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seizure disorder
1. SEIZURE DISORDER
Dr. Sunil Pahari , 3rd year resident
Yangtze university , jingzhou central hospital , hubei , china
2. SEIZURE
DEFINITION :
It is defined as abnormal ,paroxysmal, excessive,
involuntary neurological discharge from the
brain which may be manifested as –
Loss of Conciousness,
Abnormal- Motor
- Sensory ,
- Behavioral disturbance
- and Autonomic dysfunction.
4. Classifications
According to etiology.
• Primary/ Idiopathic ( etiology not identified)-
85%.
• Secondary (with identified etiology) –15%.
According to type. The chief division of seizure
types on physiological ground is between
• Generalized-. Elcrophysiological abnormalities
involve both hemisphere. (1/3rd)
• Focal/ partial.- one part of cerebrum (2/3rd)
• Unclassified.
5.
6.
7. ETIOLOGY
PERINATAL :
• Cerebral malformation.
• Intra uterine TORCH Infection.
• HIE*.(hypoxic Ischemic encephalopathy)
• Trauma
• Intra ventricular Hemorrhage *
• Maternal drug abuse
• Radiation exposure.
• Perinatal trauma and anoxia
* Common causes of convulsion.
8. • TOXIC CAUSES
• DRUGS- phenothiazide, MAOI,TCA either in overdose or at
therputic level in patient eith lowered seizure threshold.
• rapid withdrawl of antiepileptic and benzodiazepam
• chronic alcohol abuse
• CO, lead , Hg poisoning.
16. Clinical features
• The diagnosis is primarily a
clinical one. A detailed
history is there fore essential
and usually required
eyewitness reports,
particularly when
consciousness is lost during
the event.
• If an Aura precedes the
attack , patient may be able
to describe this, which help
to localize the focus.
19. Types in sps
1. MOTOR :
- Hemibody or Hemifacial twitching.
2. SENSORY :
- Tingling sensation.
- Sensation of cold, Burning.
- Special sensation –
(visual, auditory, gustatory, somatosensory).
3. AUTONOMIC.
4. PSYCHIC: Feeling of fear, dizziness.
20. Generalised seizures
• Are characterised by bilateral involvement of the cortex at the onset
of seizure.
• Patient lose consciousness at seizure onset.
• So usually no warning.
•
1. Absence ( petit mal)
2. Tonic clonic. ( Grand mal)
3. Tonic 4. Clonic 5. Myoclonic.
6. Atonic. 7. infantile spasm.
•
21. Absence seizure (petit mal)
• Typical absence seizure have an onset between 4-12yrs.
• Attack may be several times a day, 5- 15 sec.
• Patient suddenly stares vacantly.
• eye blinking ,myoclonic jerks.
• 2 types - typical ( characteristic EEG pattern of threeper –
second generalised spike –and-wave discharge.)
• - atypical - associated with more severe epilepsy
syndrome like Lenox- gastaut syndrome . Less change on
EEG
22. Generalized tonic -clonic seizure
• These seizures typically have no warning.
• Starts with sudden loss of consciousness and fall on the ground .
• This is followed by tonic phase (10 sec)
when the body is stiff, the elbows are flexed ,and the legs extended , upward
rolling of eyeball. Breathing stops and patient may turn cyanosis.
Tonic phase is followed by clonic phase . ( 1-2 minutes)
-voilent generalised rhythemic shaking . .
- tong may be bitten . There is tachycardia.
-bladder and bowel controll may be lost
23. • The frequency of clonic movement gradually decrease and
eventually cease, marking the end of seizure .
following the tonic clonic seizure, patient often cannot be
roused for several minutes and awakes with confusion ( postictal
confusion), headache , myalgia and some retrograde amnesia.
It is not unusual for patient to fall asleep after convulsion, and
this can sometimes be mistaken for unconciousness.
