Rayyan.
Seizure
-Definition : sudden abnormal brain activity + manifested by involuntary
motor, sensory, autonomic, or psychic phenomena.
-Convulsion : mainly refried to motor seizure
-Epilepsy:
2 or more unprovoked seizures separated by> 24 hours apart.
Classification : 1-focal(partial) seizure: isolated to focal segment of
hemisphere 2-generalized seizure : involve both hemisphere
1-Focal (partial) seizure :
A-Simple partial:
-consciousness not impaired and the episode it could be :
1-Motor signs (can be tonic, clonic, myoclonic) or
2-sensory signs (visual, auditory, olfactory, somato-sensory) or
3-Autonomic( sweating - nausea -Epigastric pain - syncope - increase HR)
-duration : up to 30 s if prolonged or recurrent —> may develop Tod paresis.
-No post ictal manifestation
B-Complex partial (Temporal lobe epilepsy) : occurs in dominant Temp L
-Start with warning ⚠ symptoms as : Aura or epigastric pain or metallic
taste or de javu —> consciousness impaired—> either he develop
:1-staring and unresponsiveness
2-automatism in one side(lipsmaking - stereotype hand movement -
repetitive sounds) and immobility in other side.
-Duration 30s to 2 min
-Post iacta : amnesia and unresponsiveness - drowsiness.
C-Focal seizures with secondarily generalized convulsions
📝 : Consciousness impaired don't = loss of consciousness.
Rayyan.T
GENERALIZED SEIZURES : Arise in both hemispheres and
consequences is impaired
-
1 Absence = Petit mal (staring, unresponsiveness)
2-Tonic (sustained contraction)
3-Clonic (rhythmic contractions)
4-Tonic-clonic (tonic phase followed by clonic phase)
5-Atonic (loss of tone)—>head fall
6-Myoclonic (rapid brief shock-like contraction)
7-Spasms
EPILEPSY classified as:
1-Symptomatic
cause is known , Example: Focal epilepsy associated with a remote
stroke
2-Idiopathic
Have a genetic etiology
Example: BCET, childhood absence epilepsy, JME
3-Cryptogenic
Epilepsy of uncertain etiology
Example: Infantile spasms with no identifiable cause
Causes of seizure :
1-■ Perinatal causes:
Hypoxic-ischemic encephalopathy* most common cause in neonates*
Trauma, ICHemorrhage
2-■ Infections:
Encephalitis, meningitis
Brain abscess
3-■ METABOLIC CONDITIONS
-Hypoglycemia,* hypocalcemia, hypomagnesemia, hyponatremia / hypernatremia
-Storage diseases
4- ■ NEUROCUTANEOUS SYNDROMES
Tuberous sclerosis
Neurofibromatosis
5- ■ Drug : poisoning or withdraw.
6-Others:
■ trauma
■ Increased ICP,
■ Febrile illnesses ■ Familial* ■ Cryptogenic
Generalized seizure :
1-GTC(grand mal) :
Most common type of seizure in children due its seen in febrile convulsions
Rayyan.T
-It has 4 phases:
1-warning symptoms : aura (e.g., flashing lights or seeing colors),
somatosensory (tingling), olfactory (alteration of smell), auditory,(alterations of
hearing).
2-Tonic phase: impaired consciousness -> body becomes rigid due to
sustained contraction fall as tree 🌲 and air grasping is hared ,for < 1min and
respiration becomes abnormal —> cyanosis.
3-Clonic Phase: bilateral jerky movements of all limbs, >1 min , respiration
continues.
4-Postictal: Drowsiness and confusion.
Extra :-Control of bladder or bowel is lost and tongue bitting are seen
-Epileptic syndrome : its disorder that is characterized by one or more
specific seizure type and has specific age of onset and a specific
prognosis.
1-Benign childhood epilepsy with Centro-temporal spikes (BCET):
Age of onset : 5-10 y
occurs : during sleep (Simple partial seizure involving face and arm (abnormal
movement and sensation around face and mouth , drooling , impaired speech and
swallowing) this area is supplied by rolandic area so we called it benign
Rolandic epilepsy.
EEG : spikes waves from Rolandic or centro-temporal area
ttt: -usually no need and it will resolve after puberty (benign)
-if they need it ? Give tegritol.
Rayyan.T
2-Childhood absence epilepsy(petit mal):
-onset : 4-6y
-Stare momentally and stop moving, may twitch their eyelids or a
hand minimally.
-Duration : up to 30s
-can be induced by hperventilation.
EEG : generalized 3hZ spikes
Ttt : DOC -> ethosuximide , if it atypical absence (with GTC) -> Valproate.
Prognosis : good but it affects school performance
3-Infantile spasm:
Onset : 3-8 month.
-Brief flexion of the head , trunk and limbs followed by extension of
the arms for <2s (so-called ‘salaam spasms’ 👋 👋 ).
-occurs 20-30 times a day on awakening and going to sleep.
-Associated with TSC.
Rayyan.T
EEG : SHOWS HYPSARRYTHMIA
TTT: ACTH , VIGABATRIN (espicially if he have TSC inhibit gaba break down ) ,
corticosteroids.
May be the dxx of colicy pain, sandifer syndrome due to character of seizure.
-West syndrome is : triad of infantile spasm , developmental
regression and hypsarrythmia.
-non convulsive seizure : abnormal EEG with no manifestation.
3-Juvenile myoclonic epilepsy:
Onset : early Adulthood
seizure : typically start with myoclonic jerks (exacerbated in the
morning, often causing to drop objects), generalized tonic-clonic
seizures precipitated by sleep deprivation, and absence seizures.
Management : lifelong Valporic acid or keprra
Rayyan.T
fith seizure : begins with focal seizure in 1st weak then resolve.
Diagnosis :
1-Hx (most important )
2-physical exam
3-investigation*Same as ComplexFC*
DOC
Rayyan.T
Status epilepticus :
Defintion : ongoing seizure activity or repetitive seizures without return to
consciousness for > 30 minutes(5min)
Etiology of status :
same as seizure , but the most important cause is drug non adherence and new
onset of seizure.
Management :
1-stabilize patient : ABC
2-IV access : blood test ( glucose +electrolyte(chem7) - toxicology -
drug level of anticonvulsant )
3-if pt passed more than 5 min -> start with A-benzodiazepine
*short acting and fast* (lora -diazepam - midazolam )
- after 5 min and don't respond ? Repeat benzo.
- b-after 5 min and don't respond —> Fosphenytoin(cardiac
monitoring *ECG and BP)
- c-not responding ? loading dose of Phenobarbital or valporate or
Continuous infusion of midazolam or pentobarbital (air way
protection and bp monitoring)
- d-not responding ( general anathasia with propofol)
debakin()دب اصلع
Tegritol
lamctal
Fosphenytoin better drug and less adverse effect
Rayyan.T
-The duration of anticonvulsant treatment varies according to seizure
type and epilepsy syndrome.
For most children, anticonvulsant medications can be weaned off after
2 years without seizures
Case : child bellow 4m and having episode of contraction of neck
and trunk followed by extension of arms with developmental delay
…. ?
What is dx : infantile spasm (west)
Eeg ? Hypsarrythemia
ttt: ACTH ….. vigabtrin if with TSC
CASE of absence seizure symptoms what is next step ?
1-induce it by hyperventilation
2-confirm dx by ? EEG
DOC : ethosuximide.
EEG IS the confirmatory of dx.
