Complex partial seizures

presentation that describe one type of epilepsy (complex partial seizures) based on a case scenario.

1. Complex Partial seizures

2. introduction Absence seizures ?

3. Based on the characteristics of the attack she had: Aura “ I can feel it coming “ Sometimes this attack occurs during sleep ( kick her husband) The duration of the attack (5-10 min) The frequency of the attack ( 1 or 2/ year) She feel tired and confused after the attack Tinnitus or ringing during the attack The diagnosis is: Complex Partial seizures

4. Learning Objectives: What’s Complex Partial seizure ? How the seizure happens? Etiology Clinical manifestation Diagnostic evaluation Treatment Prevention Case questions

5. Why is it important to study epilepsy ? There are around 40 different types of seizure and a person may have more than one type. Epilepsy can affect anyone , at any age and from any walk of life. Around 5 people in every 100 will have an epileptic seizure at some time in their life. Out of these five people, around four will go on to develop epilepsy . Epilepsy affect nearly 50,000,000 people worldwide. Epilepsy imposes an annual economic burden of $15.5 billion.

6. Types of epilepsy:

7. Complex Partial seizures  is an epileptic seizure that is associated with unilateral cerebral hemisphere involvement and causes impairment of consciousness, it occurs in all age groups. This type of seizures was previously know as psychomotor epilepsy , or temporal lobe epilepsy. It is due to a lesion or disturbance in the limbic system usually in the temporal lobe, and sometimes in the frontal lobe.

8. Complex Partial seizures cont… complex partial seizures are called "complex" because they impair consciousness and "partial" because they begin in a limited area of the brain then spread to the whole brain hemisphere.

9. How the seizure happens? Normally brain neurons pass signals among themselves using both electrical current and chemicals. In a seizure, the brain's electricity is not passed in an organized way from one neuron to the next, but spreads over a cluster of cells or the whole brain hemisphere all at once.

10. Etiology In the majority of cases, complex partial seizures are of unknown etiology.  Potential causes include the following: perinatal lesion (e.g. temporal sclerosis). congenital developmental anomalies, trauma, and brain tumors.

11. Clinical manifestation Aura

12. Clinical manifestation cont... Complex partial seizures have: sensory, behavioral, psychomotor , and autonomic manifestations. Which of theses manifestation will be present in the patient depend on the prices location of the epileptic focus. The manifestation could be very mild in some patients, and very sever in others.

13. Clinical manifestation cont... The seizure begins suddenly, Then the patient loses awareness and stares blankly, makes chewing and swallowing movements, or perform other purposeless actions. These movements are called "automatisms" The seizure usually last between 30 seconds and 5 minutes. Afterward, the person may be tired or confused for about 15 minutes and may not be fully normal for hours.  

14. Diagnostic evaluation Complex partial seizure activity can generally be diagnosed from its typical clinical picture. The EEG reveals temporal slow waves or spikes. But in the interictal period, however, it is usually normal.

15. Treatment the treatment line for Complex partial seizure is anti-epileptic medications.

16. anti-epileptic drugs: Drugs which decrease the frequency and/or the severity of the epilepsy. Treat the symptoms of the seizures not the underlying condition. Their goal is to maximize the quality of life by minimizing seizures.

17. anti-epileptic drugs cont… The drugs of choice in complex partial seizures are:

18. Prevention

19. stop the medication, yes or No ? The answer is No. In pregnant women with epilepsy usually the risk of harm to the mother and fetus from convulsive seizure itself outweighs the risk of continued therapy. The best way to manage the situation is to: continue with a low dose of the prescribed drug ( Lamotrigine ) 25 mg/day, because it the safest drug. and a high dose of folic acid 5mg/day

20. New researches reveals a shared genetic susceptibility to epilepsy and migraine. people with  epilepsy are substantially more likely than the general population to have migraine headache . The patients who have migraine should take some medication to relive that migraine attacks. Migraine and epilepsy.

21. Is epilepsy hereditary? certain types of epilepsy do seem to run in families. People who have a generalized epilepsy seem somewhat more likely to have other family members with seizures than those with a partial epilepsy. However most people with epilepsy do not have any relatives with seizures, and the great majority of parents with epilepsy do not have children with epilepsy. But in our patient situation, since her nephew has epilepsy from birth that is affecting his development, there is a chance that her baby will have also epilepsy.

22. Summary

23. References: Books: Mumenthaler M, & Mattle H.(2002) Fundamentals of Neurology, an illustrated guide. Courtenay M. (2012) British National Formulary. Bromfield EB, Cavazos JE, Sirven JI. (2006) An Introduction to Epilepsy. Kaplan PW, Fisher RS. (2005) Imitators of Epilepsy, second edition. Websites: http://www.who.int// http://www.epilepsyfoundation.org http://emedicine.medscape.com http://www.ncbi.nlm.nih.gov//

24. Thank you