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Epilepsy

Epilepsy. Define seizure and epilepsy. Seizure: Paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of CNS neurons Not a diagnosis, but rather a series of signs and symptoms

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Epilepsy

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  1. Epilepsy

  2. Define seizure and epilepsy • Seizure: Paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of CNS neurons • Not a diagnosis, but rather a series of signs and symptoms • Epilepsy: Disorder in which there is a continuing tendency to have recurrent unprovoked seizures due to a chronic underlying process • Refers to a clinical phenomenon rather than a single disease entity

  3. Aetiology of seizures • Endogenous factors: • Genetics / family history • Development • Epilectogenic factors: • Trauma + Surgery • Stroke • Infections / Inflammation Encephalitis, meningitis (Esp. Perinatal) • Abnormalities of CNS development • Neural degenerative disorders (Alzheimer disease, Multiple sclerosis • Intracranial mass lesions Endogenous Epilectogenic Precipitating

  4. Precipitating factors: • Psychological stress • Physical stress • Sleep deprivation • Hormonal changes associated with menstrual cycle • Exogenous factors (drugs and drug withdrawal) • Photosensitivity • Metabolic abnormalities • Hypocalcaemia, hypoglycaemia, hyponatraemia • Acute hypoxia • Uraemia, hepatocellular failure

  5. What are some common causes of seizures in young adults? • Trauma • Alcohol withdrawal • Illicit drug use • Alcohol withdrawal • Idiopathic

  6. Match - classification

  7. Name three epilepsy syndromes. • Juvenile myoclonic epilepsy • Appears in early adolescents • Characterised by myoclonic jerks • Lennox – Gastaut Syndrome • Occurs in children • Multiple generalised seizures • Mesial temporal lobe epilepsy • Most common • Hippocampal sclerosis

  8. Treatment of status epilepticus • Immediate treatment: • Airway, oxygenation and cessation of seizures • Clonzepam or diazepam or midazolam • BZD have short duration of anticonvulsant effects therefore give: • Phenytonin or phenobarbitone or sodium valporate

  9. What is the MOA and Therapeutic range of Carbamazepine? MOA: prevents repetitive neuronal discharge by blocking voltage-dependent and use-dependent Na+ channels Therapeutic range: 4-12mg/L

  10. 71. A 9-year-old boy is brought to your clinic by his parents because he has begun to have episodes of eye fluttering lasting several seconds. Sometimes he loses track of his thoughts in the middle of a sentence. There was one fall off a bicycle that may have been related to one of these events. There are no other associated symptoms, and the episodes may occur up to 20 or more times per day. The boy’s development and health have been normal up until this point. He did have two head injuries as a young child: the first when he fell off a tricycle onto the ground, and the second when he fell off of a playset onto his head. Both episodes resulted in a brief loss of consciousness and he did not think clearly for part of the day afterward, but had no medical intervention. The test most likely to confirm this patient’s diagnosis is a. Brain CT scan b. Brain MRI c. Electroencephalogram d. Lumbar puncture e. Nerve conduction study

  11. 71. The answer is c.This is a common presentation for primary generalized epilepsy of childhood.

  12. 85. A 21-year-old cocaine-abusing man develops seizures that persist for more than 30 min before emergency medical attention is available. When examined nearly 1 h later, he is still exhibiting tonic-clonic movements and has never recovered consciousness. (SELECT 1 SEIZURE TYPE) a. Generalized tonic-clonic b. Generalized absence c. Complex partial e. Simple partial sensory h. Tonic-clonic status epilepticus i. Pseudoseizures j. Myoclonic

  13. 85. A 21-year-old cocaine-abusing man develops seizures that persist for more than 30 min before emergency medical attention is available. When examined nearly 1 h later, he is still exhibiting tonic-clonic movements and has never recovered consciousness. (SELECT 1 SEIZURE TYPE) a. Generalized tonic-clonic b. Generalized absence c. Complex partial e. Simple partial sensory h. Tonic-clonic status epilepticus i. Pseudoseizures j. Myoclonic

  14. Brain tumours

  15. How do brain tumours present? (from path slides) • Generalised/non-localising signs & symptoms • 1. Slowing mental functions (memory, thought, speech, emotion) • 2. Headache +/- signs of ↑ICP • +/- worse in morning or with straining • +/- vomiting • 3. Seizures • •Focal neurological sign or symptom depending on anatomic location • eg motor weakness, paraesthesia, unilateral deafness • Asymptomatic

  16. What are some prognostic factors? 1. Tumour type 2. Grade 3. Tumour Site 4. Age 5. Performance status

  17. Gliomas • What are some subtypes of gliomas? • Astrocytoma • Oligodendroglioma • Ependymoma

  18. Poorly differentiated astrocytoma (red arrow) with haemorrhage into the tumour. Note shift of midline structures (blue arrows), and secondary brain stem (green arrow) haemorrhage.

  19. What is the peak incidence of meningoma? 50s to 70s Meningioma (blue arrow). Focal, small, old infarcts in white matter and basal ganglia.

  20. What are the common sites of mets origins? 1. Lung 2. Breast 3. Melanoma 4. Kidney 5. GIT

  21. Who am I? Histology of neurofibroma (in skin). Note the 'squiggly' spindle shaped cells.

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