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PATHOPHYSIOLOGY OF
EPILEPSY
BY-ANKUSH CHOURASIA
PHARMACEUTICAL MARKETING
ROLL NO.-100606011
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DefinitionofSeizures
jTime-limited paroxysmal eventsthatresultfrom abnormal, involuntary, rhythmicneuronal
dischargesinthe brainjSeizures areusuallyunpredictable
jSeizuresusually brief( < 5 minutes) andstopspontaneously
jConvulsion, ictus, attackandfit areusedtorefertoseizures
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EtiologyofSeizures
j Seizures areeitherprovokedorunprovoked
j Provoked Seizures: Triggered bycertainprovokingfactorsinotherwisehealthy brain
Metabolic abnormalities (hypoglycemia andhyperglycemia,
hyponatremia, hypocalcemia)
Alcohol withdrawal
Acuteneurological insult (infection, stroke, trauma)
Illicitdrugintoxication andwithdrawal
Prescribedmedicationsthat lowerseizurethreshold(theophylline, TCA)
Highfeverinchildren
j Unprovoked Seizures: Occurinthesettingofpersistent brain pathology.
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DefinitionofEpilepsy
j A diseasecharacterized byspontaneousrecurrenceofepilepticseizures (2 ormore)unprovoked by any
immediateidentifiablecause .
j Ifmultipleseizuresoccurwithin 24 hourthenitis
taken asoneevent.
j Seizures aresymptoms, whileepilepsyis a disease,
sothosetermsshouldnot beusedinterchangeably.
j Alsoepilepsyistheclinical manifestationofabnormal andexcessivedischargefrom a setof
brainneurons.
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Manifestationofepilepsy-
jSuddentransient phenomenonwhichmay
include alterationofconsciousnessor
motor, sensory, autonomicorpsychicevents perceived by individual oran
observer.
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EPIDEMIOLOGY-
jFordevelopingcountries 100 cases per
100,000 people andindeveloped 40-
70/100,000.jMore prevalenceinmale.
jHigherprevalencein lowersocioeconomic
group.
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TYPES
EPILEPSY ONBASIS OF
RECURRENCE
Active
At least 1 seizuresin5 years
Inactive
Noseizuresinmorethan 5 years
EPILEPSY ONBASIS OF
ETIOLOGICALFACTOR
Idiopathic
Geneticpredisposition.
Cryptogenic
Noetiological factor
has beenidentified
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ON BASIS OF INVOLVEDBRAIN AREA
FRONTALLOBE
PRONEPOSITION
TEMPORALLOBE
SENSATIONS
REGULATIONDISTURBED
PARIETALLOBE
BODYPOSITIONDISTURBED
OCCIPETAL
LOBE
VISUALDISTURBANCE
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IN EPILEPSY THE FUNCTION OF EACH LOBE
GET DISTURBED
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ILAE ClassificationofSeizuresPartial Seizures Generalized
Seizures
A) SIMPLE PARRTIAL-
- WITH MOTOR SYMPTOMS
- WITH SP. SENSORY SYMPTOMS
- WITH AUTONOMIC SYMPTOMS
- WITH PSYCHIC SYMPTOMS
B) COMPLEX PARTIAL-
1- BEGNNING AS SIMPLE PARTIAL SEIZURE AND
PROGRESSING TO IMPAIRMENT OF
CONSCIOUSNESS
2- WITH IMPAIRMENT OF CONSCIOUSNESS
C)PARTIAL SEIZURES EVOLVING TO
SECONDARY GENERALISED SEIZURE-
-SPS TO GS
-CPS TO GS-SPS TO CPS TO GS
A) Tonic-Clonic
(primarytonic-
clonic)
B) Absence
C) Myoclonic
D) ClonicE) Tonic
F) Atonic
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PATHOPHYSIOLOGY-
jORIGINATION CORTICAL SITES
jPS- BEGINE FOCALLY IN CORTEX
jGS -WIDESPREAD CORTICALINVOLVEMENT FROM START.
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IN BRAIN IMBALANCEIN
NEUROTRANSMISSION
EXCITATORY INHIBITORY
(GABA)
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ABSENCE SEIZURES
jTHALAMOCORTICAL CIRCUIT IS
RESPONSIBLE.
PYRAMIDALNEURONS
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CAUSES
jGENETIC
j IDIOPATHY
jCORTICAL MALFORMATIONjTRAUMA
jTUMOR
j INFECTION
jALCOHOL
jMETABOLIC DISORDER
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PRECIPITANTS
j INADEQUATE SLEEP
jALCOHOL ABUSE
jDRUGS ABUSE
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Signs and Symptoms of
EpilepsyjSymptoms of Simple Partial Seizures
jMotorsignsincludethefollowing:
jAlternatingcontraction andrelaxationofmusclegroups
jEyemovements andturningoftheheadto
thesamesidejAsymmetrical posturingofthe limbs
jSpeech arrest
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jSensory symptoms includethefollowing:
jSeeingflashesoflightsorcolors, illusions
andhallucinationsjHearinghumming, buzzing, hissingnoises
jExperiencingunpleasantodors andtastes
jDizziness, lightheadedness
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j Autonomic signs and symptoms includethefollowing:
j Borborygmi (rumblingnoises produced bygasinthe
intestines)
j Flushingj Incontinence
j Nausea, vomiting
j Pupillarydilation
j Sweating
j Tachycardia (rapidheartrate)
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j Psychic symptoms includethefollowing:
j Detachment, depersonalization
j Dreamystate
j Memorydistortion: deja vu (feelingthatonehasseensomething before), deja entendu (feelingthatonehasheard
something before), jamaisvu (feelingthatonehasnever
seensomethingthatisfamiliar), jamaisentendu (feeling
thatonehasneverheardsomethingthatisfamiliar),
panoramicvision (rapidrecall ofpastevents)
j Timedistortion
j Unprovokedemotion:fear, pleasure, displeasure,
depression, anger,
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Symptoms of Complex Partial Seizures
j Alimentary:chewing, increasedsalivation,
borborygmi (rumblingnoisescaused bygasinthe
intestines)
j Mimetic:facial expressionsoffear, discomfort,tranquility, laughter, crying
j Gestural:repetitivemovementsofthehands,
fingers, sexual gestures
j wandering, running
j Verbal:repeatedshort phrasesorswearing
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Symptoms of Tonic-Clonic (formerly called
Grand Mal) Seizures
j Fall
j Lossofconsciousness
j Yell or"toniccry"
j Extensionofarms, legs, and/orface
j Fingers andjawclenched
j Autonomicsymptoms:increased blood pressure
andheartrate, increased bladderpressure,flushing, sweating, increasedsalivation, increased
bronchial secretion, apnea (cessationofbreathing)
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Symptoms of Absence (formerly called
Petit Mal) Seizures
jAutomatisms (e.g., lickingthe lips,
chewing, scratching, )
j
BlankstaringjChangeinfacial expression
jLackofawareness, responsiveness, memory
j Jerkingmovementsoftheextremities
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j Symptoms of Myoclonic Seizures
j These briefseizurescause a suddenonsetof
musclecontractionsthatmayoccurthroughoutthe
bodyormay be limitedtocertain areasofthebody (e.g., face, oneormoreextremities,
individual orgroupsofmuscles).
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j Symptoms of Clonic seizures
j Rhythmicjerking limb movements
j Lossofbodyfunction
j Alteredconsciousnessj Confusionfollowingepisode
j Symptoms of Atonic seizure
j Sudden lossofmuscletone
j Brieflossofconsciousness
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THANK YOU