epilepsy

Bintang Senayudha Wirasakti

1610211132
Definisi

▪ Epilepsy is defined as a brain disorder characterized by an enduring

predisposition to generate epileptic seizures and by the
neurobiologic, cognitive, psychological, and social consequences of
this condition

▪ At least two unprovoked seizures are required for the diagnosis of

epilepsy
Epidemiology

▪ was about 100 cases per 100,000 persons aged 0–1 year, 40 per
100,000 persons aged 39–40 years, and 140 per 100,000 persons
aged 79–80 years. By the age of 75 years, the cumulative incidence of
epilepsy is 3400 per 100,000 men (3.4%) and 2800 per 100,000
women (2.8%)
▪ parasitic infections account for an increased incidence of epilepsy
and seizures.
ILAE classification of
Epilepsy
etiology

▪ Structural
▪ Genetic
▪ Infectious
▪ Metabolic
▪ Immune
▪ Unknown
Structural etiology

▪ A structural etiology refers to abnormalities visible on structural

neuroimaging
▪ Structural etiologies may be acquired such as stroke, trauma, and
infection, or genetic such as many malformations of cortical
development
▪ mutations in the genes TSC1 and TSC2 encoding hamartin and
tuberin
▪ Eg: tumor, neonates undevelopment of brain
Genetic etiology

▪ Neonatal Epilepsy, most families have mutations of one of the

potassium channel genes, KCNQ2 or KCNQ3
Infection

▪ neurocysticercosis, tuberculosis, HIV, cerebral malaria, subacute

sclerosing panencephalitis, cerebral toxoplasmosis
▪ may also refer to the postinfectious development of epilepsy, such as
viral encephalitis leading to seizures in the aftermath of the acute
infection
Immune etiology

▪ Examples include anti-NMDA (N-methyl-D-aspartate) receptor

encephalitis and anti-LGI1 encephalitis
Focal Epilepsies (partial epilepsies)

▪ unifocal and multifocal disorders as well as seizures involving one

hemisphere
▪ diagnosis is made on clinical grounds, supported by EEG findings.
Generalized epilepsies

▪ typically show generalized spike-wave activity on EEG

▪ may have a range of seizure types including absence, myoclonic,
atonic, tonic, and tonic–clonic seizures
▪ diagnosis of generalized epilepsy is made on clinical grounds,
supported by the finding of typical interictal EEG
diagnosis

▪ Ground clinical during ictal

▪ EEG
EEG

▪ records cerebral electrical activity detected by ‘‘surface’’ or ‘‘scalp’’

electrodes
▪ They also note the time scale, which is determined by vertical lines
on the EEG paper or displayed as 1-second horizontal bars
▪ The normal dominant EEG activity is in the alpha range of 8 to 13
cycles-per-second, or Hertz (Hz), and detectable mostly over the
occipital region
▪ Beta activity consists of high (> 13 Hz) frequency activity, usually with
low voltage overlying the frontal lobes. Beta activity replaces alpha
activity when people concentrate, become anxious, or take
medications
▪ Theta (4 to 7 Hz) and delta (< 4 Hz) activities occur normally in
children and everyone during deep sleep but are usually absent in
healthy alert adults. When present over the entire brain, theta or
delta activity often indicates a degenerative illness or metabolic
derangement
Ictal EEG

▪ During a seizure (ictus), the EEG reveals paroxysmal activity usually

consisting of bursts of spikes, slow waves, or complexes of spike-and-
waves or polyspikeand- waves. However, muscle or movement
artifacts may obscure the ictal EEG abnormalities. After the seizure
▪ in the postictal period, EEGs commonly show only slow low voltage
activity, postictal depression, often followed by diffuse high voltage
slowing