epilepsy - i

8/12/2019 Epilepsy - i

1/59

Video Epilepsi

1

Epileptic fit (epileptick zchvat) wmv


2/59

Epileptic fit (epileptick zchvat) wmv

2

EPILEPSY

Sam Lazuardi EPILEPSY (EPSY) : a disorder caused by

interruption of normal pattern by

intermittent bursts of electrical energy-more intense than usual causing epilepticseizures : episodes of uncontrolledmovements, loss of consciousness, strange

sensations, emotion & behavior, stareblankly for a few seconds or violent musclespasms.


3/59

3

SEIZURES - EPILEPSY

One in 100 people has experienced an

unprovoked seizure at some point in life

A solitary seizure does not mean an

epilepsy

High fever, severe head injury, lack of

oxygen etc can affect the brain enough tocause a single seizure


4/59

4

EPILEPSY CAUSE (1)

At least 2 unprovoked seizures are required

for epilepsy diagnosis

Epilepsy most common during childhood &

after age 65 (32 % caused by stroke)

Epilepsy has many causes (illnesses, infec-

tions, toxic substances, abn brain develop-

ment & in many cases unkown causes)


5/59


6/59

6

EPILEPSY MENTAL ILLNESS

Epilepsy in not contagious

Epilepsy is not caused by mental illness or

mental retardation

Many people with epilepsy have normal &

above average intelligence (Socrates, Alfred

Nobel)


7/59

7

TRIGGER FACTORS

Seizures are often triggeredby lack of

sleep, stress, hormonal changes associated

with menstrual cycle and smoking (nicotineacts on receptors for excitory neurotrans-

mitter acetylcholine in the brain)


8/59

8

FOCAL SEIZURES

Kinds of seizures : 2 major categories :focal & generalized seizures

Focal seizures partial seizures occur inone part of the brain (60 % of epilepsy)

Simple focal: consciousbut experience

unusual feelings (joy, anger, sadness,nausea or hear, smell, taste, see or feelthings that are not real

Jacksonian march : progressive focal

seizures


9/59


10/59

10

COMPLEX FOCAL SEIZURES

Change (dreamlike experience) or loss of

consciousness& showed repetitious

movements (automatism), blinks, twitches,washing dishes in repetitive unproductive

fashion

May show aura experience (= simple focalseizures) unusual sensations, warning of an

impending seizure (stereotyped every time)


11/59

11


12/59

12

GENERALIZED SEIZURES (1)

Abnormal neuronal activity on both sides of

the brain, loss of consciousness, falls &

massive muscle spasms

1.Absence seizures (petit mal), familial

staring, jerking, twitching, may disturb

concentration, but not IQ, starts inchildhood & stop during puberty


13/59

13


14/59

14


2. Tonic seizures : stiffening of muscles ofthe body (back, legs, arms)

3.Clonic seizures : repeated jerking move-ments of muscles on both sides of the body

4.Myoclonic seizures : jerks or twitches of

upper body, arms or legs 5.Atonic seizures : loss of normal muscle

tone & fall down, drop head involuntarily


15/59

15


6.Tonic clonic seizures (grandmal) :

stiffening of the body & repeated jerks of

arms legs & loss of consciousness Some people show afocal& spread to

entire brain (become generalized)


16/59

16

OTHER KINDS OF EPSY (1)

1.Temporal lobe epilepsy (TLE) :

most common, focal seizures with aura,

begins in childhood, frequent seizures causehippocampus shrinkagememory &

learning problemstreat early !


17/59

17


2. Neocortical epilepsy : from brains

cortex, focal or generalized, strange

sensations, visual hallucinations, emotionalchanges, muscle spasms, convulsions

depending on where it originate


18/59

18


3.Lennox-Gastaut sy (children): severe

epsy, different types of seizures incl. atonic

seizures (sudden falls / drop attacks), veryhard to treat

4.Rasmussens encephalitis : progressive

epsy, continual inflammation in half ofbrainradical hemispherectomy


19/59

19

OTHER KINDS OF EPSY(4)

