Empfohlen
Weitere ähnliche Inhalte
Was ist angesagt?
Ăhnlich wie Epilepsy
Ăhnlich wie Epilepsy (20)
Mehr von Medical Student
KĂźrzlich hochgeladen
KĂźrzlich hochgeladen (20)
Epilepsy
- 1. Epilepsy
- 2. Definition ⢠A group of disorder of unprovoked recurrent seizure (idiopathic epilepsy)
- 3. Pathophysiology 1. Hypersynchronous discharge 2. Large group of neuron activated repetitively 3. Imbalance between excitatory and inhibitory transmitter 4. Abnormal voltage-controlled membrane channel
- 4. Etiology 1. Idiopathic 2. Secondary ⢠Genetic : family history ⢠Congenital malformation of the brain : hydrocephalus with large head or headache ⢠Perinatal complications : birth asphyxia or trauma ⢠Neurocutaneous syndrome : neurofibromatosis with skin lesion ⢠Intracranial haemorrhage : bleeding disorder,NAI ⢠CNS infection : meningitis,encephalitis,brain abscess ⢠Trauma : history of MVA or NAI ⢠CVA : vasculitis ⢠Neoplasm : solid CNS tumor
- 5. Classifications ⢠Partial seizures ⢠Simple partial seizures ⢠Begin in a specific area of the brain ⢠Consciousness not impaired ⢠Motor:originate in the motor cortex cause recurrent contraction of the muscle of one part of the body ⢠Sensory:originate from sensory centrer (postcentral gyrus) ⢠Visual ⢠somatic ⢠Psychic : originate from temporal lobe ⢠Emotional disturbances ⢠Autonomic disurbances ⢠Complex partial seizures ⢠Aura > may be generalized > may be altered consciousness + post ictal confusion and drowsiness + amnesia ⢠Partial seizures evolving to secondary generalized seizures
- 7. Classification ⢠Generalized seizures ⢠Tonic clonic ⢠Tonic : generalized contraction of muscle and extension of the limb and trunk + cyanosis ⢠Clonic : bilateral symmetrical and intense jerking then slowly diminish + urine and fecal incontinence + buccal oral trauma ⢠For few seconds - minutes ⢠Post ictal drowsiness or deep sleep for several hours ⢠Awakening : confused,tired,headache,muscle pain ⢠Absence seizures ⢠Frequent brief impairment of consciounsness ⢠Stop > stares blankly or blink repeatedly not less than 30s ⢠Consciousness recovered immediately ⢠No incontinence or falling ⢠Myoclonic : Sudden brief shock like contractions of one extremity or entire body ⢠Clonic ⢠Tonic atonic : Common in retarded children with mixed children disorder ⢠Atonic > fall abruptly
- 8. Classification ⢠Unclassified epileptic seizure ⢠Primary childhood seizure ⢠West syndrome (infantile spasm) ⢠Juvenile myoclonic epilepsy ⢠Neonatal seizure ⢠Febrile convusion ⢠Status epilepticus
- 9. History ⢠Chief complaint : fitting and duration ⢠Seizures description by witness ⢠What is he doing at that time ⢠Description : sudden LOC,posture,jerking movement,up rolling eyeball,drooling of saliva,cyanosis, urine/incontinence ⢠Post ictal : drowsiness,lethargy,amnesia,insoluble crying,irritability,diarrhea,trauma ⢠Precipitated factor : flash light,extreme exhaustion,tired,emotionally unstable,sleep deprivation ⢠Etiology : fever,vomiting,photophobia,neck stiffness,insoluble crying,irritability,diarrhea,trauma
- 10. Differential diagnosis of seizures ⢠Neonates and infants ⢠Jitteriness ⢠Benign myoclonus ⢠Apnea ⢠GERD ⢠Shuddering attacks ⢠Benign paroxysmal torticollis ⢠Hyperekplexia ⢠Young children ⢠Breath holding spells ⢠Reflex anoxic seizures ⢠Parasomnia ⢠Benign paroxysmal vertigo ⢠Paroxysmal choreoathetosis ⢠Rage attack ⢠Childhood and adolescent ⢠Vasovagal syncope ⢠Migraine ⢠Narcolepsy ⢠Panic attacks ⢠Pseudoseizures ⢠Others ⢠Drugs induced dystonia ⢠Cardiac dysrythmias
- 11. Complications of seizures ⢠Muscle ache ⢠Head trauma ⢠Oral or buccal trauma ⢠Impact on life
- 12. Examination ⢠Normal ⢠Rule out secondary causes ⢠Dysmorphism ⢠Neurocutaneous sign ⢠Hydrocephalus ⢠Head trauma ⢠NF manifestation
- 13. Investigation ⢠Recommended when 2nd afebrile seizures occur ⢠FBC ⢠Blood C&S ⢠RBS ⢠Serum Ca,PO4,Mg and BUSE ⢠Skull Xray ⢠ECG ⢠EEG ⢠MRI/CT scan
- 14. Principles of anticonvulsant therapy for epilepsy 1. Treatment initiated after 2 episodes (recurrence risk is 80%) 2. Classify seizure type and epileptic syndrome 3. Monotherapy,most appropriate drug,increase dose gradually (until max dose or side effects occur) 4. 1st drug fail > optimize 2nd drug then withdraw the 1st drug 5. If combine,use different MOA 6. Monitor drugs level : compliance,well controlled,drug interaction (polypharmacy) 7. Withdraw drug when seizure free for 2 years (taper within 3-6months) 8. Seizure recur:last dose reduction is reversed and refer
- 15. Selecting anticonvulsant ⢠Partial seizure ⢠1st line : Carbamazepine,Sodium Valproate ⢠2nd line : Lamotrigine,Topiramate,Levetiracetam,Phenytoin,Phenobarbitone, Clonazepam ⢠Generalized seizure ⢠1st line : Sodium Valproate,Adrenocorticotrophin,Prednisolone,Vigabatrin ⢠2nd line : Lamotrigine,Topiramate,Nitrazepam,Clonazepam,Valproate
- 16. Side effect and toxicity of anticonvulsant ⢠Carbamazepine ⢠Side effects:drowsiness,dizziness,ataxia,diplopia,rash ⢠Toxicity:agranulocytosis,Steven-Johnson syndrome ⢠Sodium Valproate ⢠Side effects:nausea,epigastric pain,tremor,alopecia,weight gain,hair loss, thrombocytopenia ⢠Serious toxicity:hepatotoxicity (2years of age),hepatitis,pancreatitis, encephalopathy ⢠Lamotrigine ⢠Side effects:Dizziness,somnolence,insomnia,rash ⢠Serious toxicity:Steven-Johnson syndrome ⢠Topiramate ⢠Side effects:Weight loss,somnolence,mental slowing,word finding difficulty,hypohidrosis ⢠Renal calculi
- 17. Advice ⢠Educate and counsel on epilepsy ⢠Compliance! ⢠Don't stop medication by yourself > breakthrough seizure ⢠Watch TV in bright light room and avoid sleep deprivation ⢠No cycling,swimming or climbing alone ⢠Emergency treatment for seizure ⢠Inform teacher and school about the condition