, felbamate),
– potentiation of GABA receptor function
(benzodiazepines and barbiturates),
– increase in the availability of GABA (valproic acid,
gabapentin, tiagabine),
– modulation of release of synaptic vesicles
(levetiracetam)
 Specific treatment
a)Generalised tonic clonic seizure
-first line valproic acid,lamotrigine
Alternative-carbamazepine phentoin,
b)Focal seizure
first line-carbamazepine,lamotrigine,phentoin
alternative -valproic,phenobarbitol
c)Absence seizure
first line valproic,ethosuximide
Alternative-clonazepam,lamotrigine
d)myoclonic,atypical absence
valproic acid,lamotrigine,topiramate
alternative-clonazepam
• Stopping treatment-after two years of no
seizure and patient understands the risk and
benefits of discontinuation
• Gradual reduction of dosage over 2-3 months
 Status epilepticus
• continuous seizures or repetitive, discrete
seizures with impaired consciousness in the
interictal period.
• duration is between 15-30 minutes
• First line treatment-lorazepam and alternative
include phentoin 20mg/kg as a loading dose
• If after above seizure continues then
phenobarbitol 20mg/kg or valproate 25mg/kg
• If above fails admit ICU and use IV anaesthetic
like midazolam,propofol,