seizures e pileptic / n on epileptic what is that ???
DESCRIPTION
Seizures E PILEPTIC / N on Epileptic What is that ???. Al- Quds University School of Medicine Lectures 5 th year Updated September, 2012. Dr. Samir Khalil Consultant Pediatric Neurologist Makassed Hospital Clinical Assistant Professor Al-Quds University. CONCEPTS & GLOSSARY. - PowerPoint PPT PresentationTRANSCRIPT
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SeizuresEPILEPTIC / Non Epileptic
What is that ???
Dr. Samir KhalilConsultant Pediatric Neurologist
Makassed Hospital
Clinical Assistant ProfessorAl-Quds University
Al-Quds University
School of Medicine
Lectures 5th year
Updated September, 2012
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CONCEPTS & GLOSSARY
Attack
Seizure
Convulsion
Fit
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Attack
A violent act starting on with vigor
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Attack
Is used to describe epileptic & non-epileptic disorder.
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Attack
Is used to describe epileptic & non-epileptic disorder.
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attack
Is used to describe epileptic & non- epileptic disorder.
We say:
Attack of laughing Breath Holding Attack / or spell An attack of febrile convulsion Conversion Reaction Epileptic attack
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attack
?
Is used to describe epileptic & non- epileptic disorder.
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attack
?
Is used to describe epileptic & non- epileptic disorder.
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convulsion
An intense, paroxysmal, involuntary contraction or series of contractions of voluntary muscles
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convulsion
Is used to describe epileptic & non- epileptic motor act / shaking
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convulsion
Is used to describe epileptic & non- epileptic motor act / shaking
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convulsion
If there is no movement (displacement in place), the term “convulsion” is not applied.
The term “convulsion”
implies movement/s
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convulsion
We say:
Clonic convulsion but not tonic convulsions Tonic-clonic convulsions Myoclonic convulsion but not absence
convulsion. ……Absence / Petit male is not a convulsion
Neither arrhythmia nor tachycardia nor apnea
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seizure
A sudden, involuntary event/s that may include:
Motor activity
Altered level of consciousness
Somatosensory symptoms
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seizure
Used to describe epileptic disorders
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Seizure vs Convulsion
A convulsive attack:
Always labeled as seizure Contrary, not all seizures convulse
So a seizure is not synonym to convulsion
We sayEpileptic seizure/s. Grand male seizure/s.Petit male seizure/s.His absence seizures are completely controlled by Valproic acid
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Fit
A seizure or convulsion
especially those of
epileptic nature
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Seizureswork up
Pattern Duration
Frequency
Physiopathology
Diagnosis Classification
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Seizures’ Patterns
Myoclonic
Infantile
Spasm
OpsoMyoclonic
Un
Classified
Status
Epilepticus
TONIC CLONIC TONIC-
CLONIC
ATONIC
Absence
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Seizures’ Pattern
TONIC
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Seizures’ Pattern
CLONIC
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Seizures’ Pattern
TONIC-CLONIC
?
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Seizures’ Pattern
Myoclonic
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Seizures’ Pattern
Myoclonic(Startels)
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Seizures’ Pattern
Absence
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Seizures’ Pattern
Infantile Spasms
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Seizures’ Pattern
Opso Myoclonic
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Seizures’ Pattern
Opso Myoclonic
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Seizures’ Pattern
Un
Classified
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Seizures’ Pattern
StatusEpilepticus
A seizure for more than 30 minutesOr
Frequent Seizures without Regaining
Usual State of Consciousness
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Seizures’ Pattern
StatusEpilepticus
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Seizures’ Pattern
Intermittent IlluminationProvoked Seizures
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duration
Pre-ictal
Post-ictal
Ictal (Inrtra-ictal)
Immediate Post-ictal
Late Post-ictal
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frequency
Attacksper hourper day
per monthPer year
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Seizures’ Pattern
QStatus Epilepticus
Versus
Abundant Attacks
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Seizureswork up
1st Key Question
Is it a seizure ?
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Seizureswork up
1st Key Question
Is it a seizure ?
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Seizureswork up
1st Key Question
Is it a seizure ?
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Seizureswork up
1st Key Question
Is it a seizure ?
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Seizureswork up
2nd Key Question
Is it epileptic or non epileptic
?
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Seizureswork up
2nd Key Question
Is it epileptic or non epileptic
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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Seizureswork up
3rd Key Question
which Type of epilepsy
?
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1st Key Question
Is it a seizure ?
3rd Key Question
Which type of epilepsy ?
4th Key Question
How to classify ?
2nd Key Question
Is it epileptic or non epileptic ?
Seizureswork up
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Classification of Seizures
Epileptic Non-epileptic
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What epilepsy is ?
Classification of Seizures
Epileptic Non-epileptic
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Classification of Seizures
Nonepileptic
Epileptic Seizures are
non occasional (non-provoked) chronic seizures in which one single attack is not
considered as epilepsy.
