seizures e pileptic n on epileptic what is that
Download
Skip this Video
Download Presentation
Seizures E PILEPTIC / N on Epileptic What is that ???

Loading in 2 Seconds...

play fullscreen
1 / 106

Seizures E PILEPTIC / N on Epileptic What is that ??? - PowerPoint PPT Presentation


  • 133 Views
  • Uploaded on

Seizures E PILEPTIC / N on Epileptic What is that ???. Al- Quds University School of Medicine Lectures 5 th year Updated September, 2012. Dr. Samir Khalil Consultant Pediatric Neurologist Makassed Hospital Clinical Assistant Professor Al-Quds University. CONCEPTS & GLOSSARY.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Seizures E PILEPTIC / N on Epileptic What is that ???' - huyen


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
seizures e pileptic n on epileptic what is that

SeizuresEPILEPTIC / NonEpilepticWhat is that ???

Al-Quds University

School of Medicine

  • Lectures 5th year
  • Updated September, 2012

Dr. SamirKhalil

Consultant Pediatric Neurologist

Makassed Hospital

  • Clinical Assistant Professor
  • Al-Quds University
concepts glossary

CONCEPTS & GLOSSARY

  • Attack
  • Convulsion
  • Seizure
  • Fit
attack

Attack

  • A violent act starting on with vigor
slide5

Attack

  • Is used
  • to describe
  • epileptic &
  • non-epileptic
  • disorder.
attack1

Attack

  • Is used
  • to describe
  • epileptic &
  • non-epileptic
  • disorder.
attack2

attack

  • Is used
  • to describe
  • epileptic &
  • non-
  • epileptic
  • disorder.
  • We say:
    • Attack of laughing
    • Breath Holding Attack / or spell
    • An attack of febrile convulsion
    • Conversion Reaction
    • Epileptic attack
attack3

attack

  • ?
  • Is used
  • to describe
  • epileptic &
  • non-
  • epileptic
  • disorder.
attack4

attack

  • ?
  • Is used
  • to describe
  • epileptic &
  • non-
  • epileptic
  • disorder.
convulsion

convulsion

An intense, paroxysmal, involuntary contraction

or series of contractions of

voluntary muscles

convulsion1

convulsion

  • Is used to
  • describe
  • epileptic &
  • non-
  • epileptic
  • motor act /
  • shaking
convulsion2

convulsion

  • Is used to
  • describe
  • epileptic &
  • non-
  • epileptic
  • motor act /
  • shaking
convulsion3

convulsion

If there is no movement

(displacement in place), the term “convulsion” is not applied.

The term “convulsion” implies movement/s

convulsion4

convulsion

  • We say:
    • Clonic convulsion but not tonic convulsions
    • Tonic-clonic convulsions
    • Myoclonic convulsion but not absence
    • convulsion.
  • ……Absence / Petit male is not a convulsion
    • Neither arrhythmia nor tachycardia nor apnea
seizure

seizure

  • A sudden, involuntary event/s that may include:
      • Motor activity
      •  Altered level of consciousness
      • Somatosensory symptoms
seizure1

seizure

  • Used to describe epileptic disorders
seizure vs convulsion

Seizure vsConvulsion

    • A convulsive attack:
        • Always labeled as seizure
        • Contrary, not all seizures convulse
  • So a seizure is not synonym to convulsion
  • We say
      • Epileptic seizure/s.
      • Grand male seizure/s.
      • Petit male seizure/s.
      • His absence seizures are completely controlled by Valproic acid
slide18

Fit

  • A seizure or convulsion
  • especially those of
  • epileptic nature
seizures work up

Seizureswork up

Pattern

Duration

  • Frequency

Diagnosis

Physiopathology

Classification

seizures patterns

Seizures’ Patterns

  • TONIC
  • CLONIC
  • TONIC-
  • CLONIC
  • Myoclonic
  • ATONIC
  • Absence

Infantile Spasm

  • Opso
  • Myoclonic

Un Classified

Status Epilepticus

seizures pattern3

Seizures’ Pattern

  • Myoclonic
  • (Startels)
slide28

Seizures’ Pattern

  • Infantile Spasms
seizures pattern8

Seizures’ Pattern

  • Status
  • Epilepticus

A seizure for more than 30 minutes

Or

Frequent Seizures without Regaining

Usual State of Consciousness

seizures pattern9

Seizures’ Pattern

  • Status
  • Epilepticus
seizures pattern10

Seizures’ Pattern

  • Intermittent Illumination
  • Provoked Seizures
duration

duration

  • Pre-ictal
  • Ictal
  • (Inrtra-ictal)
  • Post-ictal
  • Immediate Post-ictal
  • LatePost-ictal
frequency

