Transcript Seizures and Epilepsy

Seizures and
Epilepsy
Dr.Isazadehfar
Seizures
A seizure is as a sudden, disorderly discharge of
cerebral neurons.
Seizures involve a
transient alteration in
brain function
involving motor,
sensory, autonomic,
or psychic clinical
manifestations
Epilepsy
Epilepsy is a group of related disorders
characterized by a tendency for recurrent
(2 or more) seizures.
Every 5 – 10
persons per 1,000
people have
epilepsy
Terminology
 Aura: A partial seizure experience before the onset
of a generalized seizure; often described as a ‘funny
feeling’
 Prodroma: Early clinical manifestations that may
occur hours to a few days before the onset of a
seizure (malaise, headache, or depression)
 Tonic phase: A state of muscle contraction with
increased muscle tone (associated with loss of
consciousness)
Terminology
cont.
 Clonic phase: Alternating contraction and relaxation of
muscles
 Postictal phase: Time period immediately after the end
of seizure activity
Types of Seizures
 Seizures can be classified as either partial or
generalized
 The type of seizure as well as the signs and
symptoms that accompany the seizure depend on the
part of the brain in which the seizures occur
Types of Seizures -
Partial
 Partial Seizures are seizures that begin locally (in
one part of the brain)
i. Simple Partial seizure (consciousness not
impaired)
ii. Complex partial seizure (consciousness
impaired)
iii. Secondary generalized seizure (begins as
partial and transitions into a generalized
seizure)
Types of Seizures 
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Generalized
Generalized seizures are bilaterally symmetric; there is no
local onset and although they involve the entire brain,
physical control is rarely lost.
Types of GS include:
i. Absence seizures (petit mal)- staring, slight body
movement and short periods of unawareness
ii. Myoclonic seizures- sudden jerks of arms and legs
iii. Atonic seizures (drop attacks)- suddenly collapse or
fall down
iv. Tonic-clonic seizures (grand mal)- most severe type
of seizure; characterized by loss of consciousness,
body stiffening, shaking and sometimes tongue
biting or bladder incontinence
Partial and Generalized
Primary
Generalized
Seizure
Partial Seizure
Partial Seizure with Secondary
Generalization
Etiology -
Seizures
 We all have the potential to have a seizure if the right
conditions affect our neuronal environment; some
people however, have a lower genetic threshold for
seizures.
 Causes include:
 Cerebral lesions
 Biochemical disorders
 Cerebral trauma
 Epilepsy
Etiology
seizures cont.
Seizures may be
precipitated by:
 hypoglycemia
 fatigue or lack of sleep
 emotional or physical
stress
 febrile illness
 large amounts of water
ingestion
 constipation
 use of stimulant drugs
 withdrawal from
depressants
 hyperventilation
Environmental stimuli that
can trigger seizures include:
Blinking lights
Poorly adjusted lights
Loud noises
Certain music
Certain odors
Being startled
Etiology 
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Epilepsy
Metabolic defects
Congenital malformation
Genetic predisposition
Perinatal injury
Postnatal trauma
Myoclonic syndromes
Infection
Brain tumor
Vascular disease
Fever
Drug and/or alcohol abuse
Pathogenesis
A seizure occurs when a burst of
electrical impulses in the brain escape
their normal limits (past threshold).
They spread to neighboring areas and
create an uncontrolled storm of cortical
nerve cell electrical activity. The
electrical impulses can be transmitted
to the muscles, causing twitches or
convulsions.
A seizure can also be caused by a
rapid increase in body temperature in
children; these are called fever
seizures
Clinical Manifestations
 Signs and symptoms (S&S) can be categorized as
pre-seizure, during, and post-seizure manifestations.
 Seizures may involve some or all of the following list
of symptoms depending upon the seizure type.
