EIZURE DISORDER

samrah

EIZURE DISORDERSEIZURES are episodes of abnormal motor, sensory, autonomic or psychic activity (or combination of these) that result from sudden excessive discharge from cerebral neurons.

Mostly occur in Americans . For example :

. 6000 people are in stadium ,in which 500 people are suffer from epilepsy

Rate of epilepsy most occur in age of 0 to 1 or occur in age 70

What is happening with a seizure?

o Abnormal electrical activity in the brain causing a sudden uncontrolled event.

o Seizures look different, depending upon what part of the brain they affect.

. It can be 2 hemispheres

http://commons.wikimedia.org/wiki/File:Cerebral-lobes.png

It can be 4 lobes of the brain

The 4 lobes of the brain

oFrontal lobes- planning and control of movements

oParietal lobes- deal with sensation oTemporal lobes- important for

learning, memory and emotionsoOccipital lobes- centers of brain that

allow us to see

causes

Causes divided in to two group

Brain injury

Chemical imbalance in brain

Causes of seizures in children

Brain tumoursInfectionCongenital abnormalitiesHigh fever

Causes of seizures in middle years

Head injuriesInfectionsAlcoholStimulant drugsMedication side effects

Causes of seizures in Elderly

Brain tumoursstrokes

Some others causes

Low blood sugarLow oxygenLow blood sodiumLow blood calciumKidney failureLiver failure

Diagnosis

Neurological historyExamEEGMRI

TYPES OF SEIZURES

1. PARTIAL SEIZURE

2. GENERLIZED SEIZURE

3. STATUS EPILEPTUS

Incidence of seizure types

Partial seizure

A seizure in which benign at focus and remain localized and not generalized at rest of body.

About 60% of peoples have partial seizures.

Occur due to brain injury.5% chances of genes.

Categorization of partial seizures

Simple partial seizure (sps)Complex partial seizure(cps)

Partial Seizure

simple partial seizure

o Not produce loss of consciousnesso People retain awareness and ability to recall

o motor or autonomic symptoms- movements of

part of the body, nausea or upset stomacho sensory or psychic symptoms (aura)-

numbness, tingling, pain, smell ,etc.o Only finger or hand may shake

complex-partial seizures

oConsciousness is reduced or lostoOccur most commonly in the temporal

and frontal lobesoWith sensory or motor symptomsex)lip smacking, clear throat, fiddle with clothes, laugh, staring

oActions purposeless, look as if behaving strangely

Partial seizures with impairment of consciousness

Diagnosis of partial seizures

Partial seizures can be difficult to diagnose with certainty because they vary so much from one person to another. It is helpful for the doctor to hear a detailed description from the person who is experiencing the events and from people who have seen them occur.

Electroencephalogram (EEG)

o Brain's electrical activity pattern is tested with an electroencephalogram (EEG) to see if any areas of the brain are conducting electricity in an abnormal way.

o If the EEG is abnormal, it can confirm suspicions that seizures are occurring. 

Treatment

Anti-epileptic drugs used for partial seizures

Anti-epileptic treatment is associated with a small risk of suicidal thoughts and behaviour

Generalized seizures

Generalized seizures

Seizure that begin over the entire surface of the brain are called generalized seizure.

Convulsion start in generalized seizure because of the involvement of motor system.

Types of generalized seizure:

Grand mal seizurePetit mal seizureAtonic mal seizure

Grand mal seizures

A grand mal seizure also known as a tonic-clonic seizure involve loss of consciousness and violent muscle contractions.

Convulsion involve in it Convulsion : uncontrolled movement of

muscle .

Aura

A sensation perceived by a patient that precedes a condition affecting the brain.

An aura occurs before a seizure. It may consist of flashing lights, a gleam

of light, blurred vision, an odor, the feeling of a breeze, numbness, weakness, or difficulty in speaking.

