SEIZURE DISORDER/ epilepsy in medicine.pptx

Seizure management A seizure is defined as a transient occurrence of signs and/or symptoms due to abnormal, excessive, or synchronous neuronal activity in the brain.

👉 Key points:

It is a clinical event, not a disease by itself.

Can manifest as motor, sensory, autonomic, or psychic symptoms, with or without loss of consciousness.

Causes include structural brain lesions, metabolic disturbances, infections, trauma, vascular events, or idiopathic epilepsy. Seizures may be provoked (acute symptomatic) or unprovoked (epileptic disorder).

1. STATUS EPILEPTICUS DR .KAPILGANESH T A JUNIOR RESIDENT DEPT. OF EMERGENCY MEDICINE

2. INTRODUCTION Seizure – excessive excitatory neuronal activity associated with hypersynchrony of neighbouring cells ,resulting in sensory, motor, autonomic or cognitive function alteration. Convulsion Epilepsy – disease in which threshold for seizures is lower than the normal population.

3. Status epilepticus is a series of uninterrupted seizures which results in impairment of normal brain function which if not treated as a medical emergency results in high morbidity and mortality. Bimodal peak distribution Frequency of RSE in patients with status epilepticus is 31 to 44% and 20% RSE will become SRSE.

4. DEFINITIONS 1962 – whenever a seizure persists for a sufficient length of time or is repeated frequently enough to produce a fixed or enduring epileptic condition. 1981 – a seizure that persists for a sufficient length of time or is repeated frequently enough that the recovery between attacks doesn’t occur 1993- seizure lasting more than 30 minutes or occurrence of two or more seizures without recovery of consciousness in between. 1999 – generalised convulsive seizure lasting more than 5 mins or two or more seizures during which patient doesn’t return to baseline consciousness.

5. Subtypes of status epilepticus R efractory status epilepticus Super refractory status epilepticus Prolonged NORSE FIRES

6. Status Epilepticus Subclassifications According to Semiology, Etiology, Age Group, and Electroencephalographic Correlate

7. etiology According to indian study the etiology of status epilepticus Infection 53.8% Metabolic – 14.5% Stroke – 12.8% Miscellaneous – 11% Drug default – 7.9%

8. Factors associated with poor outcomes in SE Duration of seizures Sensorium at presentation. Underlying etiology Older age Associated medical complications Focal neurological signs at onset. Symptomatic status epilepticus ,young patients, low AED levels have better prognosis.

9. Which anticonvulsants are efficacious as initial and subsequent therapy ??

10. What adverse events are associated with anticonvulsant administration?? Which is the most effective benzodiazipine ?? Is IV fosphenytoin more effective than IV phenytoin ??

11. When does anticonvulsant efficacy drops significantly( i.e., after how many different anticonvulsants does status epilepticus become refractory)?? The efficacy of each successive blinded treatment was First AED – 55% Second AED – 7.0% Third AED – 2.3% Four or more AED – 23.2% No AED was successful – 11.7%

12. Thank You