convulsive disorder 08

7/27/2019 Convulsive Disorder 08

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CONVULSIVE DISORDER

H. IBNU MAS`UD

MALANG 2008

. .

MEDICAL FACULTY

BRAWIJAYA UNIVERSITY

LECTURE BY


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NEUROPHYSIOLOGY


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CLASSIFICATION OF CONVULSIVE DISORDER

IN INFANCY AND CHILDHOOD ACCORDING TO

ETIOLOGY AND PATHOGENESIS

CHARACTER OF THE CONVULSIVE ATTACK 9CLINICAL & EEG)

ANATOMIC LOCATION OF THE POINT OF ORIGIN OF THE SEIZURE PATIENT`S AGE

CONVULSION ARE FAR MORE COMMON DURING THE FIRST TWOYEARS THAN AT ANY OTHER PERIODE OF LIFE

THE CAUSED ARE: INTRACRANIAL BIRTH INJURY (INCLUDING THE EFFECTS OF ANOXIA AND

HEMORRHAGE)

CONGINETAL DEFECTS OF THE BRAIN (MOST FREQUENTS IN VERY YOUNGINFANTS)

ACUTE INFECTION ( INTRACRANIAL OR EXTRA CRANIAL). MOST FREQUENT CAUSE IN INFANCY AND EARLY CHILDHOOD ( IN LATER

CHILDHOOD IS CAUSED BY IDIOPATHIC EPILEPSY)

LESS FREQUENT CAUSES OF CONVULSIONS IN INFANTS ARE TETANY, TRUEEPILEPSY, SPONATNEOUS HYPOGLYCAEMIA, BRAIN TUMOR, RENAL

INSUFFICIENCY, POISONING, ASPHYXIA, SPONTANEOUS HEMORRHAGE,POSTNATAL TRAUMA.

THE CHIEF CAUSES OF CONVULSIVE SEIZURE IN MIDDLE AND LATERCHILDHOOD ARE :

INFECTION, IDIOPATHIC EPILEPSY, CONGINETAL DEFECTS OF THE BRAIN,RESIDUAL CEREBRAL DAMAGE FROM EARLY TRAUMA, LEAD POISONING, BRAINTUMOR, ACUTE AND CHRONIC GLOMERULONEPHRITIS, DEGENERATIVE DISEASEOF THE BRAIN.


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EEG PATTERNEEG recording of a normal brain showing no unusual activity

http://www.epilepsyfoundation.org/answerplace/Medical/treatment/eeg.cfm


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DEFINITIONS OF SEIZURE & ITS FEATURES

Seizure: a sudden attack, spasm, or convulsion, as in epilepsy oranother disorder

Epileptic seizure: a transient episode of abnormal and excessive

neuronal activity in the brain that is apparent either to the subject oran observer.

Epilepsy: a chronic disorder of the brain characterized by recurrent,unprovoked epileptic seizures.

FEATURES OF EPILEPTIC SEIZURE ARE: The abnormal neuronal activity during an epileptic seizure may be

manifested as a motor, sensory, autonomic, cognitive, or psychicdisturbance. The neurophysiological basis is inferred on clinical grounds.

A convulsion is a subtype of seizure in which motor activity occurs. Can be provoked in individuals who do not have epilepsy

For examples of provoking insults including fever,trauma,hypoglycaemia and hypoxia)

There are many paroxysmal disturbances that mimic epileptic seizures. CLASSIFICATIONS OF EPILEPTIC SEIZURE

Generalized seizures: the first clinical change indicates initialinvolvement of both cerebral hemispheres (left & right)

Partial seizures: there is initial activation of pare of one cerebralhemisphere


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INTERNATIONAL CLASSIFICATION OF:

EPILEPTIC SEIZURES: Partial Seizures

Simple Partial

Complex Partial

Simple or Complex Partial whichgeneralize

Sensory

Motor

Autonomic

EPILEPTIC SEIZURE ~GENERALIZED:

Absence (typical and atypical)

Myoclonic

Tonic

Clonic Atonic-astatic

EPILEPTIC SEIZURE ~UNCLASSIFIED:

Febrile Seizures

Reflex Epilepsies

Status Epilepticus

Christopher M. Inglese, M.D.Regional Epilepsy CenterSt. Luke's Medical CenterMilwaukee,Wisconsin


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EEG PATTERN

EEG recording of an absence seizure showing the distinctive3-per-second spike and wave discharge

http://www.epilepsyfoundation.org/answerplace/Medical/treatment/eeg.cfm


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GENERALIZED OF SEIZURES

ABSENCE SEIZURE (PETIT MAL): brief unawareness lasting a few seconds;

no loss of posture; immediate recovery; may be very frequent; associated with automatisms.