5. Benign epsy sy (benign myoclonic epsy

& benign neonatal convulsions) do not

impair cognitive functions, easily treated &stop spontaneously

5.Infantile spasms, most common seizures,

started before 6 mo, infant bend & cry outduring attack, anticonvulsant dont work

ACTH or prednisone


20/59

20

NONEPSY SEIZURES (1)

1. First seizure : seizure occur in reaction to

anesthesia, strong drug (unless a family history

of epsy or brain damage) no 2nd

attack. 2ndattack within 4 yrs (33 %)

Risk 3rdattack after 2nd attack 73 % (4 yrs)

After 2ndattack anticonvulsant therapy

Idiopathic epsy (children) seizure free after

20 yrs (6892 %)not included severe epsy


21/59

21


2. Febrile seizures: high fever in child + seizure,

epilepsy

3. Psychogenic seizure dependence, attention

seeking, stressful conditions

4. Other nonepsy seizures : narcolepsy,

Tourette sy, cardiac arrhythmia 5. Eclampsy (pregnancy, hypertension,

seizures)


22/59

22


1.Physiologic nonepsy seizures : hypogly-

cemia, hyponatremia, cardiac arrhytmia,

syncope, migraine, TIA, eclampsia, benignfebrile convulsion

2. Psychogenic nonepsy seizures : stressful

psychological conflicts or major emotionaltrauma


23/59

23

PSYCHOGENIC SEIZURES

Seizures are usually witnessed

No seizures-related injuries

Begin slowly & escalates in intensity

Cry in the middle or at the end

Movements affect left & right alternately

Unusual posturing

Postictal state is brief & wake up immediately

D/ video / EEG monitoring


24/59

24

EPILEPSY DIAGNOSIS (1)

1.EEG monitoring : 24 hrs awake &

sleeping record & video monitoring

2.Brain scan : CT-scan or MRIbrainstructure (tumor, cyst etc)

3.Medical history : detailed history

(seizures, past illnesses, other symptoms) caregiver information is very important


25/59


26/59

26

Caption:Picture 9.

Polyspike and wave discharges seen

in juvenile myoclonic epilepsy


27/59

27

Absence epsy - Anteriorly dominant, typical3-Hz spike & wave discharges


28/59

28

Benign rolandic epilepsy

associated with typical

centrotemporal spikes


29/59

29

EPILEPSY DIAGNOSIS (2)

4.Blood tests in children for metabolic or

genetic disorders associated with seizures

and to look for underlying cause (infections,lead poisoning, diabetes, anemia)

5.Developmental : neurological &

behavioral tests


30/59

30

EPILEPSY PREVENTION

1.Head injury prevention: seatbelts, helmets

2.Medication after 2ndseizure or

complicated febrile seizures 3.Good prenatal care (hypertension,

infections in pregnancy)

4.Treat cardiovascular disease,hypertension

5.Identifying genes, genetic screening


31/59

31

EPILEPSY MANAGEMENT (1)

After D/ start therapy right away

No cure for epilepsy, but medicine can

control seizures for most people

If not, surgery, implanted device (vagus

nerve stimulators) & diet

80 % can be controlled, 20 % intractable


32/59

32


1.Try monotherapy first, combination -

polyth/ may cause side effects

2.Start with a low dose & monitor bloodlevels

3.Sudden stopping of medicationstatus

epilepticus


33/59

33


4. 75 % could stop medication if seizure

free for 3 yrs & normal EEG

5. Never stop medication for people withfamily history of epsy (+), who need

multiple medication, focal seizures and

have abnormal EEG while on medication


34/59

34

ADVANTAGES OF MONOTH/

70 89 % CONTROLLED

FEWER SIDE EFFECTS

REDUCED TERATOGENICITY

NO DRUG INTERACTIONS

EASIER DOSING GREATER

COMPLIANCE

LOWER COST


35/59

35

ADVANTAGES OF POLYTH/

MAY CONTROL AN ADDITIONAL 20 %

MAY OFFER SYNERGISTIC OR ADD-

ON EFFECTS


36/59

36

ANTICONVULSANT SIDE

EFFECTS (1) Sedation, slurring of speech & unsteadiness,

but slowly resolve as body accustomed

Double vision, weight gain, hyperactivity inchildren, irritability, gum dysplasia