Phases of grand-mal seizuresTonic phase:• Contraction of muscle start• Rigidity of arm• Duration 15 sec• Person loss consciousness and fall down• Saliva merge from the mouth• Tongue biting• Sweating increase

Clonic phase

Arm and leg jerk rapidlyAfter 30 sec or few minutes jerking slow down and endConsciousness return slowlyEye rolled Show painful expressionsThan person falls, unresponsive sleep for 15 minutesThan after awaking then sleep again for hours

Clonic phase

Treatment of tonic and clonic seizures

Treatment of tonic and clonic seizuresThere is no one treatment method for any

patient with a seizure disorder. Each treatment plan is tailored to the individual

patient based on their diagnosis and symptoms. Treatment options may include medical

therapy, nerve stimulation, dietary therapy, or surgery, as appropriate. Clinical trials may also be a valuable treatment alternative.

Guidelines for Seizure Care

Electric recoding During grand mal seizures neural firing starts at the

focus causing aura than spread.Firstly near areas than contralateral ----crossing

corpus callosum --- to thalamus ,hypothalamus and various nuclei.

Excitation increases in subcortical region and symptoms start.

Neurons in motor system show activity than tonic phase start.

Than diencephalon structures (the hypothalamus, thalamus, pineal gland) start activity and send inhibitory messages to cortex.

.The inhibitory messages comes into brief

burst that cause jerking movements that occur in clonic phase. So that muscles relax and than contract again.

The inhibition become more and than jerks become slow.

Than finally inhibition cause relaxation.

o An electroencephalogram (an EEG) is a recording of the brain's electrical activity.

o About 20 small adhesive electrodes are placed on the scalp, and the brain's activity is recorded under normal conditions.

o Then the person is exposed to various stimuli, such as bright or flashing lights, to try to provoke a seizure.

.

oDuring a seizure, electrical activity in the brain accelerates, producing a jagged wave pattern.

oSuch recordings of brain waves help identify a seizure disorder. Different types of seizures have different wave patterns.

oIt is also known as absence seizures that are type of generalized seizures.oPresent in children in which stop there activity and stare off at the distance, become unresponsive for few seconds.oIt can occur many times within day.oDue to miss diagnosis these children are considered as inattentive and less motivated.

Atonic mal seizure

Atonic seizures are a type of generalized seizure.

They involve a sudden loss of muscle tone, so that the child goes limp and falls to the ground.

They are often present in children who also have other seizure types, such as tonic.

They occur in all age groups, but are more common in children.

Possible signs and symptoms of an atonic seizure include:

Sudden loss of muscle toneThe child goes limp and falls straight to the groundThe child remains conscious or has a brief loss of

consciousnessEyelids drop, head nodsJerkingThe seizure usually lasts less than 15 seconds ,

although some may last several minutesThe child quickly becomes conscious and alert

again after the seizure

Causes

Can be due to any brain injury.Due to tumorDrugs and infectionsHigh fever Alcoholic and people who take

barbiturates ,in these people after withdraw seizures can occur.(SUDDEN inhibitory effect stopped create excitation)

A series generalized seizures that occur without full recovery of consciousness between attacks.

Electrical seizures (on EEG) lasting at least 30 minutes, even without impairment of consciousness.

Considered a medical emergency.

Status Epileptics produces:

Cumulative effects. Vigorous muscular contractions impose a heavy

metabolic demand; andInterfere with respirations.

Withdrawal of antiseizure medication,

Fever

Concurrent infection.

Factors that precipitate Status

Epilepticus:

Medical Management

Stop the seizures as quickly as possible,Ensure adequate cerebral oxygenation, and Maintain the patient in a seizure-free state. An airway and adequate oxygenation are

established. If the patient remains unconscious and

unresponsive, a cuffed Endotracheal tube is inserted.

Medications:Intravenous Diazepam (Valium), Lorazepam (Ativan), or Forphenytoin (Cerebyx)\