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EPILEPSY

EPILEPSY. Definition. Epilepsy: A group of recurrent disorders of cerebral function characterized by both seizures and convulsions. Convulsion: Sudden attack of involuntary muscular contractions and relaxations. Seizure: Abnormal central nervous system electrical activity.

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EPILEPSY

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  1. EPILEPSY

  2. Definition • Epilepsy: A group of recurrent disorders of cerebral function characterized by both seizures and convulsions. • Convulsion: Sudden attack of involuntary muscular contractions and relaxations. • Seizure: Abnormal central nervous system electrical activity. • Sezures are generated by abnormal synchronous electrical brain activity

  3. Etiology • Idiopathic – genetic conditions • Acquired: • Trauma • Brain tumors • Stroke • Infections • Degenerative diseases

  4. Ion channels • Proteins that are organised into small pores in the cell membrane • They allow selective passage of ions (Na, Ca, K, Cl), with an important contribution in maintaining the membrane potential and in forming the trans membranare electric flow. • Intercelular signals, transmembrane transport, pH and cell volume

  5. Calcium channel

  6. Na channel Natrium channel

  7. Potassium channel

  8. Classification • Generalized • Tonic • Atonic • Clonic • Tonic-clonic • Mioclonic • Absence • unclassifiable Partial (focal) • Simple • Motor • Sensitive • Vegetative • Psichical • Complex • Secondary generalized International Classification of Seizures (ILAE, Epilepsia 1981)

  9. Return to Epilepsy Article

  10. Epileptogenesis • The abnormal discharge originates usually in a definite area

  11. Investigatii • Electroencefalogrphy – spectral analysis • Cerebral Computed Tomography (CT) • MRI • Functional imagistics techniques: • PET • fMRI • SPECT • Magnetoencephalography • video – EEG monitoring

  12. Scalp EEG Data Acquisition

  13. 10-second EEGs: Seizure Evolution Normal Pre-Seizure Post-Seizure Seizure

  14. EEG - normal

  15. - Complexe virf-unda

  16. fMRI

  17. PET

  18. Magneto-encefalography

  19. TYPES OF SEIZURES

  20. Generalized Seizures • Grand Mal • Absence • Tonic seizures • Atonic seizures • Mioclonic seizures

  21. Generalized Seizures Excessive electrical activity in both cerebral hemispheres. Usually originates in the thalamus or brainstem. Affects the whole body. Loss of consciousness is common.

  22. Generalized Seizures Myoclonic: Brief shock-like muscle jerks generalized or restricted to part of one extremity. Atonic: Sudden loss of muscle tone. Tonic Seizures: sudden stiffening of the body, arms, or legs Clonic Seizures: rhythmic jerking movements of the arms and legs without a tonic component Tonic-clonic (grand mal): Tonic phase followed by clonic phase http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/19076.jpg

  23. Generalized Seizures Absence (petit mal): Person appears to “blank out” - “Daydreaming” Simple Absence (primarily effects consciousness only) Complex Absence Atypical Absence (Includes physical symptoms like eye blinking or lip movements) Status Epilepticus: A seizure lasting longer than 30 min, or 3 seizures without a normal period in between May be fatal Emergency intervention required

  24. Grand Mal epilepsy

  25. Absences

  26. Partial (focal) Seizures Excessive electrical activity in one cerebral hemisphere. -Affects only part of the body.  Simple Partial: Person may experience a range of strange or unusual sensations. Motor Sensory Autonomic Key feature: preservation of consciousness.

  27. Partial (focal) Seizures Complex Partial: Loss of awareness at seizure onset. Person seems dazed or confused and exhibits meaningless behaviors. Typically originate in frontal or temporal lobes (e.g. Temporal lobe epilepsy)

  28. Motor partial seizures • Motor (Jacksonian) seizures • Oculo-cefalogiric seizures • Adversive seizures • Supplementary motor area seizures • Tonic seizures

  29. Sensory partial seizures • Jacksonian sensory seizures • Visual • Auditive • Vestibulary • Olfactive & gustative • Vegetative

  30. Partial complex seizures Association areas are involved: • Partial loss of awareness • Dream state, • Déjà vu, • Jamais vu • Anger, fear, joy crisis

  31. Partial motor & sensory seizures

  32. Complex partial seizures

  33. TREATMENT

  34. Drugs • Cetogenic diet • Surgery • Vagal stimulation

  35. Treatment principles • Monotherapy • Politherapy • Titration • Treatment cessation

  36. Absence seizures • Etosuximide • Oxazolidindione

  37. Drugs that work in seizures other than absence • Phenobarbital • Phenitoin • Carbamazepine • Primidone

  38. Drugs efficient in all types of seizures • Sodium valproate • Clonazepam

  39. Status epilepticus • Prolonged seizure or seizures without remission periods between • Parenteral treatment: • Clonazepam • Diazepam • Phenitoin

  40. Large range of efficacy Narrow range Antiepileptics: efficacy range • Phenytoin • Carbamazepine • Ethosuximide • Gabapentin • Oxcarbazepine • Tiagabine • Pregabalin • Sodium valproate • Levetiracetam • Phenobarbital • Benzodiazepines • Topiramate • Lamotrigine • Zonisamide* * Based on preliminary evidence

  41. Topiramate Vigabatrin Oxcarbazepine Lamotrigine Clobazam Gabapentin Pregabalin Tiagabine Levetiracetam Zonisamide Modern Antiepileptics

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