Life-threatening skin reactions (Stevens

Johnson sy)Asian ancestry genetictest before th/ carbamazepine


37/59

37

ANTICONVULSANT SIDE-

EFFECT (2) Side effect warning signs :

Prolonged fever, rash, severe sore throat,

mouth ulcers, easy bruising, pinpointbleeding, weakness, excessive fatigue,

swollen glands, lack of appetite, increased

seizures Report to the doctor at once


38/59

38

ANTICONVULSANT SIDE

EFFECTS (3) Side effects of medication in pregnancy

birth defects : cleft lip / palate, cardiac

abnormalities, spinal tube defectsfolicacid 400 microgram prior & during

pregnancy

Osteoporosis

May raise suicide risk


39/59

39

TREATMENT TIPS (1)

1.Take your medication regularly (through

reminders), dont run of medication

(especially on vacation) 2.Learn about your medication (side effects,

strength, dosage, if you miss a dose, etc)

3.Dont ever stop medication abruptly

4.Dont try other peoples pills


40/59

40

TREATMENT TIPS (2)

5.Never mix alcohol with medication

6.Keep medication out of reach of children

7.Keep medication away from directsunlight, dampness & high humidity

8.Tell doctors, dentists, pharmacists that

you are taking antiepileptic medication 9. Tell your doctor about your seizure

control & unpleasant side effects


41/59

41

THE RIGHT ANTIEPILEPTIC

DRUG (AED) DEPEND ON : Type of epilepsy

Age, gender, other health issues

How the AED work & side effects

Other medicine youre taking

Are the side effects acceptable

In a female, pregnancy side effects


42/59

42

FIRST AID FOR SEIZURE

Gently roll person on 1 side & put some-

thing soft under head, loosen neckwear

Dont put fingers / something else in mouth

Dont try to stop his movements & clear

away dangerous objects

Stay until the seizure ends naturally

Try to bring him to emergency


43/59

43

STATUS EPILEPTICUS

Seizure more than 5 minuteslife-threatening

Prolonged seizure, without regaining con-sciousness between seizures

Convulsive or nonconvulsive seizure(confusion or agitation state)

Cause : trauma, tumor etc

Medical emergency


44/59

44

SURGERY

3 broad categories of epsy for successful surgery :

1. Focal seizures

2. Focal & spreading

3. Unilateral multifocal epsy with infantile hemiparesis

(Rasmussens encephalitis)

* After unsuccessful trying of 23 medication

First WADA test areas for speech & memory

Postoperative 2 yrs with anticonvulsant therapy

.


45/59

45

VAGUS NERVE STIMULATOR

For patients not well-controlled by meds

Device is surgically implanted under the

chest skin & attached to vagus nerve likepace maker

Do not stop medication

Side-effect device minimal (sore throat,nausea)


46/59

46

DIET

Ketogenic diet (rich in fats & low in carbo-

hydrates)break down of fats instead of

carbohydratesketosisreduce seizures Side-effect : retarded growth due to

nutritional deficiency

Taking large doses of vitamins harmful

Only folic acid as supplement is justified


47/59

47

How does epilepsy affect daily life ?

Children often develop behavioral &emotional problems

Do not reward negative behavior withunusual amount of attention

Most people with epsy lead a normal life

Poor self-esteem, depression & suicide arethe result of lack of understanding &avoidance by the community


48/59

EPILEPSY Tambahan dari

EPILEPSY FOUNDATION &

HEALTHDAY

SAM LAZUARDI


49/59

EPILEPSY PREVENTION HealthDay24 Nov 2011

The US Centers for Disease Control and Prevention

1. Seek prenatal care during pregnancy toreduce risk of complications during pregnancy& delivery

2 Get all recommended immunizations to wardoff serious infections

3.Protect against traumatic brain injury, usebicycle and sports helmets as appropriate

4.Manage risk factors such as high bloodpressure, diabetes & high cholesterol to reduceyour chances of stroke


50/59

EPILEPSY FOUNDATION

Pendapat salah mengenai epilepsi :

Epilepsi :

