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Department of Neurology
Andalas University
Padang
Abnormal and recurrent excessive
synchronized discharge of cerebral neuron
with clinical manifestation of epileptic
seizure which are an intermittent
stereotypical behavior, emotion, motor
function or sensation
Paroxysmal depolarization shift (PDS) of the
resting membrane potential, which triggers a
brief rapid burst of action potentials terminated
by a sustained after hyperpolarization
PDS : result of imbalance between excitatory
(glutamate and aspartate) and inhibitory
(GABA) neurotransmitters
Abnormalities of voltage controlled membrane
ion channels
Imbalance between endogenous
neuromodulators, acetylcholine favoring
depolarization and dopamine enhancing
neuronal membrane stability
Asynchronous burst firing in some
hypocampal and cortical neurons
Generalized epileptogenesis :
asynchronous burst firing in abnormal
thalamocortical interaction
Developed countries :
annual incidence 50-70 cases per 100.000
Developing countries : prevalence 1%
Incidence varies with age
Idiopathic
Cryptogenic
Symptomatic
Congenital anomalies
Tuberous sclerosis
Storage diseases
Intracranial
haemorrhage Intracranial Head Injuries
Infections
Febrile
Seizures
Drugs Cerebrovascular
Hypoxia and degenerations
Hypoglycaemia alcohol
Hypocalcaemia
0 1 5 10 20 60
Age (years)
Common Occasional
•Sleep deprivation •Barbiturate withdrawal
•Alcohol withdrawal •Dehydration
•Television flicker •Benzodiazepine
•Epileptogenic drugs withdrawal
•Systemic infection
•Hyperventilation
•Head trauma
•Flashing lights
•Recreational drugs
•Diet and missed meals
•AED non-compliance
•Menstruation
•Specific “reflex” triggers
•Stress
•Intense exercise
Partial seizures (beginning locally)
Simple partial seizures (without impaired
consciousness)
with motor symptoms
with somatosensory or special sensory symptoms
Complex partial seizures (with impaired
consciousness)
simple partial onset followed by impaired consciousness
impaired consciousness at onset
Partial seizures evolving into secondary
generalized seizures
Generalized seizures (convulsive or non-
convulsive)
Absence seizures
Typical
Atypical
Myoclonic seizures
Clonic seizures
Tonic seizures
Tonic clonic seizures
Atonic seizures
Unclassified seizures
Partial seizures
Simple – preservation of awarness
Secondary generalized
Generalized seizures
Absence
Myoclonic
Tonic-clonic
Tonic
Atonic
Localization-related (focal, local or partial)
epilepsies and syndromes
Idiopathic epilepsy with age-related onset
Structural lesion
Scan should be repeated periodically :
Suspicion of a tumour
47%
First drug Seizure-free
13%
Second drug Seizure-free
40%
Refractory
Malingering, pseudoseizures
Underlying neoplasm
Wrong drug(s)
Inappropriate for seizure type
Wrong dose
Too low (ignore target range)
Wrong patient
Poor compliance with medication