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epilepsy.pptx

1. DEFINITION It comes from the GREEK name "Epilepsia" which means " taking hold of or seizing" * It is a chronic disorder characterized by: spontaneous tendency for recurrent seizures which result from paroxysmal and excessive electrical neuronal discharges. which represent the clinical features of abnormally hyper excitable cortical neurons. Seizures are: recurrent transient attacks of somatic, psychic, or, autonomic clinical features. Seizures are: associated with EEG changes & may be disturbance of consciousness.

2. ETIOLOGY 1. Idiopathic epilepsy no cause can be detected It is the commonest cause. It may be associated with positive family history in some cases. It starts in the 1 st & 2nd decades in the form of:  Grand mal epilepsy. Petit mal epilepsy. Myoclonic epilepsy. Atonic seizures.

3. G rand Mal Epilepsy Pre ictal stage (Aura) It is a warning sign of a coming attack It may be somatic, psychic, autonomic Ictal stage (seizure) Sudden loss of consciousness (seconds to minutes) Tonic phase (few seconds) The upper and the lower limbs are extended The jaws are firmly clenched with biting of the teeth The head is retracted to one side and the eyeballs rolled up There may be incontinence of urine Clonic phase (few minutes) The head jerks forcibly The UL and LL contract and relax repeatedly and rapidly Post ictal stage (sequelae) It may be Somatic: todd’s paralysis Psychic: confusion Autonomic: vomiting ,incontinence

4. Petit Mal epilepsy It starts in the child and improves at puberty and is called Absence It is not preceeded by aura and not followed by sequelae It is usually precipitated by hyperventilation or photic stimulation It is characterized by sudden loss of consciousness of short duration It may be associated with High frequency (30-100 attacks /day) Falling to the ground without warning Jerky movements of the head and upper limb

5. 2. Secondary epilepsy (a cause can be detected) A. Local causes in the brain: 1. Congenital: cerebral palsy. 2. Traumatic: cerebral contusion or laceration. 3. Inflammatory: encephalitis, meningitis, brain abscess. 4. Neoplastic: brain tumours. 5.Degenerative: presenile dementia. (middle age) 6. Vascular: cerebral hemorrhage, thrombosis, embolism. hypertensive encephalopathy.

6. Theconmi B. General causes with secondary effects on the brain: Toxic: Alcohol, lead. Botulism, tetanus. Metabolic: high glucose & Low glucose. High Ca & Low Ca. Endocrinal: Hypoparathyroidism, Hyperthyroid crisis. Organ failure: Renal failure , Hepatic failure. Nutritional: Pellagra ,Vitamin B6 deficiency. Cardiovascular: Adam's Stoke's attacks, Fallot ’s tetralogy Physical: High fevers, Heat stroke. Iatrogenic: Ambilhar , sudden withdrawal of antiepileptic drugs. Hysterical.

7. Precipitating factors Missed treatment Menses Acidosis Alcohol use and Drug abuse Stimulation by photons and Hyperventilation Sleep deprivation and stress

8. Investigations EEG Most important diagnostic test Records the electrical activity of the brain EEG shows specific pattern epileptic waves CT , MRI of the brain To exclude a local cause for seizures in the brain Laboratory investigation To exclude a general cause

9. Treatment General measures Moderation of patient physical activity Avoid the precipitating factors(alcohol, hyperventilation, photic stimulation) A ketogenic diet is encouraged because it will induce acidosis (Acidosis is beneficial as it raises the threshold of stimulation of the brain cells)

10. Specific treatment Treatment of the cause in secondary epilepsy Anti epileptic drugs Barbiturates (Luminal) Hydantoin (Epanutin) Carbamazepine ( Tegretol ) Clonazepam ( rivotril ) Valproate ( Depakine ) Succinamide ( Zarontin )

11. STATUS EPILEPTICUS DEFINITION - A medical emergency where there are: 1. Repeated attacks of generalized convulsions, with lack of recovery of consciousness OR 2. Persistent attack of seizure lasting for at least 30 minutes. - If the convulsions are not stopped rapidly, coma deepens & death may occur due to: heart failure or respiratory failure or brain damage. - The most common causes are: sudden withdrawal of anti-epileptic drugs & stroke.

12. TREATMENT A. General Measures: 1.Take care of ABC. Place the patient on the ground , to guard against falling from bed. Mouth gag & 02 inhalation ,endo-tracheal intubation may be needed. Record the vital signs regularly. 2.Take a sample of: Venous blood : for the level of: anti-epileptic drugs, alcohol. Arterial blood : for the level of: pH, p02, pCOz, HCO3. 3.Give cerebral dehydrating measures: e.g.(Lasix), conc. Mannitol, Brain Oedema may occur with d examethazone.

13. B. Specific Treatment: Epanutin with Valium ( or Rivotril) are given immediately: 1.EPANUTIN (Phenytoin ):15 g / Kg slow infusion. 2.VALIUM (Diazepam ): 5,mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 20g . OR: RIVOTRIL (Clonazepam ): 2 mg slowly IV, to be repeated after 5 minutes if seizures recur: maximum dose: 6 mg. If seizures persist after 20 min. of Epanutin & Valium: 3. PHENOBARBITONE: (200) mg infusion. - In resistant cases: 4. GENERAL ANAESTHESIA: may be used

14. Hemiplegia Definition Paralysis of one side of the body due to pyramidal tract lesion at any point of its course from the cerebral cortex down to the 5 th cervical segment Causes Traumatic : cerebral laceration subdural hematoma Inflammatory: Meningitis, encephalitis, Brain abscess Neoplastic :Glioma meningioma Vascular: Thrombosis, Embolism Hemorrhage Congenital: Cerebral palsy Demylinating: Multiple sclerosis

15. Clinical picture Muscle weakness on one side of the body Exaggerated reflexes on the weak side Positive B abiniski sign on the weak side