EPILEPSY

a seizure is a convulsion resulting from a paroxysmal discharge of cerebral neurones (abnormal electrical activity) Classification

1- generalized seizure A-Tonic- clonic seizures (grand mal,) B-Myoclonic seizures. C-Tonic seizures. D-Absence seizures(Petit mal) E-Atonic seizures

2- Partial seizures(focal seizures) These start by activation of a group of neurones in one part of one hemisphere. A- Complex partial seizures(T .L .E) With impairment of consciousnes B- Simple focal seizures without impairment of consciousnes ex.. Jacksonian seizures 3- Unclassified

Clinical features of complex partial seizures (T .L .E)

Domain Features
*Consciousness Altered *Autonomic and visceral Epigastric aura dizziness, flushing, tachycardia, and other bodily sensations *Perceptual visual auditory, olfactory, gustatory, somatic hallucinations, dj vu, jamais vu.

*Cognitive

*Affective

*Psychomotor

Disturbances of speech, thought, and memory, derealization, depersonalization Fear and anxiety; occasionally euphoria. Automatisms, grimacing and other bodily movements; repetitive or more complex stereotyped behaviours

Aetiological and precipitating factors in epilepsy

-Genetic predisposition *Development, e.g, neuronal migration abnormalities -Trauma and surgery -Pyrexia -Intracranial mass lesions, e.g. tumour, neurocysticercosis.

-vascular
, e.g. cerebral infarction,- arteriovenous malformation

-Drugs and drug withdrawal. -Encephalitis and inflammatory conditions -Metabolic abnormalities, e.g. porphyria, hypocalcaemia. -Provoked seizures, e.g. photosensitivity, sleep deprivation.

Drug
Carbamazepine

Focal

Tonicclonic

abscence

Myoclonic

+ +

valproate

Phenytoin

Phenobarbital

lamotrigine

+ +

+ +

o ?

_? +

Some unwanted effects of anticonvulsant drugs

Drug
Phenytoin

side-effects
Rashes, gum hypertrophy Blood dyscrasias Lymphadenopathy Toxic epidermal necrolysis Rashes Blood dyscrasias, leucopenia Toxic epidermal necrolysis

Carbamazepine

*Carbamazepine

*Sodium valproate

*Lamotrigine *Vigabatrin

Rashes severe leucopenia Toxic epidermal necrolysis Anorexia Hair loss Liver damage Toxic epidermal necrolysis Retinal damage (visual field constriction) Psychological change

Antideperssant and Epilepsy:Most classes of antidepressant lower the seizures thresholds to some extent. This can lead to an increased risk of seizures in patients who have epilepsy or are predisposed. Ingeneral SSRis are less likely to lower the seizure threshold than tricyclic. SSRis can increase carbamazepine levels. Valproate can elevate tricyclic concentration

Status epilepticus
Continuous seizures without recovery of consciousness (two or more) Management: at home diazepam 10 20mg i.v at 5mg /min and repeated once. Admission: oxygen, monitor E .C .G, routine bloods. Exclude hypoglycaemia. if seizures continue i.v phenytoin 15mg kg in normal saline (phenytoin 250mg 5ml ampoule)