Dr shabeel pnDr shabeel pn

Clinical cases

EPILEPSYEPILEPSY

It is a condition in which a person has recurrent seizures

Seizure – Paroxysmal event due to abnormal,excessive,hyper synchronous discharge from CNS neurons

Classification – Partial seizure Primary generalized

Partial SeizurePartial Seizure

Simple partialComplex partialPartial seizure with secondary

generalization

PRIMARILY GENERALISEDPRIMARILY GENERALISED

Absence ( Petit Mal)Tonic- clonic ( Grand Mal )TonicAtonicMyoclonic

PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF PARTIAL SEIZUREPARTIAL SEIZURE

Paroxysmal discharge in a focal area

Secondary generalization- spread to both hemispheres simultaneously

PATHOPHYSIOLOGY OF PATHOPHYSIOLOGY OF GENERALIZED SEIZUREGENERALIZED SEIZURE

Discharge spreads simultaneously in both hemispheres

SIMPLE PARTIAL SEIZURESIMPLE PARTIAL SEIZURE

Consciousness is fully preservedMotor, sensory, autonomic or psychic

symptomsJacksonian marchTodd’s paralysis- lasts for minutes to hoursEpilepsia partialis continua

COMPLEX PARTIAL COMPLEX PARTIAL SEIZURESEIZURE

Consciousness is impaired in the form of transient impairment in the patients ability to maintain normal contact with the environment

Aura ( simple partial seizure) Automatisms- lip smacking, chewing,

swallowing , picking movements of the hand Confused following seizure

PARTIAL SEIZURE WITH PARTIAL SEIZURE WITH SECONDARY SECONDARY

GENERALIZATIONGENERALIZATIONStarts with partial seizure & then becomes

generalized

ABSENCE SEIZUREABSENCE SEIZURE( PETIT MAL)( PETIT MAL)

Sudden brief lapse of consciousness without loss of postural control

Lasts for few seconds onlyNo post ictal confusionBegin in child hoodOccur hundreds of times per dayEEG – spike & wave discharge

GENERALIZED TONIC-GENERALIZED TONIC-CLONIC ( GRAND MAL)CLONIC ( GRAND MAL)

No auraTonic contractions of the muscles of the

bodyOften starts with a cry – laryngeal muscle

contractionImpaired respirationPooling of secretions

GENERALIZED TONIC-GENERALIZED TONIC-CLONIC ( Contd)CLONIC ( Contd)

CyanosisBiting of the tongueHR/BP increasedAfter 10-20 sec tonic phase is evolved into

a clonic phaseBladder / Bowel incontinencePost ictal confusion / coma /

myalgia/fatigue

ATONICATONIC

Sudden loss of postural muscle tone lasting for 1-2 sec ( Head drop)

Consciousness is impairedNo post ictal confusion

MYOCLONICMYOCLONIC

Sudden clonic movement of the limbsObjects fall from the hand as if it is thrown

away

CAUSES OF GEN. SEIZURECAUSES OF GEN. SEIZURE

Cerebral anoxiaAlcohol & withdrawalMetabolic

Hyponatraemia Hypoglycemia Hypocalcaemia

CAUSES ( Contd)CAUSES ( Contd)

Drugs Penicillin Lignocaine Metronidazole Chloroquin

CAUSES ( Contd)CAUSES ( Contd)

Infective Meningitis Encephalitis

CAUSES OF PARTIAL CAUSES OF PARTIAL SEIZURESEIZURE

Cerebral embolismAV malformationTumorCerebral abscessTuberculoma

INVESTIGATIONSINVESTIGATIONS

EEGCTMRIElectrolytesSugarCalcium

FACTORS TRIGGER FACTORS TRIGGER SEIZURESEIZURE

Sleep deprivationAlcohol / withdrawalPhysical / mental strainFlashing / flickering lightsInfectionLoud noiseHot water

MANAGEMENT- IMMEDIATEMANAGEMENT- IMMEDIATE

Air wayBreathingCarry the person away from dangerDiazepam – IV/ PR

PARTIAL SEIZURE PARTIAL SEIZURE MANAGEMENT - LONG MANAGEMENT - LONG

TERMTERMCarbamazepineValproatePhenytoin

MANAGEMENT – GTCS - MANAGEMENT – GTCS - Long termLong term

ValproateCarbamazepinePhenytoin

STATUS EPILEPTICUSSTATUS EPILEPTICUS

Continuous seizure or repetitive seizures with impaired consciousness in the inter ictal period