SEIZURE AND Dr VENKATESH JALLU.

EPILEPSY
DEFINITION
SEIZURE: Transient occurrence of
signs or symptoms due to abnormal
excessive or synchronous neuronal
activity in the brain.

EPILEPSY: Condition in which a

person is in risk of having recurrent
seizures due to chronic underlying
process. Single or recurrent seizures
due to correctable or avoidable
circumstances, does not necessarily
have epilepsy.
FOCAL
ONSET
SEIZUR
ES
FOCAL SEIZURE WITH
AWARENESS
FOCAL SEIZURE WITH
IMPAIRED AWARENESS
EVOLUTION OF FOCAL TO
GENERALISED SEIZURE
GENER
ALISED
ONSET
SEIZUR
E
GENERALISED TONIC CLONIC
SEIZURE
TYPICAL ABSENCE SEIZURE
PSYCHOGENIC,
NONEPILEPTIC
SEIZURES
(PSEUDOSEIZURES)
Completely asynchronous thrashing of the limbs
and repeated side to side movements of the
head; striking out at the person who is trying to
restrain the person; hand biting, kicking,
trembling, quivering, pelvic thrusting,
opisthotonic arching postures; and screaming or
talking during the ictus; eyes kept quietly or
forcefully closed.
CREATINE KINASE LEVELS AND SR.
PROLACTIN LEVELS ARE NORMAL
AFTER HYSTERICAL CONVULSIONS.
CAUSES OF
SEIZURE AND
EPILEPSY
APPROACH TO A
PATIENT WITH
SEIZURE
MANAGEMENT
1. Treatment of underlying condition.
2. Avoidance of precipitating factors.
3. Antiepileptic drug therapy.
4. Surgical treatment of refractory epilepsy.
WHEN TO START
ANTIEPILEPTICS??
One or more risk factors present:
1. An abnormal neurological examination.
2. Seizures presenting as status epilepticus.
3. Postictal Todd’s paralysis.
4. A strong family history.
5. An abnormal EEG.
Other considerations of structural abnormalities and job description.
SELECTIO
N OF
ANTIEPILE
PTICS
WHEN TO DISCONTINUE
THERAPY??
1. Complete medical control of seizures for 1-5 years.
2. Single seizure type, with generalised seizure having better prognosis than focal
seizures.
3. Normal neurological examination including intelligence.
4. No family history of epilepsy.
5. Normal EEG.
ATTEMPT TO WITHDRAW THERAPY BY TAPERING OVER 2-3 MONTHS
AFTER 2 YEARS WHO MEET ALL THE ABOVE CRITERIAS.
STATUS EPILEPTICUS
Continuous seizures or repetitive, discrete seizures with impaired consciousness in
the interictal period whose duration is traditionally 15-30 min, but practically
considered if acute use of anticonvulsant is needed.
For GCSE, typically beyond 5 min.
Focal SE with impaired consciousness 10 minutes.
Absence status epilepticus 10-15 min.
NON CONVULSIVE STATUS
EPILEPTICUS
A condition of ongoing or intermittent seizure activity without recovery of
consciousness in between attacks without convulsions and lasting more than 10
minutes.

Tt: IV Lorazepam + Antiepileptic

REFERENCES
1. Harrison’s Principles of Internal Medicine 20e
2. Adam and Victor’s Principles of Neurology 11e
3. API Medicine update 2020
4. International league against epilepsy
5. Neurological Society of India
THANK YOU