epilepsia
TRANSCRIPT
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DefinitieDefinitie
• Reprezinta o boala cronica sau un grup de boli cronice caracterizate prin aparitia de crize recurente, neprevazute si de obicei neprovocate.
• O criza de epilepsie este generata de o descarcare electrica sincrona a creierului.
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EtiologieEtiologie
• Idiopatica – conditionata genetic
• Secundara:– Traumatisme– Tumori– A.V.C.– Infectii– Boli degenerative
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Canale ioniceCanale ionice
• Canalele ionice sunt constituite din proteine care
formeaza pori la nivelul membranei celulare si
permit trecerea selectiva a anumitor ioni (Na, Ca, K,
Cl) contribuind astfel la mentinerea diferentei de
potential intra- extracelular si formarea curentilor
electrici transmembranari.
• Canalele ionice au deasemenea rol in semnalizarea
intercelulara, transportul transmembranar, reglarea
ph-ului si a volumului celular.
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Canalul de CalciuCanalul de Calciu
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Canalul de SodiuCanalul de Sodiu
Na channel
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Canalul de PotasiuCanalul de Potasiu
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ClasificareClasificarePartiale (focale)• Simple
– Motorii– Senzitive– Vegetative– Psihice
• Complexe
• Secundar generalizate
Generalizate• Tonice• Atonice• Clonice• Tonico-clonice• Mioclonice• Absente
Neclasificabile
International Classification of Seizures International Classification of Seizures (ILAE, Epilepsia 1981)(ILAE, Epilepsia 1981)
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Copyright 2002 The Cleveland Clinic Foundation
Return to Epilepsy Article
Epilepsy Primary Generalized Epilepsy Focal or Partial
Seizure Features
Auras Not present Present
Prodrome Occasionally present Occasionally present
Starting with LOC Present Present
Starting with automatisms Not usually present Present
Prolonged postical confusion without generalization
Not usually present Present
Generalized tonic-clonic seizure Present Present
True versive head movements Not present Present
Focal motor clonic or tonic seizures
Not usually present Present
Risk Factors for Epilepsy
Family history of seizures May be present Not usually present
History of CNS infections, head truama, febrile seizures, CNS tumors, vascular malformation
Not usually present May be present
Examination Findings
Neurologic examination Usually normal May be abnormal
Neuroimaging Findings
Brain MRI Usually normal May be abnormal
EEG Findings
Generalized epileptiform activity Present Not present
Focal epileptiform activity Not present Present
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• Epileptogeneza
• Descarcarea anormala are ca punct de plecare o zona bine delimitata – focar epileptic.
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InvestigatiiInvestigatii• Electroencefalografia – analiza spectrala
• Computer Tomografia cerebrala (CT)
• Imageria prin rezonanta magnetica (IRM)
• Tehnici de imagerie functionala:– PET– fMRI– SPECT
• Magnetoencefalografia
• Monitorizarea video - EEG
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EEG - normal
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Complexe virf-unda
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fMRIfMRI
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PETPET
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Magneto-Magneto-encefalografencefalograf
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Crize generalizateCrize generalizate
• Crizele Grand Mal
• Crizele de absenta
• Crize tonice
• Crize atone
• Crize mioclonice
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Epilepsia Grand MalEpilepsia Grand Mal
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Crizele de absentaCrizele de absenta
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Crize partiale motoriiCrize partiale motorii• Crize somatice motorii (clonii pe jumatate
de corp)
• Crize Jacksoniene motorii
• Crize oculocefalogire
• Crize adversive
• Crize de arie motorie suplimentara (vocalizari si contractiile membrelor)
• Crize tonice
• Crize miotonice
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Crize partiale senzitiveCrize partiale senzitive
• Crize Jacksoniene senzitive
• Crize vizuale
• Crize auditive
• Crize vestibulare
• Crize olfactive si gustative
• Crize vegetative
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Crize partiale complexeCrize partiale complexe
Afectarea ariilor de asociatie:
• Alterarea partiala a starii de constienta
• Starea de vis,
• Déjà vu,
• Jamais vu
• Crize de furie, frica, bucurie…
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Crize partiale motorii si senzitiveCrize partiale motorii si senzitive
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Crize partiale complexeCrize partiale complexe
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• Medicamentos
• Dieta cetogena
• Chirurgical
• Stimulare vagala
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Principii de tratamentPrincipii de tratament
• Monoterapie
• Politerapie
• Titrare
• Oprirea medicatiei
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Medicamente eficiente in crizele de Medicamente eficiente in crizele de absentaabsenta
• Etosuximida
• Oxazolidindiona
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Medicamente eficiente in toate Medicamente eficiente in toate crizele cu exceptia absentelorcrizele cu exceptia absentelor
• Fenobarbital
• Fenitoin
• Carbamaxepin
• Primidon
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Medicamente eficiente in toate Medicamente eficiente in toate tipurile de crizetipurile de crize
• Valproat de sodiu
• Clonazepam
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Status epilepticStatus epileptic
• Crize subintrante
• Tratament injectabil cu :
–Clonazepam
–Diazepam
–Fenitoin
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Antiepileptice: Spectru de Antiepileptice: Spectru de activitateactivitate
Antiepileptice: Spectru de Antiepileptice: Spectru de activitateactivitate
Spectru larg Spectru ingust
* Based on preliminary evidence* Based on preliminary evidence
• Sodium valproate
• Levetiracetam
• Phenobarbital
• Benzodiazepines
• Topiramate
• Lamotrigine
• Zonisamide*
• Phenytoin
• Carbamazepine
• Ethosuximide
• Gabapentin
• Oxcarbazepine
• Tiagabine
• Pregabalin
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Antiepileptice moderneAntiepileptice moderne
• Topiramat
• Vigabatrin
• Oxcarbazepina
• Lamotrigina
• Clobazam
• Gabapentin
• Pregabalin
• Tiagabin
• Levetiracetam
• Zonisamid
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Efecte secundare ale tratamentului Efecte secundare ale tratamentului antiepilepticantiepileptic
• Hipertrofie gingivala
• Hirsutism
• Ovar polichistic
• Carente de folat
• Boala Dupuytren
• Modificari ale metabolismului osos
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Tratament chirurgicalTratament chirurgical
• Rezectia focarului epileptic
• Lobectomie
• Hemisferectomie
• Calosotomie
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Stimularea vagalaStimularea vagala
• Electrozii de stimulare sunt atasati pe nervul vag
• Stimularea se face intermitent
• Indicat in forme de epilepsie refractara
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ParticularitatiParticularitati
• Conducerea autovehiculelor
• Sporturi cu risc
• Anumite profesii
• Sarcina si alaptarea
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Lord Byron
““People with epilepsy have People with epilepsy have excelled in every area.”excelled in every area.”
Kardinal Richelieu
Wladimir Iljitsch Lenin
Margaux Hemingway
Vincent van Gogh
Gustave Flaubert
Jeanne d'Arc
Hermann von Helmholtz
Alfred Nobel
Sokrates
G. Julius Caesar
Napoleon Bonaparte
F.M. Dostojewskij