epilepsy and excessive impulse discharge

epilepsy is a neurological disorder characterized by excessive nerve impulse discharge

1. EPILEPSY  DR.ANAM ANIS CONSULTANT NEUROLOGIST

2. A seizure can be defined as the occurrence of signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. Imbalance between excitatory and inhibitory activities in brain, GABA vs glutamate/aspartate

3. Provoked fits and unprovoked fits

4. Types of epilepsy 

5. Focal epilepsy  Characteristics depends upon involved cortical region. TEMPORAL LOBE SEIZURES: Stereotyped subjective experience Automatism –lip smacking, picking of clothes, dystonic posturing of limb Unresponsiveness for a period of time Post ictal confusion, fatigue and amnesia of event .

6. Frontal lobe epilepsy  Dramatic with prominent motor manifestations Nocturnal,loud vocalization,shaking of limbs,forced head turing to one side Bicycling movement . Jacksonian march Fencer position

7. Occipital lobe epilepsy  Poorly formed colours and lights Alteration in visual perception-micropsia, metamorphopsia, stereotyped visual hallucinations. PARIETAL LOBE EPILEPSY: Uncommon Tingling, numbness, pain, inability to remain upright, vertigo.

8. Generalized seizures  Simultaneous involvement of both cortical hemispheres. GENERALIZED TONIC CLONIC SEIZURES Abnormal feeling before attack  Sudden loud cry –tonic phase –loss of postural control- clonic phase . Lasts for 30 sec to 2-3 mins

9. ABSENCE SEIZURES Behavorial arrest ,staring 10-20 secs  Eye blinking ,flutter No post event confusion Typical absence seizure Atypical absence seizure

10. MYOCLONIC SEIZURES  Sudden ,brief ,lightening like  Physiological  Pathological 

11. Tonic seizures  Sudden loss of consciousness and rigid posture  ATONIC SEIZURES  Loss of consciousness and body tone.

12. Epilepsy syndromes WEST SYNDROME SEVERE MYOCLONIC EPILEPSY OF INFANCY-Temp sensitive JUVENILE MYOCLONIC EPILEPSY-photo sensitive LENNOX-GASTAUT SYNDROME MESIAL TEMPORAL LOBE EPILEPSY WITH HIPPOCAMPAL SCLEROSIS

13. INVESTIGATION Electroencephalography Neuroimaging  Metabolic disorders Infective/inflammatory causes

14. Treatment 

15. Neurosurgical treatment of epilepsy  Vagal nerve stimultor Responsive brain stimulator Ketogenic diet

16. Status epilepticus 30 mins of continuous seizure or 2 consective seizures in 30 mins without re gain of conscious in between .

17. Treatment  Diagnose ,O2 ABC ,I.V access ,ECG blood samples,BS levels  Thiamine 100mg with 50 ml of 50% dextrose I.v Inj lorazepam 4mg over 2 mins repeat  Inj fosphenytoin  20 PE/kg  Continuous I.V midazolam  CIV propofol I.V valproate I.V phenobarbital 

18. Febrile fits 3 months –5 years during fever not due to CNS infection

19. Epilepsy and driving 

20. The end