Epilepsy

Fereshteh Ashtari MDProfessor of Neurology

Isfahan University of Medical Sciences

یا Seizureتشنج

در ناگهانی و پاروکسیسمال حاالت و عالئم بروز. مغز نرونهای زیاد و طبیعی غیر الکتریکی اثرفعالیت

اساس بر شود می ایجاد تشنج اثر در که عالئمی. است متفاوت دیسشارژ بروز محل

کوتاه بطور و شده ایجاد ناگهانی بطور عالئم اینیا و حرکتی اختالالت یا هوشیاری اختالل بروز باعث

. گردد می بیمار در حسی

بنام باشد داشته حرکتی جزء تشنج اگرConvulse . شود می خوانده

Epilepsy صرع یا

تشنج حمالت دچار فرد ان در که شرایطی. گردد می متناوب

خاصی شرایط در تشنج تکرار یا و تشنج بار یکنمی خوانده صرع است پیشگیری قابل که

شود.

Epilepsy: two or more unprovoked

seizure.

Incidence : 0.3-0.5%.

Prevalence: 0.5-1%

Classification and seizure type

What Causes a Seizure ?

in newborns and infants:

birth trauma  congenital (present at birth)

problems fevermetabolic or chemical

imbalances in the body  

children, adolescents, and adults:

alcohol or drugs head trauma infection unknown reasons

What are the Symptoms of a Seizure?

staring

jerking movements of the arms and legs

stiffening of the body

loss of consciousness

breathing problems or breathing stops

loss of bowel or bladder control

falling suddenly for no apparent reason

not responding to noise or words for brief periods

appearing confused or in a haze

sleepiness and irritable upon waking in the morning

periods of rapid eye blinking and staring

EEG

Activation by sleep deprivation, photic stimulation, and/or hyperventilation

Normal : do not exclude the possibility of epilepsy.

Electroencephalography

Seizure types

Partial (focal):the seizure activity is restricted to discrete areas of the cerebral cortex. usually associated with structural abnormalities of the brain.

Generalized : involve diffuse regions of the brain simultaneously.

Result from cellular biochemical or structural abnormalities that have a more widspread distribution.

Partial seizure: simple: consciousness is fully preserved

during the seizure. Complex: consciousness is impaired . the symptomatology is more complex

and the seizure is termed complex partial seizure.

Kinds of partial seizure

Simple partial seizure Complex partial seizure Secondary generalized seizure

Simple partial seizure: motor, sensory , autonomic or psychic symptoms without alteration

in consciousness.

Complex partial seizure: Frequently begin with an aura Ictal phase : often sudden behavioral

arrest or motionless stare whitch marks the onset of the period of amnesia.

Accompanied by automatisms( involuntary automatic behaviors that have a wide range manifestations such as chewing, lip smacking , swallowing, ...)

Secondary generalized seizure

Temporal lobe epilepsy

Aura Ictal : automatism , GMSPostictal15-30 y

Generalized seizure

Arise from both cerebral hemispheres simultaneously. Absence Primary tonic clonic seizure Myoclonic epilepsy

Absence seizure(petitmal):

Sudden, brief laps of consciousness without loss of postural control

seconds No postictal confusion Begin in childhood(4-8) May recurs hundreds times EEG is characterized

Petitmal

2-15 s 5-15 y After awaking Exacerbate by hyperventilation ,exersise Simple , complex

Generalized tonic clonic seizure:

Begin abruptly without warning No aura Initial phase is tonic contraction of

muscles ( ictal cry, contraction of jaw and tongue biting , apnea

Clonic phase Post ictal

GMS STAGES:

Perodormal Aura Tonic Clonic Clonic postictall

Atonic seizure: sudden loss of postural muscles lasting 1-2 sec

Consciousness briefly impaired but usually no post ictal confusion

Myoclonic seizure:

Sudden and brief muscle contraction One part of body or entire the body. Sudden jerking movement

Epilepsy syndromes

Disorders in which epilepsy is predominant features and there is sufficient evidences to suggest common underlying mechanisms'.

Juvenile myoclonic epilepsy Lennox-Gastaut syndrom Mesial temporal lobe epilepsy

syndrome

Infantil spasm (West syndrome) 4-7 momth Clinical findings? With brain anomalies ,metabolic

errors disease and tuberous sclerosis,

Juvenile myoclonus epilepsy

unknown cause early adolescence bilateral myoclonic jerks In the morning after

awakening and can be provoked by sleep deprivation.

. Many patients also experience generalized tonic-clonic seizures, and up to one-third have absence seizures.

The condition is otherwise benign, There is often a family history of epilepsy,

and genetic linkage studies suggest a polygenic cause.

Atonic

Drop attack 1s 6-7 years of old

Lenox – gastaut syndrome

Tonic, clonic, tonic clonic, absence, atonic

1-10 more in 3-5 yearls of old Primary Secondary Hemiplegia,

paraplegia,hydrocephalus, microcephalus in 20%

Status epilepsy