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.Definition The term "epilepsy" denotes any disorder characterized by recurrent seizures. A seizure is a transient disturbance of cerebral function due to an abnormal paroxysmal neuronal discharge in the brain.
. Infections as a cause of epilepsy are more common in developing countries.Prevalence The prevalence of epilepsy is 4-8 per cent. The causes of epilepsy differ in different parts of the world. Solitary lesions of neurocysticercosis are an important cause of epilepsy in India.
Cerebral anoxia. carbon monoxide poisoning) Congenital abnormalities (hydrocephalus) . hypocalcaemia. microcephaly. Infection (meningitis. porencephaly) . phenylketonuria) Infection (meningitis.Etiology Newborn and infancy Birth trauma. parasitic infestations) Toxins (heavy metals like lead.g. Childhood Birth trauma. Metabolic abnormalities (e. congenital syphilis) 2.g. Developmental abnormalities (e.
.Etiology contd. Neoplasm Cerebrovascular disease Degenerative (Alzheimer's disease . Older adults (36-65 years) Head injury. Adolescence (10-20 years)Idiopathic Infection Head injury Toxic Degenerative (Ramsay-Hunt syndrome) 4. 3. Young adults (20-35 years) Head injury Neoplasm Infection Idiopathic 5.
large groups of neurones are activated repetitively. This produces high-voltage spike-and-wave EEG activity. . During a seizure. the electrophysiological hallmark of epilepsy.Pathophysiology Spread of electrical activity between neurones is normally restricted and synchronous discharge of neurones takes place in restricted groups producing the normal EEG rhythms. Inhibitory synaptic activity between neurones fails. unrestrictedly and hypersynchronously.
. During seizures of almost all types. These bursts are Na+ dependent at their onset and Ca+2 dependent at the end. Extracellular K+ rises after a brief delay in comparison with the drop in Ca+2. A sustained depolarisation of the membrane with a burst of action potential occurs during convulsive seizures. Seizures develop when the balance between excitatory and inhibitory mechanisms is disturbed at the cellular or the synaptic level At the cellular level Depolarising inward ionic currents = repolarising outward currents – normally. the extracellular concentration of Ca+2 drops significantly. The extracellular Na+ falls moderately with a smaller rise in extracellular CI-.
cytokines and steroids and inhibitory ones like Gamma Amino Butyric Acid (GABA) and glycine. peptides.Neurotransmitter imbalance At the synaptic level there is an imbalance between the excitatory transmitters like glutamate.acetylcholine. purines. histamine. . corticotropin releasing factor.aspartate.norepin ephrine.
Types of Epilepsy .
Complex partial seizures (consciousness is impaired) 1.Simple partial onset followed by impaired consciousness 2. olfactory.Partial (focal) seizures A.Autonomic symptoms B. Simple partial seizures (consciousness preserved) 1. C.With motor signs 2.With psychic symptoms (dysphasia. Partial seizures evolving into secondarily generalised seizures .With sensory symptoms (visual. affective symptoms) 4. auditory. hallucinatory.With automatisms. somatosensory) 3.With impairment of consciousness at onset 3.
II. normal activity is resumed.Absence seizures. Each attack is accompanied by 3 Hz spike-and-wave EEG activity .Generalised seizures (non focal origin) A. After an attack. Activity ceases. B. This generalized epilepsy almost invariably begins in childhood.Myoclonic seizures Myoclonic seizures describe isolated muscle jerking . the patient stares and pales slightly for a few seconds. The eyelids twitch. a few muscle jerks may occur.
Tonic-clonic seizures Characterized by sudden loss of consciousness. which usually lasts for less than a minute. is followed by a clonic phase in which there is jerking of the body musculature that may last for 2 or 3 minutes and is then followed by a stage of flaccid coma. with falling and loss of consciousness. D. and respiration is arrested. the patient becomes rigid and falls to the ground. This tonic phase.Atonic seizures Atonic seizures cause sudden loss of tone.Tonic seizures Tonic seizures describe intense stiffening of the body not followed by convulsive jerking E. III.C.Unclassified epileptic seizures (due to incomplete data) .