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Ronald Chrisbianto Gani405090223Faculty of MedicineTarumanagara University

EMERGENCY MEDICINE BLOCKSEIZURE

EPILEPSY & SEIZURE DISORDERSETIOLOGY

Adams and Victors Principle of Neurology 9th EdEPIDEMIOLOGY

Adams and Victors Principle of Neurology 9th EdPATHOPHYSIOLOGYOFEPILEPSY

CLASSIFICATIONOFSEIZURES

Adams and Victors Principle of Neurology 9th EdGENERALIZED SEIZURESGeneralized Tonic-Clonic Seizures (Grand Mal)Prodrome : apathetic, depressed, irritable, abdominal pain/cramps, throbbing headache, constipation, diarrhea, etcFlexion of trunk, mouth & eyelids opening, upward deviation of eye, arms elevated and abducted, elbows semifelxed, hands pronatedTonic phase(10-20s): stiff body, piercing cry, pupils dilated, unresponsive to light, bladder emptyAdams and Victors Principle of Neurology 9th EdGENERALIZED SEIZURESClonic Phase : tremors, violent flexor spasm in rhytmic salvos agitate the entire bodyTerminal phase : all movements ended, deep coma, pupils contract to light, breathing quiet or stertorous.Wake up confused and bewildered, dont remember anything, pulsatile headache, sleepy Adams and Victors Principle of Neurology 9th EdGENERALIZED SEIZURESAbsence, Petit Mal SeizuresComing without warningSudden interruption of conciousness10% motionless. Minor automatism : lip-smacking, chewing, fumbling movement of fingersMay continue complex acts (walking, riding bike)After 2-10s reestablish full contact, resume preseizure activityHyperventilation provoke seizureAdams and Victors Principle of Neurology 9th EdGENERALIZED SEIZURESAbsence VariantsLess complete loss of conciousness, prominent myoclonusLennox-Gastaut Syndrome : atonic, astatic seizures, succeded by motor, tonic-clonic, partial seizureAdams and Victors Principle of Neurology 9th EdGENERALIZED SEIZURESMyoclonic SeizuresBrusque, brief, muscular contractionMay affect part muscle, or entire muscleBenign, respond well to medicationDissemniated myoclonus suspicion of some other diseasesJuvenile Myoclonic Epilepsy : most common form of generalized epilepsy in older children and young adults

Adams and Victors Principle of Neurology 9th EdPARTIAL OR FOCAL SEIZURESSimplex Partial SeizuresSeizures begin in a focal area and do not impair awarenessComplex Partial SeizuresSeizures with focal onset and impair awarenessAdams and Victors Principle of Neurology 9th EdEPILEPSY SYNDROMES

Blueprints Neurology 3rd EdDIAGNOSISHistoryMost important, diagnosis can be made by history alonePatient or witness describes the conditionPhysical ExaminationRarely benefits in diagnosisUsed to diagnose meningitis, or other underlying etiology of seizures

Blueprints Neurology 3rd EdDIAGNOSISLaboratory TestReveal underlying metabolic etiologyHyponatremia, hypocalcemia, lactic acidosisRadiographic ImagingMRI and CT to find structural abnormalitiesElectroencephalography (EEG)

Blueprints Neurology 3rd EdEEG

Blueprints Neurology 3rd Ed

TREATMENTAntiepileptic drugs for adults

Adams and Victors Principle of Neurology 9th EdTREATMENTAntiepileptic drugs for children

Adams and Victors Principle of Neurology 9th EdTREATMENTDrugs combination

Adams and Victors Principle of Neurology 9th EdSTATUS EPILEPTICUSRecurrent generalized convulsions at a frequency that precludes regaining of consciousness in the interval between seizuresProlonged convulsive status >30 minutesEmergencies : Rising temperature, acidosis, hypotension, renal failure, epileptic encephalopathy, neurogenic pulmonary edema hypertensive encephalopathyAdams and Victors Principle of Neurology 9th EdSTATUS EPILEPTICUSEtiologies : all fundamentals of seizureMostly associated with viral or paraneopastic encephalitis, old traumatic injury, epilepsy with idiopathic mental retardation

Adams and Victors Principle of Neurology 9th EdAPPROACH TO TREATMENT OF STATUS EPILEPTICUS

Adams and Victors Principle of Neurology 9th EdAPPROACH TO TREATMENT OF STATUS EPILEPTICUS

Adams and Victors Principle of Neurology 9th EdREFERENCESRopper AH, Brown RH. Adams and Victors Principles of Neurology, 9th ed. New York : McGraw-Hill, 2009Drislane FW et al. Neurology Blueprints. Philadelphia : Lippincot Williams & Wilkins, 2006