24. SYNDROMEASSOCIATEDWITH EPILEPSY:
GENERALIZED EPILEPSY :
1. WEST SYNDROME:- Infantile Spasm.
2. Lenox- Gastaut SYNDROME:- severe form of epilepsy,
seizure before 4 years.
3. JANJ Syndrome : Juvenile Myoclonic Epilepsy.
4. LANDAU—KLEFFNER Syndrome: aphasia + abnormal
EEG.
26. COMPLEXPARTIALSEIZURE
( CPS)
• Temporal lobe seizure.
• Impaired conciousness.
• Conciousness impaired -
- at bigining or
- SPS followed by loss of conciousness.
• Usually presents with Motor Automatism(50—75%) : -
- Lip smacking.
- Chewing, Swallowing.
- Running , Walking, picking or pulling at bed sheet.
- Hallucinations/ strange sensations.
27. • Convulsions.
• Last for 2—3 min.
• EEG—interictal sharp waves or focal or
multifocal spikes (usually originating from
temporal lobe).
• CT/ MRI to detect temporal lobe lesion.
28. ETIOLOGY OF PARTIAL SEIZURE
1. Inflammatory Granuloma.
2. ICSOL.
3. Head Trauma.
4. Atrophic lesion.
5. Birth Asphyxia.
29. II. GENERALIZED SEIZURE
• Onset in both hemisphere.
• B/L synchronus discharge.
• Symmetrical seizure.
• Loss of conciousness.
30. ABSENCE SEIZURE
TYPES: 1. Typical.( PETIT MAL)
2. Atypical.
TYPICAL :
• Age: 4—10 years. Sex- Female (common)
• No Aura, no post ictal phase.
• Transient loss of Conciousness ( 2—10 sec).
• With abrupt onset and Termination.
31. • Sudden cessation of motor activity or Speech.
• Blank facial expression / starring look.
• Eye blinking , lip smacking .
• Rare before 4 years.
• Hyperventillation for 3—4 min. induce Absence
seizure due to alkalosis.
• EEG : Diffused or generalized 3hz/ sec.
34. PhaseI - Aura:
presenceofauraindicatesthefocusoforigin.
Phase II. Tonic phase ( few sec—min )
• Skeletal musscles under goes sustained spasm.
• May fall on the ground and sustain injury.
• Upward rolling of eye ball.
• apnea & Cyanosis.
• Frothing form mouth, tongue bite.
35. IIICLONICPHASE:
• Rhythmical contraction of muscle groups.
• For few min.
• Stool & urine incontinence.
IV POST ICTAL PHASE :
• Child may complain of Head ache, Confusion.
• Transient paresis (Todd’s palsy).
• Prolonged deep sleep for several hours.
• Rarely personality change , loss of bladder & Bowel control.
36. TONICSEIZURE:
• Generalized increased in muscle tone.
ATONIC SEIZURE :
• Often combined with myoclonic jerks.
• Sudden loss of body tone leading to sudden fall
on floor Or drop of head.
37. MYOCLONIC SEIZURE.
• Quick , brief, paroxysmal often repetative Jerky movement of
limbs , Neck , Trunks.
• Not all myoclonus is result of epilepsy ,it is epileptic if it occur
in the contest of epilepsy , which is cortical origin ( not brain
stem and spinal cord )
• Loss of body tone & falling forward.
• Sustains injury.
• Usually idiopathic (genetic)
• Mental retardation is common.
38. INFANTILESPASM
(Salamseizure)
• Age of onset : 4—8 month.
• Characterized by brief contraction of neck , trunk,
extremities, multiple attack/day.
• Occurs mainly due to underlying brain disease.
• TYPES: 3 types
• 1. Flexor. 2. Extensor. 3. Mixed.
39. • Occurs in :
- Drowsy state.
- Immidiately after getting up.
• EEG : Hypsarrythmia.
- high voltage, bilaterally asynchronous, slow wave
activity.