Epilepsy and Seizures

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Epilepsy and
Seizures

Definition
The epilepsies are a group of disorders
characterized by chronic recurrent
paroxysmal changes in neurologic
function caused by abnormalities in the
electrical activity of the brain

Epilepsy vs.
Seizures
• A seizure is defined by release of excessive and
uncontrolled electrical activity in the brain.
Seizures themselves are not a disease, they are
an event.
• Epilepsy (seizure disorder) is a neurological
condition, that in different times produce brief
disturbances in the electrical functions of the
brain. Seizures are a symptom of epilepsy.

Classification of
Seizures
• Seizures are classified into partial and
generalized
• Partial seizures are divided into
o Simple partial - Consciousness is not impaired
o Complex partial - Consciousness is impaired
o About 2/3 of people with epilepsy have complex partial seizures

II. GENERALIZED SEIZURES
A. Absence seizures
B. Generalized tonic-clonic seizures
C. Myoclonic seizures
D. Tonic & atonic seizures

Absence Seizures
o Sudden onset
o Interruption of ongoing activities
o Blank stare
o Brief upward rotation of eyes
o Duration: a few seconds to 1/2 minute
o Evaporates as rapidly as it started
o Mild eyelid clonus
o Slight loss of neck muscle tone
o Oral automatisms

Generalized Tonic-Clonic
Seizures
Tonic Phase
o Sudden sharp tonic
contraction of respiratory
muscle: stridor / moan
o Falls
o Respiratory inhibition
cyanosis
o Tongue biting
o Urinary incontinence

Clonic Phase
o Small gusts of grunting
respiration
o Frothing of saliva
o Deep respiration
o Muscle relaxation
o Remains unconscious
o Goes into deep sleep
o Awakens feeling sore,
headaches

Myoclonic Seizures
o Sudden, brief, shock-like
o Predominantly around the hours of going
to or awakening from sleep
o May be exacerbated by volitional
movement (action myoclonus)
o Symmetrical myoclonic jerks

Tonic Seizures
o Rigid violent muscle contraction
o Limbs are fixed in strained position









patient stands in one place
bends forward with abducted arms
deep red face
noises - pressing air through a closed mouth

Elevates both hands
Extreme forward bending posture
Keeps walking without faling
Passes urine

Atonic Seizures
o Sudden reduction in muscle tone
o Atonic head drop
o Loss of consciousness

Myoclonus
A single abrupt shock like extensor
movement of a limb. myoclonic seizures.
Petit Mal Used to describe absence seizures as
well as atypical absence.
Tonic Sustained contraction of one or more muscle
groups, independent of position (i.e. can be flexed,
extended, or opisthotonic).
Aura A generic term for a warning. A colloquial term
for simple partial seizure.
Convulsion Tonic, clonic or tonic-clonic seizure

Tonic and Clonic
(Most often, these alternate)

PATHOPHYSIOLOGY
• A seizure is a temporary involuntary disturbance
of brain function that may be manifested as
impaired consciousness, abnormal motor activity,
sensory disturbances or autonomic dysfunction.

PATHOPHYSIOLOGY
• Seizures are accompanied by abnormal
electrical discharges in the brain that can
usually be detected by electroencephalography.
• Increased permeability of neuronal cell
membranes causes an increase in neuronal cell
excitability.

PATHOPHYSIOLOGY
• Things that can cause membrane instability:
o Deficiency in Oxygen
o Deficiency in Glucose
o Decrease in Calcium

Epilepsy Scientific Background
• When the brain functions normally, millions
of fluctuating, simultaneous, tiny electrical
charges go from the nerve cells to all parts of
the body.
• People who have seizures / epilepsy have
these normal electrical “patterns” interrupted
by sudden and relatively intense bursts of
electrical energy that may affect
consciousness, body movements, and
sensation.

Epilepsy Scientific Background
• Nerve cells normally transmit electrochemical
signals and maintain a balance of excitatory and
inhibitory neurotransmitters as well as sodium,
potassium, and other factors critical to energy
stability.
• When this balance is changed, a seizure may
result.

CAUSES
• Adult-Onset Epilepsy most often indicates the
presence of a structural lesion of the brain.
• Primary (genetic epilepsy) - 65% of persons with
recurrent seizures.