Pre-seizure S&S
S&S include “Aura” symptoms: unusual smell, visual loss or
blurring and/or feelings of deja-vu
 Racing thoughts
 Tingling feeling (most often felt in the stomach)
 Fear and panic
 Dizziness
 Light-headedness
 Numbness
S&S after the initial onset
 Symptoms may be isolated to one side of the body or
generalized throughout the body
 Blackouts and loss of consciousness
 Chewing movements, drooling, swallowing, tonguebiting, spitting, lip-smacking, tooth grinding
 Difficulty talking, unusual sounds
 Eyelid fluttering, eyes rolling back
 Stiffness and/or inability to move
During seizure S&S
cont.
 Twitching movements, jerking, shaking or uncontrolled
limb movements
 Incontinence
 Breathing difficulty
-Older adults generally experience less exaggerated
physical signs and symptoms than younger adults
Post-seizure S&S
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(postictal phase)
Deep sleep
Memory loss
Confusion
Writing and speech difficulties
Weakness
Injuries, bruising, aching and pain from muscle activity
-The above symptoms experienced after a seizure
generally last longer in adults
Diagnosis and Management
of Seizures
 Initial assessment
 Airway
 Breathing
 Circulation
 Call for help
 Ask for more history
 How long has the
patient been seizing?
 New-onset vs. known
seizure disorder
 Baseline seizure
frequency, is this
typical or not?
 Events leading up to
this episode
 Meds/triggers
 History of status
Diagnosis
 FAMILY HISTORY!
 Seizure, developmental delay , genetic/metabolic
problems, consanguinity
 Setting in which the seizure occurs:
 Nocturnal? Medications? Illness/fever
 What happened before the event?
 Precipitants? Headache, anorexia, nausea,
vomiting, breath-holding? Certain activities? Aura?
 What happened after the event?
 Immediate recovery? Confusion/somnolence? How
long did this last? Ability to speak/follow
commands? Not moving limbs?
Diagnosis
 Has the patient had these episodes before?
 What has been done to evaluate/treat these
episodes? How many? How often? Has the
patient ever been in status epilepticus?
 Normal development? Social stressors?
Previous history of neurological illness
(infection, trauma)? Drug use? (especially in
adolescents)
Diagnosis & Treatment
There are many different diagnostic tests that are used to
determine and classify seizures and seizure disorders.
Diagnostic tests include:
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EEGs can be used to confirm diagnosis and determine type
of seizure
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An MRI may be ordered if the initial medications pt. is on fail
to control seizures or a CT scan if pt. is an older adult
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Plasma levels of electrolytes, glucose and calcium levels,
renal function tests, liver function tests and even drug
screening may be performed
Diagnosis & Treatment cont.
 If the pt. has already been diagnosed with
epilepsy: anti-epileptic drug (AED) levels may
be tested to ensure that the dosage levels are
accurate
 An ECG can exclude cardiac cause of symptoms or
seizure
 CSF may be tested for infection
Diagnosis & Treatment cont.
Current treatment methods can control seizures for
approximately 66% of people with epilepsy.
Treatments include:
Anti-epileptic drugs are the most common form of
treatment
Brain surgery is performed if seizures originate in a
small, defined area in the temporal or frontal lobes, but is
not common otherwise due to added risk of damaging
vital brain functions
Diagnosis & Treatment cont.
 Vagus nerve stimulation- a vagus nerve stimulator is
implanted into the chest beneath the collarbone, wraps
around the vagus nerve and stimulates the brain to
inhibit seizures
 Children (and some adults) who don’t respond to
medicinal treatment have been prescribed a high-fat,
high-protein and low carbohydrate diet to produce
ketones, which allow the body to use fat instead of
glucose for energy. The exact mechanism for why this
works is unknown.
Witness Response
When you see someone having a seizure you should:
 Loosen their clothing
 Move surrounded objects that the seizing individual
could hurt him/herself on
 Stay until seizure ends to make sure the person is okay
and can get up
Status Epilepticus
 A patient is in status epilepticus if seizure
activity has lasted > 30 minutes or there
are multiple seizure episodes with failure
to regain consciousness between
episodes