1. Seizures & Epilepsy:
DR. TARIQ SAEED

2. Outline
Definition
Etiology
Classification
Treatment of Epilepsy

3. 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

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

5. 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

6. 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.

7. 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.

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

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

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

11. 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.

12. 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.

13. 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.

14. 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)

15. New Interventions

16. Vagus Nerve Stimulator (VNS)

17. Experimental Treatment- Responsive Neurostimulator (RNS)

18. Experimental Treatment – Deep Brain Stimulator (DBS)

19. Thank You