frequency

  • Attacks
  • per hour
  • per day
  • per month
  • Per year
seizures pattern11

Seizures’ Pattern

  • Q

StatusEpilepticus

Versus

AbundantAttacks

slide39

Seizureswork up

  • 1st Key
  • Question
  • Is
  • it
  • a
  • seizure ?
slide40

Seizureswork up

  • 1st Key
  • Question
  • Is
  • it
  • a
  • seizure ?
slide41

Seizureswork up

  • 1st Key
  • Question
  • Is
  • it
  • a
  • seizure ?
slide42

Seizureswork up

  • 1st Key
  • Question
  • Is
  • it
  • a
  • seizure ?
slide43

Seizureswork up

  • 2nd Key
  • Question
  • Is it
  • epileptic
  • or
  • non
  • epileptic
  • ?
slide44

Seizureswork up

  • 2nd Key
  • Question
  • Is it
  • epileptic
  • or
  • non
  • epileptic
  • ?
slide45

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide46

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide47

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide48

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide49

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide50

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide51

Seizureswork up

  • 3rd Key
  • Question
  • which
  • Type
  • of
  • epilepsy
  • ?
slide52

Seizureswork up

  • 1st Key Question
      • Is it a seizure ?
  • 2nd Key Question
  • Is it epileptic or
  • non epileptic ?
  • 3rd Key Question
  • Which type of epilepsy ?
  • 4th Key Question
  • How to classify ?
slide53

Classification of

Seizures

Epileptic

Non-epileptic

slide54

What epilepsy is ?

Classification of

Seizures

Epileptic

Non-epileptic

slide55

Classification of

Seizures

Non

epileptic

Epileptic Seizures

are

non occasional (non-provoked) chronic seizures in which one single attack is not considered as epilepsy.

slide56

Classification of

Seizures

Epileptic

Non-epileptic seizures

are

occasional (provoked) seizures produced by an acute identified cause

(pyretic, infectious, traumatic or metabolic)

slide57

Classification of

Seizures

Epileptic

Seizures

Non Occasional

Chronic

Non-Epileptic Seizures

Occasional

Acute

slide58

definition of epilepsy

A chronicclinical condition defined as

2 or more seizures

resulting from

hypersynchronous electrical discharge of a population of neurons and not secondary to specific provocation factor such as fever, infection, electrolyte imbalances or trauma

slide59

Pathophysiology of

epilepsy

Epilepsy

Abnormal, hypersynchronous electrical

activation of a population of neurons in the cerebral cortex, either in:

  • Localized area
  • Focal //Partial seizure
  • Multiple areas
  • Generalized seizure
slide60

Pathophysiology of

epilepsy

Neurotransmitters

Excitatory

Inhibitory

(GABA)

Gamma

Aminobutyric

Acid

Acetylcholine (Ach)

Glutamate

Aspartate

slide61

Pathophysiology of

epilepsy

Neurotransmitters

Excitatory

Inhibitory

Acetylcholine (Ach)

Glutamate

Aspartate

(GABA)

Gamma

Aminobutyric Acid

Any perturbation that interferes with the synthesis, release, re-uptake or metabolism of these neurotransmitters may result in the occurrence of a seizure.

slide62

Pathophysiology of

epilepsy

  • Many pharmacologic therapies for seizures act upon these neurotransmitters
  • Increase
  • Inhibition
  • Decrease
  • Excitation
slide63

Pathophysiology of

epilepsy

Controversy exists regarding the duration of seizure necessary to cause neuronal cell injury.

