Seizures Dr.Nathasha Luke

Overview Definition Classification Clinical Features Differential Diagnosis Treatment Cases

Brain Electrical activity Neurotransmitters Balance of electrical activity

Definitions Seizure: episode of abnormal neurologic function caused by inappropriate electrical discharge of brain neurons. Epilepsy: clinical condition in which an individual is subject to recurrent seizures.

Generalized Seizures Caused by a activation of the entire cerebral cortex

Partial seizures Due to electrical discharges in a localized structural lesion of the brain. Affects whatever physical or mental activity that area controls.

Partial (focal) seizures Simple partial no alteration of consciousness Complex partial consciousness impaired Partial seizures (simple or complex) with secondary generalization

Classification of Seizures Generalized seizures (consciousness always lost) Tonic clonic seizures (grand mal) Absence seizures (petit mal) Myclonic seizure Clonic seizures Atonic seizures

Seizures can occur Due to epilepsy Due to secondary causes

Causes: secondary seizures Trauma (recent or remote) Intracranial hemorrhage Eclampsia-increased blood pressure in pregnancy causing fits Hypertensive encephalopathy Structural abnormalities Vascular lesion (aneurysm, AV malformation) Mass lesion Degenerative disease Congenital abnormalities

Causes: secondary seizures Toxins and drugs Anoxic brain injury Metabolic disturbances Hypo or hyperglycemia Hypo or hypernatremia Hyperosmolar states Uremia Hepatic failure Hypocalcemia, hypomagnesemia (rare)

Features: Tonic clonic seizures Abrupt loss of consciousness and loss of postural tone May then become rigid With extension of the trunk and extremities Apnea Cyanosis Urinary incontinence

Features: tonic clonic seizures As the tonic (rigid) phase subsides, clonic (symmetric rhythmic) jerking of the trunk and extremities develop Episode lasts from 60-90 seconds Consciousness returns gradually Postictal confusion may persist for several hours

Features : absence seizures Brief, usually lasting only a few seconds. Loss of consciousness without losing postural tone. Appear confused or withdrawn, and current activity ceases. May stare and have twitching of their eyelids. Do not respond to voice or other stimulation Are not incontinent. End abruptly, and there is no postictal confusion

Absence seizures Common in children May keep on repeatedly asking what was said School children may present with poor school performance May get even or more than 50 episodes a day

Myoclonic seizures Brief, shock-like jerks of a muscle or a group of muscles. "Myo" means muscle and "clonus" means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle.

Simple partial seizures Remain localized and consciousness is not affected.

Clinical features of simple partial Remain localized and consciousness is not affected. types Unilateral tonic or clonic movements limited to one extremity suggest a focus in the motor cortex, while tonic deviation of the head and eyes suggest a front lobe focus. Visual symptoms often result from an occipital focus, while olfactory or gustatory hallucinations may arise from the medial temporal lobe Sensory phenomena, or aura are often the initial symptoms of attacks.

Complex partial seizures These seizures usually start in a small area of the brain. They quickly involve other areas of the brain that affect alertness and awareness. So even though the person's eyes are open their consciousness is lost Some people can have seizures of this kind without realizing that anything has happened. Some of these seizures start with an aura, a warning sign. Examples for Auras odd feeling in the stomach move their mouth, pick at the air or their clothing/ perform other purposeless actions. repeat words or phrases, laugh, scream, or cry. Déjà vu and jamais vu

Differential diagnosis-what can mimic seizures Syncope Complex migraine Movement disorders Narcolepsy Pseudo-seizures

Investigations EEG Can record the abnormal electrical activity of the brain Can confirm the diagnosis of fits and identify the type of fits However a normal EEG cant exclude the diagnosis of fits

Other investigations Particularly important in looking for a secondary cause Blood glucose Electrolytes Renal and liver functions Full blood count LP CT and MRI scans

Management- first aid Note duration of fits

Most fits subside spontaneously with out treatment Rarely fits can be prolonged and in this case treatment is needed

Treatment: Airway: Oxygen Maintain airway

Treatment: Breathing: Circulation: IV access Suction Circulation: IV access IV glucose if confirmed hypoglycemia

First Line Medication: Benzodiazepines Ex-Midazolam Diazepam If not resolving can give other drugs

For unresolving fits: ICU Care and General anesthesia

Why are fits bad? Prolonged fit can cause permanent brain damage…

How to treat epilepsy They are given anti epileptic drugs Ex- carbamezapine They have to be on long term treatment Special advice given regarding -treatment -what to do when fitting -advice for safety

Status epilepticus Continuous seizure activity lasting for at least 30 min Or Two or more seizures without intervening return of conciousness

Seizures in children Fits are commoner in children with underlying brain abnormality and those who have suffered ischemic injury at birth. Simple febrile convulsions occur in 3-4% of children and this is the commonest cause of fits in childhood

Febrile seizures: Fits occurring with fever In children Aged 3 month to 5 years Family history increases risk. Usually occurs when fever is rising IT is extremely important to exclude brain infection in children who have fever with fits Most children become free of fits as they grow up

Febrile seizures Managed by finding cause and treating fever Parents should be reassured and given information about febrile fits They must be told about the first aid measures

Questions??