Transcript Epilepsy
DR ZULFIQAR ALI RIZVI CONSULTANT PSYCHIATRIST PIMH LAHORE Changing concepts of EPILEPSY from ancient times to 21st century What can be the biggest desire of patients suffering from epilepsy? Who will help me back from exclusion to inclusion in society? YES, IT IS Our Executive director Dr Nusrat Habib Rana, with the team of Doctors of PIMH, Lahore have raised their hands and taken responsibility to create awareness about epilepsy and bring epilepsy patients back in society with sense of dignity and respect. Epilepsy is one of the oldest disorders known to mankind. Over 50 million people worldwide. No racial, social, cultural, economical ethnic and geographical boundaries. In ancient times, associated with religious experiences and demonic possessions. Hippocrates ( Greek Physician 500 BC) wrote the first book about epilepsy. Saint Cyriakus In 17th and 18th century, In 20th century, 21st century and concept of epilepsy:. Actually what epilepsy is? Epilepsy is a neurological condition with tendency to recurrent seizures. At least two unprovoked seizures: • • 24 hours apart, of cerebral origin are necessary to make a diagnosis of epilepsy. Life time prevalence of seizures: 5-10 %. Prevalence of active epilepsy 1-2%. ETIOLOGY : About 60-65 percent (two third) idiopathic It is more common in 2-14 years age group In symptomatic cases, one can find physical basis of seizures: Younger and early adulthood patients: Adults and elderly: Pathophysiology Multifactorial. Determining factor is the result of interaction between genetically determined seizure threshold, underlying pathological and metabolic conditions, and acute precipitating factors. Reflex seizures Caused by certain stimuli in predisposed persons. Precipitating stimuli for reflex seizures: Visual stimuli- flickering light Thinking Music - certain frequencies Reading CLASSIFICATION The ILAE classification • Partial-onset seizures • Generalized-onset seizures. Generalized-onset • Tonic-clonic seizures (grand mal) lasts 1-2 min • Absence seizures ( petit mal ) (10-30 seconds) with no postictal symptoms. Clonic involve tonic clonic contractions. • • Myoclonic • Tonic seizures( sustained contractions ) last 10-15 sec. • Atonic Partial onset • Simple partial • Complex partial The origin of symptoms and signs in focal seizures DIAGNOSIS 1)History and clinical findings 2)Physical evaluation. 3) Electroencephalography: 4) Lab Studies : 5) CT SCAN:. 6) MRI: 7)PET scanning Principal of treatment • New cases, 2/3 of cases go into spontaneous • • • • remission. Only 1/3 of cases will have 2nd seizure in next 5 years If left untreated, about 75% cases show 2nd seizure A single drug, controls 60%. If seizures are difficult to control ( in 30-40% ) , 2 or > 2 drugs may be required. In intractable cases ( refractory) 20% 2 or > drugs. Drug treatment 1) Primary generalized tonic-clonic seizures First-line monotherapy Carbamazepine Phenytoin Valproate ( epival ) Topiramate ( topamax ) 2nd-line monotherapy or adjunctive therapy Lamotrigine Levetiracetam ( lerace ) 2) Partial seizures with or without secondary generalizations First-line monotherapy Carbamazepine( seiznil) Lamotrigine ( lojin ) Oxcarbazepine (oxalepsy ) Topiramate Levetiracetam 2nd-line monotherapy or adjunctive therapy Gabapentin ( neogab ) Pregabalin Valproate 3rd-line monotherapy or adjunctive therapy Felbamate Vigabatrin 3) Absence seizures First-line monotherapy Ethosuximide Lamotrigine Valproate 2nd-line monotherapy Levetiracetam Topiramate MESSAGE • Epilepsy has nothing to do with mental disease or retardation. This has been proved beyond all doubt by the "epileptic geniuses", people who achieved great things in spite of suffering from epilepsy. Margaux Hemingway American Actress Alexander the Great Macedonian King G. Julius Caesar Roman Statesman Alfred Nobel Swedish Chemist