Epilepsy Dr Audu A A FNPH Calabar Outline • • • • • • • Introduction Classification Clinical features Conditions that may look like epilepsy Evaluation Treatment Key points Introduction • Origin= Greek word “epilepsia” meaning “to possess/grasp/seize/hold.” • A seizure is a sudden, transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic, or psychic phenomena, alone or in any combination, often accompanied by alteration or loss of consciousness. • A seizure may occur after a metabolic, traumatic, anoxic, or infectious insult to the brain. Introduction • Epilepsy is the tendency to recurrent seizures • Repeated seizures without evident cause justify the label of epilepsy • It is not contagious and people with epilepsy are NOT “crazy” • It is not caused by “evil spirits” • The most common of the chronic neurological disorders – 1:100-200 Classification • Classified by cause – Idiopathic (essential) epilepsy – Symptomatic (secondary) epilepsy – Cryptogenic epilepsy Seizures Generalised Focal Classification Classified by seizure type • Partial (focal, local) seizures – Simple partial seizures, without impairment of consciousness – Complex partial seizures, with impairment of consciousness – Partial seizures evolving to secondarily generalized seizures Classification Classified by seizure type • Generalized seizures – – – – – – – Absence seizures Myoclonic seizures Clonic seizures Tonic seizures Tonic-clonic seizures Atonic seizures Infant spasm, tonic-spasm • Unclassified epileptic seizures Clinical features • Diagnosed with the occurrence of two or more seizures • Seizures prevent the brain from interpreting and processing incoming sensory signals & controlling muscles. • Sometimes people know when they are about to have a seizure because they see, hear or feel something different – this is known as an “aura.” Auras can act as an early warning for a person that a seizure is about to happen. Clinical features- partial epilepsy • Simple partial seizures – – – – – “Jacksonian” or “focal” seizures Short seizures with no loss of consciousness motor or sensory symptoms localized to one body part People may see, hear or smell something odd & their body may jerk These may evolve to a tonic-clonic seizures (secondary generalization) – Weakness following the event may occur for minutes or hours (todd’s paresis). • Complex partial seizures – “Psychomotor” seizures – A seizure with a change, but no loss, in consciousness. – People may hear or see things or have a memory resurface. Déjà vu may occur. Focal seizures Clinical features- Generalized seizures • Tonic-clonic seizures – “grand mal” – massive discharge of neurons on both cerebral hemispheres. Body becomes rigid and jerks. “Tonic-clonic” means “stiffness-violent” “grand mal” means “great sickness” • Absence seizures – Absence attacks usually consist of a brief interruption of activity, sometimes with complex motor activity (such as fumbling with clothes), but without collapse Tonic clonic seizures Tonic (stiffening) Clonic (jerking) Absence seizures Clinical features- Generalized seizures • Atonic seizures – Loss of muscle tone – causes person to fall down • Myoclonic seizures – twitching or jerking of certain body parts. • Status epilepticus – Frequent, long-lasting electrical activity with no regaining of consciousness between attacks. Very dangerous and requires immediate medical attention Conditions that may look like epilepsy • Febrile Seizures – – – – Ages 3 months to 5 years Fever Non-CNS infection Generalized seizures Last less than 5 minutes • Migraine – – – – – Positive family history. Pulsatile headache Manifestations of autonomic nerve disorder Visual disorder Sensory disturbance • Panic attacks Conditions that may look like epilepsy • Breath-holding spells – Age 6 months to 3 years, – Cry, loss of consciousness – Apnea and cyanosis • Sleep disturbance – Sleepwalking , – Nightmare – Night terrors Conditions that may look like epilepsy • Masturbation – Consciousness not impaired – Normal EEG • Pseudoseizures – Effectual Suggestive therapy – Normal EEG • Tourette sydrome – Simple or complete stereotyped jerks or movements – Cough and grunt – Normal EEG Approach to seizures Time the seizure 1 Put something soft under their head 2 Keep the area safe 4 Stay calm and reassure 5 Put them into the recovery position AFTER the shaking has stopped 6 3 Get help Evaluation of seizure • • • • • • • History of event Medical History Family History Social History Physical Examination Neurological Examination Laboratory Evaluation – EEG – MRI – Routine lab work Treatment of epilepsy • Principles of treatment with antiepilepsy drugs – Early treatment – Treatment as the types of epileptic seizure – Treatment with one drug – Individual therapy – Long course of treatment – Slow drug withdrawal – Periodic re-examination Key points • In epilepsy, there is a problem with the electrical messages in the brain • People with epilepsy experience sudden bursts of electricity in the brain - called a seizure • Seizures disrupt the way the brain works for a short time • Most people with epilepsy take medication every day to help prevent their seizures Key points • During a seizure, we need to keep the person safe • People with epilepsy can join in most activities just like everyone else. 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