Most, brief seizures, do not cause brain damage.

slide64

classification of

epilepsy

Idiopathic

(Primary)

Epilepsy

Unknown etiology

Neurological Examine

absolutely normal

Paraclinical

explorations are normal

Secondary

Epilepsy

A chronic affection of

the brain by means of

actual methods of

exploration

Cryptogenic

Epilepsy

A chronic affection of

the brain which is

obscure or doubtful by

means of actual

methods of exploration

slide65

classification of

epilepsy

Idiopathic

(Primary)

Epilepsy

Unknown etiology

Neurological Examine

absolutely normal

Paraclinical

explorations are normal

Secondary

Epilepsy

A chronic affection of

the brain by means of

actual methods of

exploration

Cryptogenic

Epilepsy

A chronic affection of

the brain which is

obscure or doubtful by

means of actual

methods of exploration

slide66

classification of

epilepsy

Idiopathic

(Primary)

Epilepsy

Unknown etiology

Neurological Examine

absolutely normal

Paraclinical

explorations are normal

Secondary

Epilepsy

A chronic affection of

the brain by means of

actual methods of

exploration

Cryptogenic

Epilepsy

A chronic affection of

the brain which is

obscure or doubtful by

means of actual

methods of exploration

slide67

classification of

epilepsy

Idiopathic

(Primary)

Epilepsy

Unknown etiology

Neurological Examine

absolutely normal

Paraclinical

explorations are normal

Secondary

Epilepsy

A chronic affection of

the brain by means of

actual methods of

exploration

Cryptogenic

Epilepsy

A chronic affection of

the brain which is

obscure or doubtful by

means of actual

methods of exploration

slide68

Classification of

epilepsy

  • Generalized Epilepsy

Partial epilepsy

(simple & complex)

  • Secondary Generalized Epilepsy

Status Epilepticus

slide69

Presentation

epilepsy

Provoked seizures associated with a fever, electrolyte abnormality, or other metabolic derangement, are usually generalized rather than focal.

classification of epilepsy according to extension
Classification of Epilepsy(According to Extension)

By means of:

  • Clinical presentation
  • Electrical Guidance (EEG)
status epilepticus
Status Epilepticus
  • A continuous seizure activity lasting

>30minutes,

or

  • The occurrence of ≥ 2 seizures in quick succession without return to usual level of consciousness

An emergencyneurologic sequelae or death iftreatment is delayed

seizure presentation on arrival at the er
Seizure Presentation On arrival at the ER
  • On active seizure
      • Shaking, deviation of eyes, frothy secretions,….
      • Staring
      • Breath holding (apneic) with cyanosis
  • Early post-ictal
      • Drowsy, in deep sleep, paralytic (odd),………
  • Late post-Ictal
      • Free of any manifestation (conscious alert ……..the attack is past).
seizure presentation on arrival at the er1
Seizure PresentationOn arrival at the ER
  • 1st attack
  • Previous attacks (1, 2 or more)
  • Under treatment with AED (withdrawal)
  • Never been treated with AED
  •  fever
seizure presentation on arrival at the er2
Seizure PresentationOn arrival at the ER
  • The minority
  • New onset,non-febrile seizure

The Majority

Febrile convulsion

or

Aknown previous seizures

A very small %

Status epilepticus

Most not seizing upon arrival in the casualty department

prognosis expectations
Prognosis / expectations
  • The majority of pediatric seizures are single events without neurologic sequelae and most recurrent seizures can be controlled with medications.
  • Occasionally, however, seizures can be life-threatening (status epilepticus)
incidence of epilepsy
Incidence of Epilepsy
  • More common in children than adults
  • 1styr. of life / Highest incidence
incidence of epilepsy1
Incidence of Epilepsy
  • About 3-5% of children will have at least one seizure by the age of 5 yr.:
      • >50% Benign febrile seizures.
      • 15% acute provoked seizure:
        • The leading cause:
          • Children under 5yr. /CNS infection
          • Adolescents / Head trauma
      • 10% Single unprovoked seizure and will never have another seizure
      • The remaining 25% Recurrent seizures or epilepsy
incidence of epilepsy2
Incidence of Epilepsy
  • ¾ …… Idiopathic, with no known cause
  • ¼ ……Identifiable brain pathologyor

underlying metabolic disorders.

  • A family history of epilepsy in 1st-degree relatives was found in 46.6% of patients.
seizure work up
Seizure work-up

To R/O conditions mimic seizures

  • The exact nature of the seizure:
    • Does the child have a known seizure disorder?
    • If this is the child’s 1st seizure, was the seizure febrile or non-febrile?
    • Was the seizure partial, generalized, or partial with secondary generalization?
    • Was the seizure provoked or unprovoked?
ad