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SeizuresSeizures
Dr.Nathasha Luke
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OverviewOverviewDefinitionClassificationClinical FeaturesDifferential DiagnosisTreatmentCases
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BrainBrainElectrical activityNeurotransmittersBalance of electrical activity
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DefinitionsDefinitionsSeizure: episode of abnormal
neurologic function caused by inappropriate electrical discharge of brain neurons.
Epilepsy: clinical condition in which an individual is subject to recurrent seizures.
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Generalized SeizuresGeneralized Seizures
Caused by a activation of the entire cerebral cortex
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Partial seizuresPartial seizures
Due to electrical discharges in a localized structural lesion of the brain.
Affects whatever physical or mental activity that area controls.
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Partial (focal) seizuresPartial (focal) seizuresSimple partial
no alteration of consciousnessComplex partial
consciousness impairedPartial seizures (simple or
complex) with secondary generalization
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Classification of SeizuresClassification of SeizuresGeneralized seizures
(consciousness always lost)Tonic clonic seizures (grand mal)Absence seizures (petit mal)Myclonic seizureClonic seizuresAtonic seizures
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Seizures can occurSeizures can occurDue to epilepsyDue to secondary causes
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Causes: secondary seizuresCauses: secondary seizuresTrauma (recent or remote)Intracranial hemorrhageEclampsia-increased blood pressure in
pregnancy causing fitsHypertensive encephalopathyStructural abnormalities
◦ Vascular lesion (aneurysm, AV malformation)
◦ Mass lesion◦ Degenerative disease◦ Congenital abnormalities
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Causes: secondary seizuresCauses: secondary seizuresToxins and drugsAnoxic brain injury Metabolic disturbances
◦ Hypo or hyperglycemia◦ Hypo or hypernatremia◦ Hyperosmolar states◦ Uremia◦ Hepatic failure◦ Hypocalcemia, hypomagnesemia (rare)
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Features: Tonic clonic seizuresFeatures: Tonic clonic seizures
Abrupt loss of consciousness and loss of postural tone
May then become rigidWith extension of the trunk and
extremitiesApneaCyanosis Urinary incontinence
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Features: tonic clonic Features: tonic clonic seizuresseizuresAs the tonic (rigid) phase
subsides, clonic (symmetric rhythmic) jerking of the trunk and extremities develop
Episode lasts from 60-90 secondsConsciousness returns graduallyPostictal confusion may persist
for several hours
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Features : absence seizuresFeatures : absence seizures
Brief, usually lasting only a few seconds. Loss of consciousness without losing postural
tone.Appear confused or withdrawn, and current
activity ceases. May stare and have twitching of their eyelids.Do not respond to voice or other stimulationAre not incontinent.End abruptly, and there is no postictal
confusion
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Absence seizuresAbsence seizuresCommon in childrenMay keep on repeatedly asking
what was saidSchool children may present with
poor school performanceMay get even or more than 50
episodes a day
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Myoclonic seizuresMyoclonic seizuresBrief, shock-like jerks of a muscle
or a group of muscles. "Myo" means muscle and "clonus" means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle.
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Simple partial seizuresSimple partial seizuresRemain localized and
consciousness is not affected.
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Clinical features of simple Clinical features of simple partialpartialRemain localized and consciousness is
not affected.types Unilateral tonic or clonic movements
limited to one extremity suggest a focus in the motor cortex, while tonic deviation of the head and eyes suggest a front lobe focus.
Visual symptoms often result from an occipital focus, while olfactory or gustatory hallucinations may arise from the medial temporal lobe
Sensory phenomena, or aura are often the initial symptoms of attacks.
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Complex partial seizuresComplex partial seizures These seizures usually start in a small area of the
brain. They quickly involve other areas of the brain that affect alertness and awareness. So even though the person's eyes are open their consciousness is lost
Some people can have seizures of this kind without realizing that anything has happened.
Some of these seizures start with an aura, a warning sign.
Examples for Auras odd feeling in the stomach move their mouth, pick at the air or their
clothing/ perform other purposeless actions. repeat words or phrases, laugh, scream, or cry. Déjà vu and jamais vu
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Differential diagnosis-what Differential diagnosis-what can mimic seizurescan mimic seizuresSyncopeComplex migraineMovement disordersNarcolepsyPseudo-seizures
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Investigations Investigations EEGCan record the abnormal electrical
activity of the brainCan confirm the diagnosis of fits
and identify the type of fitsHowever a normal EEG cant
exclude the diagnosis of fits
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Other investigationsOther investigationsParticularly important in looking
for a secondary causeBlood glucoseElectrolytesRenal and liver functionsFull blood countLP CT and MRI scans
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Management- first aidManagement- first aid
Note duration of fits
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Most fits subside spontaneously with out treatment
Rarely fits can be prolonged and in this case treatment is needed
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Treatment: Airway: Treatment: Airway: OxygenMaintain airway
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Treatment:Treatment:Breathing:
◦SuctionCirculation: IV accessIV glucose if confirmed
hypoglycemia
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First Line Medication: First Line Medication: BenzodiazepinesBenzodiazepines
Ex-MidazolamEx-Midazolam
DiazepamDiazepam
If not resolving can give If not resolving can give other drugsother drugs
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For unresolving fits:For unresolving fits:ICU Care and General anesthesia
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Why are fits bad?Why are fits bad?
Prolonged fit can cause permanent brain damage…
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How to treat epilepsyThey are given anti epileptic
drugsEx- carbamezapineThey have to be on long term
treatmentSpecial advice given regarding -treatment-what to do when fitting-advice for safety
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Status epilepticusStatus epilepticusContinuous seizure activity
lasting for at least 30 minOrTwo or more seizures without
intervening return of conciousness
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Seizures in childrenSeizures in childrenFits are commoner in children
with underlying brain abnormality and those who have suffered ischemic injury at birth.
Simple febrile convulsions occur in 3-4% of children and this is the commonest cause of fits in childhood
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Febrile seizures:Febrile seizures:
Fits occurring with feverIn children Aged 3 month to 5 yearsFamily history increases risk. Usually occurs when fever is risingIT is extremely important to exclude
brain infection in children who have fever with fits
Most children become free of fits as they grow up
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Febrile seizuresFebrile seizuresManaged by finding cause and
treating feverParents should be reassured and
given information about febrile fits
They must be told about the first aid measures
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Questions??