EpilepsyShi Xue Chuan.General ConsiderationsnA seizure is a sudden, transient disturbance of brain function, manifested by involuntary motor, sensory, autonomic, or psychic phenomena, alone or in any combination, often accompanied by alteration or loss of consciousness.nA seizure may occur after a metabolic, traumatic, anoxic, or infectious insult to the brain.nRepeated seizures without evident cause justify the label of epilepsy.General ConsiderationsnIncidence is greatest in early and late life, with a prevalence of approximately 36 .nChance of having a second seizure after an initial unprovoked episode is 30%.nChance of remission from epilepsy in childhood is 80%.General ConsiderationsnRecurrence rate after the withdrawal of drugs is about 30%.nIdiopathic or genetic epilepsy most often appears between ages 4 and 16 yaers.General ConsiderationsnFactors adversely influencing recurrence include:nDifficulty in getting the seizures under controlnNeurologic dysfunction or mental retardationnAge at onset under 2 yearsnAbnormal EEG at the time of discontinuing medication nType of epilepsy.EtiologynGenetic factor nBrain damage and dysmetabolism nInbornnAcquired nCausative factor.ClassificationnClassified by etiologynIdiopathic (essential) epilepsy nSymptomatic (secondary) epilepsynCryptogenic epilepsy.ClassificationnClassified by epileptic seizuresnPartial (foal, local) seizuresnSimple partial seizures, without impairment of consciousnessnWith motor signsnWith somatosensory or special-sensory symptomsnWith autonomic symptoms or signsnWith psychic symptoms.ClassificationnClassified by epileptic seizuresnComplex partial seizures, with impairment of consciousnessnPartial seizures evolving to secondarily generalized seizures.ClassificationnClassified by epileptic seizuresnGeneralized seizures nAbsence seizuresnTypical absencenAtypical absencenMyoclonic seizuresnClonic seizuresnTonic seizuresnTonic-clonic seizuresnAtonic seizuresnInfant spasm, tonic-spasmnUnclassified epileptic seizures.ClassificationnClassification of epilepsy and epilepsy syndromes nBenign children epilepsy with centrol-temporal spikenLennox-Gastaut syndromenInfantile spaamsnJuvenile myoclonic.Clinical manifestationnPartial epilepsynFocal epilepsy may arise from an intracerebral structural defect, causing motor or sensory symptoms localized to one body part, which may then spreads to contiguous regions of the cortex (e.g. jacksonian seizures).nThere are simple partial seizures without impairment of consciousness.nComplex partial seizures associated with disturbance of consciousness usually arise in the temporal lobe.Clinical manifestationnPartial epilepsynSeizures arising in the medial temporal lobe may produce disturbances of smell and taste, visual hallucinations.nThese may evolve to a tonic-clonic seizures ( secondary generalization).nWeakness following the event may occur for minutes or hours (todds paresis).Clinical manifestationnGeneralized seizuresnAbsence attacks usually consist of a brief interruption of activity, sometimes with complex motor activity (such as fumbling with clothes), but without collapse.nEEG during this event shows a three-per-second spike-and-wave activity.Clinical manifestationnGeneralized seizuresnIn a generalized tonic-clonic seizures, the tonic phase is a sudden tonic contraction of muscles usually with upward eye deviation. The clonic (with clonus-type activity) phase follows.nInitial EEG changes are often bilateral.nThis condition usually has its onset in childhood.Diagnosis of epilepsynThe integrate diagnosis should include seizure type, anatomy, etiology and concomitant mental disorders.nFor example: nEpilepsy-grand malsecondary (symptomatic) mental retardationnEpilepsycentrotemporal spike wave-benign childhood epilepsy.Diagnosis of epilepsynClinical picturenClinical historynDescription of SznSymptomatologynPhysical/Neurologic examinationnTherapy nEEGnBackground activitynEpileptiform activitynInterictalnIctalnPostictalnLaboratory testsnNeuroimaging.Differenial diagnosisnFebrile Seizures nAges 3 months to 5 yearsnFever nNon-CNS infectionnGeneralized seizuresnLast less than 5 minutesnMigrainenPositive family history. nPulsatile headache nManifestations of autonomic nerve disordernVisual disordernSensory disturbance .Differenial diagnosisnBreath-holding spellsnAge 6 months to 3 years,nCry, loss of consciousnessnApnea and cyanosisnFamily historypositive in 30%nNormal EEG.nSleeping disturbance nSleepwalking , nNightmarenNight terrors .Differenial diagnosisnMasturbation nConsciousness not impairednNormal EEGnPseudoseizuresnEffectual Suggestive therapy nNormal EEGnTourette sydromenSimple or complete stereotyped jerks or movementsnCough and grunt nNormal EEG nPositive Family history .An approach to Seizures.Treatment of epilepsynTherapeutic principle of ntiepilepsy drugs (AEDs)nEarly treatmentnTreatment as the types of epileptic seizurenTreatment with one drugnIndividual therapy nLong course of treatment nSlow drug withdrawal nPeriodic re-examination .Treatment of epilepsy AEDs selection on types of epileptic seizure types drugsTonic-clonic seizures VPA, PB, CBZ, PRM or PHT Absence seizures VPA, ES, CNPMyoclonic seizures VPA, CNP, PRM, TopamaxPartial seizures CBZ, VPA, PB, PHT, PRM, TInfantile spasms CNP, ACTH, Prednison, VPA.Antiepilepsy drugs,AEDs.Update on newer AEDs.Treatment of epilepsy.Status epilepticusnStatus epilepticus is a clinical or electrical seizure lasting at least 30 minutes, or a series of seizures without complete recovery over the same period of time.nEmergency Treatment nABC(airway, breathing, circulation)nDiazepam 0.3-0.5mg/kg ;may repeat in 15-30 minutesnPhenytoin 10-20mg/kgnPhenobarbital 5-20mg/kg. 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