Karena kesetanan, kesambet

Berkaitan dg retardasi mental, gangguan

jiwa

Bersifat heriditer

Merupakan penyakit menular


51/59


52/59

TINDAKAN MENGHADAPI

SERANGAN EPILEPSI Tetap tenang, menunggu hingga serangan selesai &

angkat benda benda tajam disekitarnya

Berikan alas utk kepalanya & miringkan kepalanya

ke satu sisi Jangan masukkan sesuatu kedalam mulutnya

Longgarkan bajunya terutama di daerah leher

Harus di bawa ke RS bila : kejang > 5 menit, kejang

pertama kali, kejang bentuknya lain,timbul luka, sedang hamil, serangan di air,

bernafas kurang baik setelah kejang


53/59

PENGOBATAN EPILEPSI -1

Sebagian besar medikamentosa dan bilakurang berhasil, dpt dicoba : diet ketogenikpada anak dan operasi n vagus (vagus nervestimulation therapy- VNS)

Epilepsi tak dpt diobati dg vitamin atau herbal

Obat hrs dijaga ketat, diminum teratur, jangan

kehabisan, krn penghentian mendadak bisamenimbulkan kejang hebat

Bila timbul efek samping, cepat melapor


54/59

PENGOBATAN EPILEPSI - 2

Bila berobat ke dokter lain utk penyakit lain,informasikan ttg penyakitnya & obat yg diminum

Diet ketogenik pd anak : tinggi lemak tanpa gula

selama 2 th. Sering sukar pelaksanaannya

VNS ditanam spt pacemaker yg mengirim energilistrik ke otak dari batere yg ditanam di dada &

berhubungan dg n.vagus di leher. Letupan energi

berupaya mencegah serangan epilepsi Bila serangan datang juga, pakai magnet utk

menghentikannnya. Efek samping suara parau


55/59

TIDUR DAN SERANGAN

EPILEPSI KADANG SERANGAN DPT TIMBUL DI

WAKTU TIDUR LELAP, TAPI BUKAN PADAREM SLEEP

SERANGAN DPT JUGA TIMBUL PD WAKTUTIDUR NGOROK (SLEEP APNOE)

KURANG TIDUR DPT MENIMBULKAN SE-RANGAN KEJANG, YG DPT DICEGAH DG :JANGAN MINUM KAFEIN, ALKOHOL,

MAKAN TERLALU BANYAK, SIANGBANYAK TIDUR, JANGAN TEGANG(LATIHAN RELAKSASI)


56/59

MENCEGAH KECELAKAAN

PADA PENDERITA EPILEPSI - 1 Semua harus direncanakan berdasarkan fakta

pd penderita epilepsi tersebut

Keluarga harus tahu harus dibawa kemana bila

timbul serangan hebat yg sukar diatasi Harus membawa tanda pengenal

Harus selalu bawa obat yg cukup, terutamabila mau menginap di luar

Bawa Hp utk beritahu dimana serangan mulaitimbul


57/59

MENCEGAH KECELAKAAN

PADA PENDERITA EPILEPSI

2 Harus cukup tidur, cukup makan, jangan stres,

jangan minum alkohol atau obat terlarang

Bila sering dpt serangan, selalu cari tempat yg baik

di lantai utk dpt tiduran bila serangan & tidurlah dgkepala dimiringkan

Bila ke toilet jangan dikunci & bila mandi hati hatijangan sampai tenggelam bila serangan

Bila ke dapur, waspada terhadap api

Jangan pakai bahan gelas, tapi plastik

Jangan mengendarai kendaraan


58/59

EPILEPSY & AUTISM (HealthDay,

5 Dec 2011) Fetal exposure in uterine to epilepsy drug

valproate might raise autism risk nearly

three times higher and almost five timesmore likely to have early onset autism

Autistic teens with epilepsy are often light -

sensitive


59/59

CATAMENIAL EPILEPSY

(HealthDay 3 Dec 2011) Seizures among women of childbearing age

with epilepsy may worsen during menstruationor ovulation : catamenial epilepsy

Two-third of them had a diagnosis of partialepilepsy & the rest had primary generalizedepilepsy

About 75 % of them are medically refractory

seizures, resistant to treatment and a highpercentage of them reported having moreseizures during pregnancy

epilepsy - i

Documents