MYOCLONIC SEIZURE: repaid, brief, usually isolated jerks of the limbs, neck or trunk.

TONIC SEIZURES: a generalised increase in tone

TONIC-CLONIC SEIZURES (GRAND MAL SEIZURE): tonic phase of rigidity with loss of posture followed by clonic

movements of all four limbs; loss of consciousness; duration 2-20minutes; postictal drowsiness.

ATONIC SEIZURE (ASTATIC): a trainsient loss of muscle tone caused a sudden fall to the floor or

drop of the head.


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http://professionals.epilepsy.com/page/generalized_absence.html

Absence seizures

Adapted from: Holmes GL. Classification of seizures and the epilepsies. In: Schachter SC, Schomer DL, eds. The

comprehensive evaluation and treatment of epilepsy. San Diego, CA: Academic Press; 1997. p. 1-36.


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WHAT CAUSES A SEIZURE?

[K]o = extracellular potassium

AHP = after hyper-polarization

NMDA = N-methyl-D-aspartate

IPSP = inhibitory post-synaptic potential

EC = extracellular

Interictal = between seizures


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SEIZURE Definition

A seizure is a sudden change in behavior due to an excessiveelectrical activity in the brain.

Seizure: A clinical event in which there is a sudden disturbance ofneurological function in association with an abnormal or excessiveneuronal discharge. (Lissauer, 2002).

There are a wide variety of possible symptoms of seizures,depending on what parts of the brain are affected. Many types of seizures cause loss of consciousness with twitching or

shaking of the body. However, some seizures consist of staring spells that can easily go

unnoticed.

Occasionally, seizures can cause temporary abnormal sensations orvisual disturbances.

Seizures can generally be classified as either "simple" (no changein level of consciousness) or "complex" (change in level ofconsciousness). Seizures may also be classified as generalized(whole body affected) or focal (only one part or side of the body isaffected).

Epilepsy is a chronic disorder with recurrent seizures. Some typesof epilepsy are hereditary.


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SEIZURE Any medical condition that irritates brain cells may result in a seizure.

Common medical conditions that commonly cause seizures include: Hypoglycemia (low blood sugar)

Drug use (especially cocaine or stimulants) Alcohol withdrawal Very high fever (fever convulsions in children)

Febrile convulsions occur in young children when there is a rapidincrease in their body temperature. It affects up to 1 in 20 childrenbetween the ages of one and four but can affect children between sixmonths and about five years old.

The child's risk of febrile convulsion rises if: they are genetically predisposed to it

They suffer frequent illnesses, which include high temperaturesThe first attack of febrile convulsion was accompanied by arelatively low body temperature - below 39C.

most febrile seizures (fever convulsion) are harmless and do not causebrain damage

Febrile seizures are convulsions brought on by a fever in infants orsmall children. During a febrile seizure, a child often loses consciousness and shakes, moving limbs on both sides of the body. Less commonly, the child becomes rigid or has twitches in only a

portion of the body. Most febrile seizures last a minute or two; some can be as brief as a

few seconds, while others last for more than 15 minutes.
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FEBRILE SEIZURE FEBRILE SEIZURE (F S):

the most common seizure disorder in children ( infancy & childhood) associated with a rapidly rising temperature

usually develop when the core temperature reaches 39 C or greater

occur with the diseases out side the CNS and associated with fever age dependent: 3-6month ( peak age of onset:14-18 month of age) till 5 years of age

With normal CNS structure and function (without evidence intracranial infection ordefined cause)

Without febrile seizure history

Genetic predisposition

CLINICAL MANISFESTATION OF F S Simple FS:

Occurs in the children: 3 month - 5 yr of age

Typically generalized seizure (tonic-clonic)

Duration: a few seconds to 10-min

Only has once or twice of seizures during a period of disease

Atypical FS

Age of seizure onset: < 6 mont or > 6 years Seizure persisting for more than 15 min

Repeated convulsions during a febrile period

A focal seizure.

An EEG is indicated for atypical febrile seizures or for the child at riskfor developing epilepsy


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FEBRILE SEIZURE

Febrile convulsions are a common paediatric presentation to A&Edepartments, occurring in about 3% of children between the ages of

six months and five years. The seizure usually occurs early on in aviral infection when the temperature is rising rapidly, and typicallylasts less than five minutes. It is the abrupt rise in temperaturerather than the high level that is important.

The seizures are tonic or tonic-clonic, with loss of consciousness and

muscular rigidity forming the tonic stage. This may be preceded bya frightened cry from the child.

Cessation of respiratory movements and incontinence of urine andfaeces may occur during this stage, which lasts about 30 seconds.

The clonic stage that follows is characterised by repetitive

movements of the limbs and face.


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IS IT FS or EPILEPSY?

