seizures dr.nathasha luke. overview definition classification clinical features differential...

SeizuresSeizures

Dr.Nathasha Luke

OverviewOverviewDefinitionClassificationClinical FeaturesDifferential DiagnosisTreatmentCases

BrainBrainElectrical activityNeurotransmittersBalance of electrical activity

DefinitionsDefinitionsSeizure: episode of abnormal

neurologic function caused by inappropriate electrical discharge of brain neurons.

Epilepsy: clinical condition in which an individual is subject to recurrent seizures.

Generalized SeizuresGeneralized Seizures

Caused by a activation of the entire cerebral cortex

Partial seizuresPartial seizures

Due to electrical discharges in a localized structural lesion of the brain.

Affects whatever physical or mental activity that area controls.

Partial (focal) seizuresPartial (focal) seizuresSimple partial

no alteration of consciousnessComplex partial

consciousness impairedPartial seizures (simple or

complex) with secondary generalization

Classification of SeizuresClassification of SeizuresGeneralized seizures

(consciousness always lost)Tonic clonic seizures (grand mal)Absence seizures (petit mal)Myclonic seizureClonic seizuresAtonic seizures

Seizures can occurSeizures can occurDue to epilepsyDue to secondary causes

Causes: secondary seizuresCauses: secondary seizuresTrauma (recent or remote)Intracranial hemorrhageEclampsia-increased blood pressure in

pregnancy causing fitsHypertensive encephalopathyStructural abnormalities

◦ Vascular lesion (aneurysm, AV malformation)

◦ Mass lesion◦ Degenerative disease◦ Congenital abnormalities

Causes: secondary seizuresCauses: secondary seizuresToxins and drugsAnoxic brain injury Metabolic disturbances

◦ Hypo or hyperglycemia◦ Hypo or hypernatremia◦ Hyperosmolar states◦ Uremia◦ Hepatic failure◦ Hypocalcemia, hypomagnesemia (rare)

Features: Tonic clonic seizuresFeatures: Tonic clonic seizures

Abrupt loss of consciousness and loss of postural tone

May then become rigidWith extension of the trunk and

extremitiesApneaCyanosis Urinary incontinence

Features: tonic clonic Features: tonic clonic seizuresseizuresAs the tonic (rigid) phase

subsides, clonic (symmetric rhythmic) jerking of the trunk and extremities develop

Episode lasts from 60-90 secondsConsciousness returns graduallyPostictal confusion may persist

for several hours

Features : absence seizuresFeatures : absence seizures

Brief, usually lasting only a few seconds. Loss of consciousness without losing postural

tone.Appear confused or withdrawn, and current

activity ceases. May stare and have twitching of their eyelids.Do not respond to voice or other stimulationAre not incontinent.End abruptly, and there is no postictal

confusion

Absence seizuresAbsence seizuresCommon in childrenMay keep on repeatedly asking

what was saidSchool children may present with

poor school performanceMay get even or more than 50

episodes a day

Myoclonic seizuresMyoclonic seizuresBrief, shock-like jerks of a muscle

or a group of muscles. "Myo" means muscle and "clonus" means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle.

Simple partial seizuresSimple partial seizuresRemain localized and

consciousness is not affected.

Clinical features of simple Clinical features of simple partialpartialRemain localized and consciousness is

not affected.types Unilateral tonic or clonic movements

limited to one extremity suggest a focus in the motor cortex, while tonic deviation of the head and eyes suggest a front lobe focus.

Visual symptoms often result from an occipital focus, while olfactory or gustatory hallucinations may arise from the medial temporal lobe

Sensory phenomena, or aura are often the initial symptoms of attacks.

Complex partial seizuresComplex partial seizures These seizures usually start in a small area of the

brain. They quickly involve other areas of the brain that affect alertness and awareness. So even though the person's eyes are open their consciousness is lost

Some people can have seizures of this kind without realizing that anything has happened.

Some of these seizures start with an aura, a warning sign.

Examples for Auras odd feeling in the stomach move their mouth, pick at the air or their

clothing/ perform other purposeless actions. repeat words or phrases, laugh, scream, or cry. Déjà vu and jamais vu

Differential diagnosis-what Differential diagnosis-what can mimic seizurescan mimic seizuresSyncopeComplex migraineMovement disordersNarcolepsyPseudo-seizures

Investigations Investigations EEGCan record the abnormal electrical

activity of the brainCan confirm the diagnosis of fits

and identify the type of fitsHowever a normal EEG cant

exclude the diagnosis of fits

Other investigationsOther investigationsParticularly important in looking

for a secondary causeBlood glucoseElectrolytesRenal and liver functionsFull blood countLP CT and MRI scans

Management- first aidManagement- first aid

Note duration of fits

Most fits subside spontaneously with out treatment

Rarely fits can be prolonged and in this case treatment is needed

Treatment: Airway: Treatment: Airway: OxygenMaintain airway

Treatment:Treatment:Breathing:

◦SuctionCirculation: IV accessIV glucose if confirmed

hypoglycemia

First Line Medication: First Line Medication: BenzodiazepinesBenzodiazepines

Ex-MidazolamEx-Midazolam

DiazepamDiazepam

If not resolving can give If not resolving can give other drugsother drugs

For unresolving fits:For unresolving fits:ICU Care and General anesthesia

Why are fits bad?Why are fits bad?

Prolonged fit can cause permanent brain damage…

How to treat epilepsyThey are given anti epileptic

drugsEx- carbamezapineThey have to be on long term

treatmentSpecial advice given regarding -treatment-what to do when fitting-advice for safety

Status epilepticusStatus epilepticusContinuous seizure activity

lasting for at least 30 minOrTwo or more seizures without

intervening return of conciousness

Seizures in childrenSeizures in childrenFits are commoner in children

with underlying brain abnormality and those who have suffered ischemic injury at birth.

Simple febrile convulsions occur in 3-4% of children and this is the commonest cause of fits in childhood

Febrile seizures:Febrile seizures:

Fits occurring with feverIn children Aged 3 month to 5 yearsFamily history increases risk. Usually occurs when fever is risingIT is extremely important to exclude

brain infection in children who have fever with fits

Most children become free of fits as they grow up

Febrile seizuresFebrile seizuresManaged by finding cause and

treating feverParents should be reassured and

given information about febrile fits

They must be told about the first aid measures

Questions??