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Epilepsy

Epilepsy. Dr Hazem Elhewag Ass.Professor of Neurology. Definition.

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Epilepsy

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  1. Epilepsy DrHazemElhewag Ass.Professor of Neurology

  2. Definition • Epileptic seizures: can be defined as an intermittent ,transient, stereotyped paroxysmal attacks of motor, sensory, behavior or emotions disturbances usually but not always accompanied by loss of consciousness resulting from uncontrolled paroxysms of neuronal cortical discharge.

  3. Classification of Epilepsy • A)Partial seizures: • -Simple partial :(no disturbance of consciousness) • *with motor symptoms. • *with sensory symptoms: somatosensory or special sensory. • *with autonomic symptoms. • *with psychic symptoms. • -Complex partial (with impairment of consciousness) • -Partial seizures secondarily generalized. • B)Generalized seizures: • -Tonic-clonic seizures (grand mal). • -Absence seizures (petit mal). • -Myoclonic seizures. • -Clonic seizures. • -Tonic seizures. • -Atonic seizures.

  4. Aetiology of Epilepsy: • Idiopathic Epilepsy: • The most form of epilepsy • no local or generalized causes can be detected. • most cases here are heredofamilial

  5. Symptomatic causes of epilepsy • Fluid and Electrolyte disturbances • Metabolic disordes: • Diabetic coma ( hypo-or hyperglycemic coma) • Hypothyroidismor Hyperthyroidism • Porphyria • Acute hepatic failure • Renal failure • hyperpyrexia

  6. Symptomatic causes of epilepsy • Drug induced seizures • Cerebrovascular accident • Head injury • post craniotomy • Brain tumours • Hypoxic Ischemic encephalopathy • C.N.S.infection and infestation

  7. Clinical features of epilepsy • Simple partial seizures • a)Simple motor: in the form of tonic or clonic movement of any part of the body usually involve the face ,hand, arm, or leg • b)Simple somatosensory: • -focus lies in the sensory cortex, seizures in the form of transient attacks of numbness, tingling,orparasthesia affect the face or hand and may spread as do Jacksonian seizures

  8. Clinical features of epilepsy • Visual Fits : Fits of visual symptoms including spots, flashes of light may occur with occipital seizures. • Auditory Fits : Fits of buzzing, hissing,whistlingand ringing noises can occur with seizures originating in the lateral temporal parts • Uncinate Fits: Fits of olfactory and gustatory symptoms in the form of unpleasant smells, tastes, in seizures originating from the uncus.

  9. Clinical features of epilepsy • Autonomic epilepsy: Vague epigastic sensation, nausea, vomiting, belching, pallor, flushing, sweating, palpitation, intense desire to micturate. • Complicated psychic symptoms: in the form of dreamy like state, depersonalization, illusions, hallucinations, intense fear, sense of familiarity(déjà vu),or strangeness (jamaisvu)

  10. Complex partial seizures:(Psychomotor epilepsy, Temporal lobe epilepsy) • usually arise in the medial temporal lobe • must include some impairment of consciousness. • may or may not be associated with simple partial seizures. • The psychic manifestations of complex partial seizures include: eye staring, motionless star, arrest of activity ( Behavioral Arrest) followed by stereotyped automatism, which may be: • motor automatism in the form of lip smacking, chewing, swallowing, walking or running • verbal automatism ,usually followed by confusion. if prolonged, will be secondarily generalized

  11. Differential diagnosis • Syncope • Impairment of consciousness resulting from decrease cerebral blood flow • Occurs mostly in the up right position , • Precipitated by heat , hunger , dehydration , alcohol excess , long standing unpleasant sounds or sights • Associated with pallor, sweating, cold extremities, and palpitation. • Gradual onset with no convulsions. • With the onset, there is feeling of warmth, dry mouth desire for fresh air. • Recovery is rapid, with no post ictealsequalae

  12. Pseudoseizures (hysterical or malingering) • The patient rare to injure himself & bite his tongue. • No urination, pupil is unchanged • Blood pressure & heart rate do not afected. • No stereotyped or typical presentation, but vague, of long duration, never occur alone or during sleep, but in front of others to attract the attention.

  13. Other differential diagnosis • Sleep disorders AS: sleep walking and sleep talking • Migraine. As complicated migran • TIA. • Hypoglycemia. • Vertigo. • Psychogenic disorders

  14. Management of epilepsy • Diagnosis: • Mainly clinical features. • Investigations: • EEG • CT • MRI • Lab investigation

  15. Tratment • Single fit is not need for treatment except if: prolonged , status , focal , abnormal EEG , +ve family history , neurological diseases • two or more unprovoked fits→ start treatment.

  16. Teratment • The main goal in the treatment of epilepsy is to achieve complete seizure control, with minimal side effects. • The best AED is different for each patients according to age, gender, type of seizers

  17. Treatment of focal seizuresin children, young people and adults

  18. Treatment of generalized tonic clonic seizures in children, young people and adults.

  19. Treatment of absence seizures in children, young people and adults

  20. Treatment of myoclonic seizures

  21. Thank you

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