epilepsy final.pptx

7/29/2019 EPILEPSY final.pptx

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EPILEPSY/

STATUS EPILEPTICUS


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EPILEPSY

Epilepsy is a paroxysmalneurological disorder and ischaracterized by recurrent episodesof convulsive movements or other

motor activity, loss of consciousness,sensory disturbances, and otherbehavioral abnormalities.

Because epilepsy occurs

in more than 50 diseases,it is considered a syndromerather than a disease.


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Convulsive seizures are the most common

forms of attacks of epilepsy. Seizures occurwith abnormal electrical discharges from brain

cells, and these discharges are caused by the

movement of ions across the cell membrane.

Although seizures are the dominant

manifestation of epilepsy, patients can

have a seizure and not have epilepsy.


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Status epilepticusis a clinical or electricalseizure lasting at least 30 minutes, or a series

of seizures without complete recovery over

the same period of time.Pseudoseizures are the physical

appearance of seizure activity without the

cerebral electrical activity.


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CAUSESA. Central nervous system (CNS) disorders

1. potential mass effect (tumor, abscess, atrioventricular malformation,aneurysm, or hematoma)

2. strokes, especially those that are embolic.

B. Metabolic or systemic disorders

1. acute overdose

2. acute drug withdrawal (especially CNS depressants, alcohol,

benzodiazepines, and barbiturates)

3. febrile states

4. Hypoxia

5. Hyperosmolarity6. hypertensive encephalopathy

7. Hyperthermia

8. electrolyte disturbances

C. Idiopathic origins


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classifications

I. PARTIAL (FOCAL, LOCAL)

SEIZURES

A. Simple partial seizures: No

impairment of consciousness

B. Complex partial seizures:

Impaired consciousness,

frequently include automatisms C. Partial seizures that

secondarily generalize


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II. SEIZURES: All have impairment of

consciousness

A. Absence (previously known as petitmal) of blank stare; generally in

children

B. Myoclonic seizures: Short, abrupt

muscular contractions

C. Clonic seizures: Muscle contractionand relaxation

D. Tonic seizures: Abrupt increase in

muscle tone

E. Tonic-clonic seizures (previouslyknown as grand mal): quick, bilateral,

severe jerking movements

F. Atonic seizures (drop attacks):

Abrupt loss of muscle


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III. Unclassified epileptic seizures: Inadequate

or incomplete data to identify classification


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DIAGNOSTICS HIGHLIGHTSTest Normal

Result

Abnormality with

Condition

Explanation

Magneticresonance

imaging

(MRI)

Normalbrain

structures

Assesses the centralnervous system for

changes in brain

structure

such as atrophy of

certain areas or brain

tumors

Structural brain changes such assclerosis, tumors, infarcts, or atrophy

can lead to seizures

Electro-

encephalo-

gram

(EEG)

Normal

patterns

of

electrical

activity

Assesses the central

nervous system for

changes in brain

structure

such as atrophy of

certain areas or brain

tumors

Recording of electrical potentials

based on distribution of waveforms

generated by cerebral cortex

of brain; waveforms demonstrate

abnormal patterns during

seizures; they are not useful inthe acute management of status

epilepticus

Other Tests: Computed tomography (CT) scans, positron emission tomography (PET),

and skull x-rays; serum laboratory data to explore possible causes include glucose;

calcium; blood urea nitrogen (BUN); and electrolyte, toxic, and metabolic screens


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DIAGNOSTICS HIGHLIGHTS

Medicatio

n or

Drug Class

Dosage Description Rationale

Anticonv

ulsants

Varies

with

drug

Multiple drug

therapies

are available:

Phenytoin

sodium

(Dilantin),

phenobarbitol,

lorazepam

(Ativan),diazepam

(Valium).

Lorazepam (Ativan) or diazepam

(Valium) may be used to stop seizures

quickly. Phenytoin (Dilantin) is

preferred

maintenance anticonvulsant for

status

epilepticus. A newer drug,

fosphenytoin

(Cerebyx), has been developedthat is safer for parenteral

administration.

Phenobarbitol may be given if

seizures occur after phenytoin

loading.


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Other: Thiamine 100 mg and 50 ml of 50% dextrose inwater may be administered in an emergency to rule

out seizures because of thiamine deficiency orhypoglycemia.

Other Information about Anticonvulsants: The primarytreatment for epilepsy is one or more of the multitudeof antiepileptic drugs (AED) or anticonvulsants. Thechoice of AED or combination of AEDs depends onseizure type, patient tolerance, and cost.

Carbamazepine (Tegretol) is a widely used andcost-effective anticonvulsant. Valproic acid, primidone

(Mysoline), clonazepam, and ethosuximide areprescribed, depending on the seizure type. Lamotrigine(Lamictal) is a new AED approved as adjunctive therapyand single therapy for partial seizures.


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Surgical Treatment

1. A proportion of the pts with intractable epilepsywill benefit from surgery.

2. Epilepsy surgery procedures: Curative (removalof epileptic focus) and palliative (seizure-related

risk decrease and improvement of the QOL)3. Curative (resective) procedures: Anteromesial

temporal resection, selectiveamygdalohippocampectomy, extensive

lesionectomy, cortical resection,hemispherectomy.

4. Palliative procedures: Corpus callosotomy andVagal nerve stimulation (VNS).


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STATUS EPILEPTICUS

SE is a common medical and one of the

most serious neurological emergency

associated with high mortality and morbidity.

SE refers to a condition in which there is a

failure of the normal factors that serve to

terminate a typical seizure. SE may be

classifies based solely on the presence orabsence of convulsions into convulsive SE

(CSE) and non-convulsive SE (NCSE).


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ALGORITHM FOR TREATMENT OF

CONVULSIVE STATUS EPILEPTICUS


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fin.

epilepsy final.pptx

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