Challenge 2010


Lecture Notes

Lecture Title : Epilepsy Prof name : Dr.Mostafa Shihebat Done by : Pharmacy students Corrected by : Dentistry students


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First we must differentiate between epilepsy and seizure: Seizure )‫ :( النوبة‬it is a pretemporary disturbance in the electrical activity and excessive neuronal discharge and it is the symptom of epilepsy disorder .

‫( زٌادة فً الشحنات الكهربٌة فً الدماغ او منطقة معٌنة منه , او زٌادة نشاط‬ )‫الخالٌاة العصبٌة أو مجموعة منها‬
Epilepsy )‫ : (الصرع‬it is a chronic neurologic disorder, characterized by a seizures . Remind that neurotransmitters are: 1-exitotary, for example : glutamate and aspartate 2-inhibitory, for example : GABA (ɣ-aminobutyric acid) ɣ=gama


when there is an excessive secretion of excitatory neurotransmitters or imbalance between excitatory and inhibitory neurotransmitters , this will lead to epilepsy , so we can say that the cause is some neuronal cells fire abnormally.


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- if a person has one seizure , can we say that he has epilepsy
? No, because ti one time seizure, if he stay for 2-3 years without recurrent of other once , he is not an epileptic patient , so the seizure must recurrent to consider epilepsy .

- 90% of epilepsy occurs in developing countries, and the average age of epileptic patient is 25 yr. old, however, any age can get epilepsy any time . There are many people with epilepsy who are within the age 6 to 10 years. So there is no limited age for epilepsy, it could happen to old or young people.(50% epilepsy happens at the age of 25) The brain is the source of epilepsy , all brain functions like moving muscles ,thinking, seeing, feeling and others are depend on electrical signals that pass between neurons in the brain . Seizures occur when too many nerves in the brain fire too quickly causing an electrical store.


causes of epilepsy: 1) 70% of epileptic people with unknown . 2) 30% have known causes: 1. trauma in the head )‫( صدمة أو رضة‬


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2. Infections in brain like meningitis. 3. Heredity, genetic mutation. Let us talk about genetic mutation: Some genetic mutations may occur in the genes that code for sodium channel proteins; these defective sodium channels stay open for too long, so more Na enter the post synaptic and Glutamate, an excitatory neurotransmitter, may, therefore, be released in large amount , so the excitation increased in the post synaptic neurons .

‫ٌعنً ان التغٌر الذ ي ٌحدث عادة ما ٌحدث فً الجٌن المسؤول عن صناعة‬ ‫البروتٌن المخصص لصنع قنوات الصودٌوم , فعندما ٌحدث الخلل , تبقى قنوات‬ ‫الصودٌوم مفتوحة , فٌزٌد افراز الخلٌة العصبٌة للصودٌوم وٌدخل للخلٌة‬ ‫العصبٌة المجاورة لها, وبذلك أٌضا ٌتم افراز الناقل العصبً المُنشط مثل‬ ‫الجلو تامٌت , وٌدخل الخلٌة المجاورة مما ٌجعلها فً حالة نشاط وتحفز لفترة‬ ‫أطول , وهذا ما ٌخلق سٌاالت عصبٌة وشحنات كهربٌة متسارعة وبشكل غٌر‬ . ‫الذي ٌألفه الدماغ‬
Seizures are classified into 2 types:

Generalized seizure

Partial ( or localized ) seizure


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Involve all the brain and include loss of consciousness

The source of charges is only a part from the brain , it may include loss of consciousness or not ,usually it can be marked by jerking of eyes only


Very important note :

Source of seizures it may be any region in the brain , but some regions are more susceptible to cause seizures , the most important region is the Hippocampus which is responsible for short term memory , long term memory , spatial navigation.

The Hippocampus, which contains a large volume of just such glutamate ( excitatory neurotransmitter) , is especially vulnerable to epileptic seizure and subsequent spread of excitation , so it is considered as a major source of epilepsy .


symptoms that indicate a seizure disorder :


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1. 2. 3. 4. 5.

(it is vary from one to other ,depending on the seizure type ) The most important one is, the recurrence of seizure. Sudden falls for unknown reason. Confused memory, emotional disorders. Visual and hearing disorders . Convulsion or not ,( don’t forget that generalized epilepsy is always associated with convulsion) .

6. Lip smashing, chewing, repetitive and involuntary but coordinated movement, muscular contraction of the face. 7. Muscle rigidity, spasm, head turning, eye jerking (blinking). The duration of a seizure it may range from 1-2 minutes , it may happened only by jerking eyes , it depend on the seizures type and the region in the brain that considered the source of the electrical changes .


Treatment :

Epilepsy is not curable , treatment is for controlling only , that means , instead of having one episode ) ‫( نوبة‬every week , it will be every 3 years . -Epilepsy is not shameful. -It doesn’t effect the IQ of person , and doesn’t cause any mental retardation in general .
Epilepsy Page 6

- How to diagnosis epilepsy? 1) ECG , but it may appear normal in some epileptic patient 2) MRI (Magnetic resonance imaging) . 3) CG scan = computed tomography scan .


What to tell your doctor if you have epilepsy ?

Tell him about symptoms patterns , how you felt after the episode and preseizure activity.


What propagate epilepsy?

1) There is 2 important factors: flashing of lights, photosensitivity and Hyperventilation. 2) Stress and anxiety. 3) Hormonal changes. 4) Lack of sleep. 5) Menses (menstrual cycle ). 6) Mismedication.


Treatment may be by medications or by surgery which used to remove the hyper active region in the brain. How o help an epileptic patient? First and the most important thing is to keep the airways opened , and put something rubber to bite by his teeth in order not to bite his tongue or cut it and to avoid any
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thing may stop his breathing . (shoes), as Doctor mentioned as an example for the previous case.


avoid any thing may harm him like knives , sharp things. In the hospital , they may give him( IV) Na- thiopental or pentothal which is short rapid acting Barbiturates . that are a class of drugs that act on the GABAA receptor in the CNS. We know that GABA have inhibitory action that antagonize )‫ ( لها عمل وتأثٌر مضاد‬the excitatory action , then it decrease and prevent the neuronal hyperactivity Barbiturates have anxiolytic )‫ ( مهدىء‬and anticonvulsant
) ‫. (مضاد للتشنجات‬ ) ‫) وهذا مناسب فً حالة النوبات الصرعٌة التً ترافقها التشنجات‬





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