Febrile seizures are not classified as epilepsy, about 3% of childrenwith FS go on to develop afebrile recurrent seizures ( epilepsy)

Risk factors for epilepsy include: seizures that are focal, prolonged(>15mins) or recur in the same illness; first-degree relative withepilepsy; neurological abnormality

Classification of epilepsies

According to the seizure type

Generalized epilepsies and syndromes

Localization-related epilepsies and syndromes

According to aetiology

Idiopathic ( or primary) ---in which there is no apparent causeexcept perhaps for genetic predisposition

Symptomatic---in which the cause is known or suspected


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SEIZURE

Seizures can generally be classified as either:

"simple" (no change in level of consciousness) or

"complex" (change in level of consciousness).

Seizures may also be classified as:

generalized (whole body affected) or

Focal (only one part or side of the body is affected).

Epilepsy is a chronic disorder with recurrent seizures. Some

types of epilepsy are hereditary. Causes of seizure: Any condition that results in abnormal

electrical excitation of the brain may result in a seizure,including:

Epilepsy

Injury or trauma to the head Infection (brain abscess, meningitis)

Brain tumor

Stroke
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CAUSES OF EPILEPSY

Fever 36%

Medication change 20%

Unknown 9%

Metabolic 8%

Congenital 7%

Anoxic 5%

Other(trauma, vascular, infection, tumor, drugs) 15%

DeLorenzo RJ. Epilepsia 1992;33 Suppl 4:S15-25


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BASAL NUCLEI

Basal nuclei: gray matter ygletaknya didalam (within) whitematter td: Corpus striatum:

Caudate nucleus.

Lentiform nucleus

Functions: memperbaiki gerakanmotor sadar menjadi lebih baik (inthe refinement of voluntarymovements.)

Parkinsons: penyebabnya adalahdegeneration of neurons ygmenghubungkan substantia nigra( midbrain) ke caudate nucleus.

Hilangnya kendali GB terhadapaktivitas cortex motor yg berlebihan

menyebabkan rentetan rangsnganpada bagian otot tubuh ygberlebihan dan timbul seizure

Kejang sesuai rangsangan daribagian cortex yg mana?kaki,lengan dan bisa menyeluruh.F:doc.aging immunity/8brainM.ppt/Lt.ibnu/2005

BAGIAN DALAM OTAK:


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MALIGNANT HYPERTHERMIA

Sensory input to


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Sensory input to

the CNS comes

from receptors of

many different

types situatedthroughout the

body. From the

sensory cortex

to the motorcortex etc and

produce a body

movement. But

the cortex motor

can stimulate by

some terrible

stimulant ie:

infection, fever

or poison etc.


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Nervous system conveys high-speed electrical signalsalongneurons such rapid messagescontrol the movement of bodyparts in response to suddenenvironmental changes

Receptor (sensor) detects astimulus and sends information tocontrol center Control center = compares the

incoming info to a set point(desired value) and sendsout a signal that directs aneffector to respond

Example. ~ a change in bloodcalcium level

Repetitive stimulation from the

motor cortex conveys moreelectrical signal to the part ofbody and make a convulsion.Why? Control center fail toregulate set point & signal thatdirects stimulation to the effectorrepetitively

Stimulation by fever,poison, drugs or infection


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Somatosensory and Motorcortex

Both of their neurons aredistributed according to thepart of the body thatgenerates the sensory inputor receives the motorcommands

Primary Motor Cortex helps

issue commands that consist ofaction potentials produced byneurons [located: rear offrontal lobe, adjacent to theprimary somatosensory cortex] Action potentials travel

along axons to brainstem &

spinal cord excite motorneurons excite skeletalmuscle cells

What happen when stimulationrepetitively & uncontrollable tothe primary motor cortex?


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Management of the fitting febrile child:

Clothing should be removed and the child covered with a sheet.

The child should be placed on its side, or prone with its head to one side, sincevomiting with aspiration is a hazard.

Rectal diazepam is the drug of choice, producing an effective bloodconcentration of anticonvulsant within ten minutes.

All children with a first febrile convulsion should be admitted to hospital to a)exclude meningitis and b) educate the parents.

A urine specimen should be taken to exclude infection, and a blood glucose levelshould be taken.

A lumbar puncture may be performed if the child is less than eighteen monthsold shows signs of meningitis or sepsis.Treatment of the febrile child:Fever should be treated to promote the comfort of the child and to prevent

dehydration. Paracetamol is the preferred anti-pyretic and fluid levels should bemaintained. Ibuprofen can be given if the fever does not respond toparacetamol.Rectal diazepam should be administered as soon as possible after the start of theconvulsion, and should not be given after the convulsion has stopped.

convulsive disorder 08

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