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Seizure Disorder
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Definitions Seizure: clinical manifestations of an abnormal, uncontrolled activity by a group of neurons Unprovoked (idiopathic) Provoked (acute symptomatic) Seizure disorder: condition with recurrent, paroxysmal seizures without evidence of a reversible metabolic cause
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Definitions Tonic – A sustained muscular contraction
Clonic – Intermittent muscular contractions and relaxations Aura: subjective disturbance of perception representing a focal electrical disturbance
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Pathophysiology A seizure is a temporary involuntary disturbance of brain function that may be manifested as impaired consciousness, abnormal motor activity, sensory disturbances or autonomic dysfunction.
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Pathophysiology Seizures are accompanied by abnormal electrical discharges in the brain that can usually be detected by electroencephalography (EEG). Caused by an increase in cell excitability of neurons. Maybe caused by a deficiency in an inhibitory neurotransmitter eg. GABA
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Signs and Symptoms One or a combination Motor symptoms
Sensory symptoms Autonomic symptoms
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Signs and Symptoms Motor cortex: cause movements on contralateral side according to the somatotopic location of the seizure focus. Somatosensory cortex: cause an epileptic aura in which a sensation is experienced. Also depends on somatotopic representation
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Signs and Symptoms Auditory cortex: cause an auditory aura (humming, buzzing, and ringing). Visual cortex: cause a visual aura (flashes, colours).
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Classification Of all patients with epilepsy, 70% have only one type of seizure disorder whereas the remaining 30% have two or more types.
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Staging of Seizures Aura The Attack Post-Ictal Period
The first self-experienced symptom The Attack Post-Ictal Period Associated with headache, drowsiness, or focal neurologic abnormalities May last for hours or days
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Classification Partial seizures Generalized seizures
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Partial Seizures Focal origin Types: Simple partial Complex partial
Secondarily generalized partial
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EEG: Partial Seizures
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Generalized Seizures Virtually simultaneous onset in both hemispheres
Diverse clinical manifestations Loss of consciousness
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Classification All Seizures Generalized Partial
Absence Tonic-Clonic Simple Complex Secondarily generalized partial Also Atonic & Myoclonic
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EEG: Generalized Seizures
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Generalized Seizures 4 categories: Absence (petit mal) Atonic
Myoclonic Tonic-clonic (grand mal)
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Absence Seizures (Petit mal seizures)
Generalised non-convulsive epileptic events Eg. Blank stare, motionless, unresponsive May have assoicated automated movements eg. Lip smacking, grimacing
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Atonic Seizures (Drop attacks)
Sudden loss of muscle tone leading to slackening of the jaw, drooping of the limbs or falling to the ground
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Myoclonic Seizures Brief involuntary Muscle contractions
Bilateral jerking of muscles (generalised or localised)
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Tonic-clonic Seizures
(Grand mal seizures) Major motor seizure Tonic-clonic contraction of muscles with loss of consiousness Cyanosis may occur due to contraction of respiratory muscles Normally lasts s
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Diagnosis History Examination “Routine laboratory tests” EEG
Neuroimaging (CT/MRI) Differential Diagnosis
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