Seizures & Epilepsy: DR. TARIQ SAEED

Outline Definition Etiology Classification Treatment of Epilepsy

Definition A sudden, involuntary, time-limited alteration in behavior, motor activity, autonomic function, consciousness, or sensation, accompanied by an abnormal electrical discharge in the brain

Status Epilepticus More than thirty minutes of continuous seizure activity, or recurrent seizures without intercurrent recovery of consciousness

Seizures are either provoked or unprovoked Provoked Seizures: Triggered by certain provoking factors in otherwise healthy brain Unprovoked Seizures: Occur in the setting of persistent brain pathology

Etiology Brain injury to the fetus during pregnancy Birth trauma –lack of oxygen Head trauma Brain tumor and stroke Infection e.g., meningitis Poisoning from substance abuse or environmental contaminants, e.g., lead poisoning.

DETAILED HISTORY OF THE CHILD WITH CONVULSION Onset of convulsion, character, duration, any similar previous history Drug, metabolic dis- turbance. Family history of convulsion, inborn error of metabolism. Peri-natal/Natal history-birth asphyxia, jaundice, birth trauma, central nervous system (CNS) infection e.g. meningitis, encephalitis CNS status-cerebral palsy, mental retardation (learning difficulty), any post-convulsive state.

Classification of Epileptic Seizures Partial seizures Simple partial (consciousness retained) Motor Sensory Autonomic Psychic Complex partial (consciousness impaired) Simple Partial seizures with secondary generalization

Classification of Epileptic Seizures Generalized seizures Absencess Typical Atypical Generalized tonic clonic Tonic Clonic Myoclonic Atonic Infantile spasms Unclassified seizures

Establishing a Diagnosis Tests (EEG, MRI,CT) may help Diagnosis is established clinically

Treatment First Aid Keep calm- seizures usually only last a few minutes and do not require medical attention. Protect from injury – ease the person to the floor, Move away any objects Protect the person’s head with a pillow or rolled up coat Loosen any tight neckwear. Do not restrain the person Do not insert anything into the person’s mouth. After the seizure, roll the person on to their side. Be reassuring – talk calmly to the person. *If a seizure lasts longer than 5 minutes, seek Medical Attention.

Treatment of status epilepticus Initial Treatment in Hospital Assessment of the respiratory and cardiovascular systems; A nasogastric tube insertion; IV catheter; A rapid infusion of 5 mL/kg of 10% dextrose; Blood is obtained for a CBC and for determination of electrolytes. A physical and neurologic examination.

Treatment of status epilepticus Drugs: Should always be administered IV; have resuscitation equipment at the bedside; A benzodiazepine (diazepam) may be used initially; if the seizures persist, phenytoin is given immediately The choices for further drug management include paraldehyde, a diazepam infusion, barbiturate coma, or general anesthesia.

Antiepileptic Drugs (AED) First Generation Second Generation Unconventional Carbamazepine (Tegretol) Clonazepam (Klonopin) Clorazepate (Tranxene) Ethosuximide (Zarontin) Phenobarbital Phenytoin (Dilantin) Primidone (Mysoline) Valproic acid (Depakote) Felbamate (Felbatol) Gabapentin (Neurontin) Lamotrigine (Lamictal) Levetiracetam (Keppra) Oxcarbazepine (Trileptal) Pregabalin (Lyrica) Tiagabine (Gabitril) Topiramate (Topamax) Zonisamide (Zonegran) Adrenocorticotropic hormone (ACTH ) Acetazolamide (Diamox) Amantadine (Symmetrel) Bromides Clomiphene (Clomid) Ethotoin (Peganone) Mephenytoin (Mesantoin) Mephobarbital (Mebaral) Methsuximide (Celontin) Trimethadione (Tridione)

New Interventions

Vagus Nerve Stimulator (VNS)

Experimental Treatment- Responsive Neurostimulator (RNS)

Experimental Treatment – Deep Brain Stimulator (DBS)

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