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Classification of Seizures
Epileptic
Non-epileptic seizures are
occasional (provoked) seizures produced by an acute identified cause
(pyretic, infectious, traumatic or metabolic)
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Classification of Seizures
Epileptic Seizures
Non Occasional Chronic
Non-Epileptic Seizures
Occasional Acute
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definition of epilepsy
A chronic clinical condition defined as 2 or more seizures
resulting from hypersynchronous electrical discharge of a
population of neurons and not secondary to specific provocation factor such as fever, infection,
electrolyte imbalances or trauma
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Pathophysiology of epilepsy
Epilepsy Abnormal, hypersynchronous electrical
activation of a population of neurons in the cerebral cortex, either in:
Localized area Focal //Partial seizure
Multiple areas Generalized seizure
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Pathophysiology of epilepsy
(GABA) GammaAminobutyric Acid
Excitatory
Neurotransmitters
Acetylcholine (Ach) GlutamateAspartate
Inhibitory
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Pathophysiology of epilepsy
(GABA) GammaAminobutyric Acid
Excitatory
Neurotransmitters
Acetylcholine (Ach) GlutamateAspartate
Inhibitory
Any perturbation that interferes with the synthesis, release, re-uptake or metabolism of these neurotransmitters may result in
the occurrence of a seizure.
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Pathophysiology of epilepsy
Many pharmacologic therapies for seizures act upon these neurotransmitters
Increase Inhibition
Decrease Excitation
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Controversy exists regarding the duration of seizure necessary to cause neuronal cell injury.
Most, brief seizures, do not cause brain damage.
Pathophysiology of epilepsy
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classification ofepilepsy
Idiopathic (Primary)Epilepsy
Unknown etiology
Neurological Examine
absolutely normal
Paraclinical explorations are
normal
Secondary Epilepsy
A chronic affection of
the brain by means of
actual methods ofexploration
Cryptogenic Epilepsy
A chronic affection of
the brain which isobscure or
doubtful by means of actualmethods of
exploration
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classification ofepilepsy
Idiopathic (Primary)Epilepsy
Unknown etiology
Neurological Examine
absolutely normal
Paraclinical explorations are
normal
Secondary Epilepsy
A chronic affection of
the brain by means of
actual methods ofexploration
Cryptogenic Epilepsy
A chronic affection of
the brain which isobscure or
doubtful by means of actualmethods of
exploration
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classification ofepilepsy
Idiopathic (Primary)Epilepsy
Unknown etiology
Neurological Examine
absolutely normal
Paraclinical explorations are
normal
Secondary Epilepsy
A chronic affection of
the brain by means of
actual methods ofexploration
Cryptogenic Epilepsy
A chronic affection of
the brain which isobscure or
doubtful by means of actualmethods of
exploration
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classification ofepilepsy
Idiopathic (Primary)Epilepsy
Unknown etiology
Neurological Examine
absolutely normal
Paraclinical explorations are
normal
Secondary Epilepsy
A chronic affection of
the brain by means of
actual methods ofexploration
Cryptogenic Epilepsy
A chronic affection of
the brain which isobscure or
doubtful by means of actualmethods of
exploration
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Generalized Epilepsy
Secondary Generalized
EpilepsyStatus Epilepticus
Partial epilepsy (simple & complex)
Classification of epilepsy
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Provoked seizures associated with a fever, electrolyte abnormality, or other metabolic derangement, are usually generalized rather than focal.
Presentationepilepsy
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Thankyou
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Classification of Epilepsy(According to Extension)
By means of: Clinical presentation Electrical Guidance (EEG)
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Status Epilepticus
• A continuous seizure activity lasting > 30 minutes,
or • The occurrence of ≥ 2 seizures in quick
succession without return to usual level of consciousness
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An emergency neurologic sequelae or death if treatment is delayed
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Seizure Presentation On arrival at the ER
• On active seizure• Shaking, deviation of eyes, frothy secretions,…. Staring• Breath holding (apneic) with cyanosis
• Early post-ictal Drowsy, in deep sleep, paralytic (odd),………
• Late post-Ictal • Free of any manifestation (conscious alert ……..the attack is
past).
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Seizure Presentation On arrival at the ER
• 1st attack• Previous attacks (1, 2 or more)
• Under treatment with AED (withdrawal)• Never been treated with AED
• fever
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Seizure Presentation On arrival at the ER
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The minority
New onset, non-febrile seizure
A very small %
Status epilepticus
Most not seizing upon arrival in the casualty department
The MajorityFebrile convulsion or A known previous seizures
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Prognosis / expectations
• The majority of pediatric seizures are single events without neurologic sequelae and most recurrent seizures can be controlled with medications.
• Occasionally, however, seizures can be life-threatening (status epilepticus)
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Febrile Convulsions
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Incidence of Epilepsy
• More common in children than adults• 1st yr. of life / Highest incidence
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Incidence of Epilepsy
• About 3-5% of children will have at least one seizure by the age of 5 yr.:
• >50% Benign febrile seizures. • 15% acute provoked seizure:
– The leading cause:» Children under 5yr. /CNS infection» Adolescents / Head trauma
• 10% Single unprovoked seizure and will never have another seizure
• The remaining 25% Recurrent seizures or epilepsy
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Incidence of Epilepsy
• ¾ …… Idiopathic, with no known cause • ¼ ……Identifiable brain pathology or underlying metabolic disorders.
• A family history of epilepsy in 1st-degree relatives was found in 46.6% of patients.
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Seizure work-up
To R/O conditions mimic seizures
• The exact nature of the seizure:– Does the child have a known seizure disorder? – If this is the child’s 1st seizure, was the seizure febrile or
non-febrile? – Was the seizure partial, generalized, or partial with
secondary generalization? – Was the seizure provoked or unprovoked?
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Jitterrness
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