CAUSES
• Secondary (acquired epilepsy) - 35% of persons
with recurrent seizures.
• Most common secondary causes:
o
o
o
o
o
o
o
o

Congenital abnormalities
Perinatal Injuries
Metabolic and Toxic Disorders
Head Trauma
Tumors
Vascular Disease
Degenerative Disorders
Infectious Diseases

CAUSES OF SECONDARY
GENERALISED EPILEPSY
Genetic- Inborn errors of metabolism, Storage diseases
Cerebral birth injury
Hydrocephalus
Cerebral anoxia
Drugs--Antibiotics: penicillin, isoniazid, metronidazole
Antimalarials: chloroquine, mefloquine
Ciclosporin
Cardiac anti-arrhythmics: lidocaine; disopyramide
Psychotropic agents: phenothiazines, tricyclic antidepressants, lithium
Amphetamines (withdrawal)
Alcohol (especially withdrawal)
Toxins
Heavy metals (lead, tin), Organophosphates (sarin)

Metabolic disease
Hypocalcaemia, Hyponatraemia, Hypomagnesaemia, Hypoglycaemia
Renal failure
Liver failure
Infective
Meningitis
Post-infectious encephalopathy
Inflammatory
Multiple sclerosis (uncommon)
SLE
Diffuse degenerative diseases
Alzheimer's disease (uncommonly)
Creutzfeldt-Jakob disease (rarely)

TRIGGER FACTORS













Fatigue
Decreased physical health
Alcohol ingestion
Emotional stress
Flashing lights
Menstrual cycle
Missed meals
Sleep deprivation
Recreational drug misuse
Physical and mental exhaustion
Intercurrent infections and metabolic disturbances
Uncommonly: loud noises, music, reading, hot baths

Patient Evaluation
• Evaluation should include a complete history,
thorough general medical and neurological
examination,
and
pertinent
laboratory
examinations.

Patient Evaluation
• HISTORY: A precise and extensive history is the
most crucial step in the evaluation
• A good description of the event and symptoms
and signs surrounding the event must be
obtained

MEDICAL CONSIDERATIONS
• A thorough med. hx is key. Questions:
o
o
o
o
o
o

What medications are you taking?
What type of seizure do you have?
How often do you have a seizure?
What signals the onset of your seizure?
How long do your seizures last?
Have you ever been hospitalized?

MEDICAL CONSIDERATIONS
o
o
o
o
o

partial loss of memory
incontinent
deep sleep
loss of consciousness
musculoskeletal contractions and relaxations

Patient Evaluation
• Pertinent information includes:
o Precipitating factors
o Determination of the Presence
Description
o Description of the event
o Post Event Signs and Symptoms
o Effect of Consciousness
o Duration of Event
o History of Previous Events

of

an Aura and its

Patient Evaluation
• It is important to determine common
risk factors:
o
o
o
o
o
o

Abnormalities of pregnancy, birth, and development
Febrile seizures
Meningitis or encephalitis
Head trauma with loss of consciousness
Drug and alcohol abuse
Predisposing medical/neurological conditions

Patient Evaluation
• It is important to determine common
risk factors:
o
o
o
o
o
o

Family history
Prescribed medications
Birthmarks or skin lesions
Exposure to toxins
Metabolic or nutritional disturbances
Vascular disturbances

Physical and neurological
examination
• A thorough general physical and neurological
examination are required at the time of
presentation
• The clinician must search for evidence of an
underlying systemic or neurological disorder

Differential Seizure Diagnosis
Conditions resembling seizures and epilepsy
o
o
o
o
o
o
o
o
o
o

Syncopes
Cardiac Arrhythmias
Pseudoseizures
Paroxysmal torticollis
Movement disorders
Migraines
Hyperventilation
CVA
Hypoglycaemia
Breath-holding spells

FEATURES HELPFUL IN DISTINGUISHING SEIZURES
FROM FAINTS

Aura (e.g. olfactory)

Seizure
+

Faint
-

Cyanosis
Tongue-biting
Post-ictal confusion

+
+
+

-

Post-ictal amnesia

+

-

Post-ictal headache

+

-

Rapid recovery

-

+

 

Status Epilepticus
Status Epilepticus - A state of recurring seizures
when consciousness does not return between
seizure events.
o Can be very serious and at times fatal. This is a seizure that
lasts for about 30 minutes, and can cause serious brain
damage, if not aborted.
o Benzodiazepines like diazepam or lorazepam may be given to
patients in the hospital for treatment.

Common Myths
• Epilepsy is contagious
• People may swallow their tongue during a seizure
• Putting things in people’s mouths (like wallets or
a stick) while seizing is a good idea
• Ambulance should be called immediately
o

If the seizure lasts longer than 5 minutes, it is their first seizure, they
request an ambulance, or have multiple seizures in a row

Thank you

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