EPILESPYPROF W MATUJA

Definitions
Epileptic seizure: Is a brief alteration
of body function or behavior that is
due to a paroxysmal excessive neural
discharge
Epilepsy: is/are chronic disorder/s
whereby an individual/s has/have an
established tendency to recurrent
unprovoked seizures that are not due
to an acute medical illness, alcohol or
drug abuse
SEIZURE CLASSIFICATION
Depends on the clinical symptomatology and supplemented by the
EEG data
I. Partial seizures:
A. Simple(consciousness not impaired)
Motor, Sensory, Psychic, Automatism
B. Complex partial( consciousness is impaired)
Simple followed by impairment of consc.
with impairment of consci. at onset
C. Partial evolving to secondary generalized
II. Generliazed or nonfocal in origin
A. Absences( True, Atypical), B. Myoclonic, C. Atonic
D. Tonic-Clonic, E. Tonic
III. Unclassified (where description is incomplete /inadequate)
 EPIDEMILOGY OF EPILESPSY
Epilepsy is a worldwide disorder
Prevalence of 1.3-20/1000 population in developed countries. In Africa varies from 20-58/1000 population in certain communities
The incidence of all epilepsy 24.5/100,000 in Minnesota, Bordeaux France
In Africa there are estimated annual incidence rate eg. Tanzania 73.3/100,000
The annual incidence rate is highest in the youngest age group, decreases during childhood, diminishes among adults, and rises again in old age

.
 epilepsy incidence rate

120

100

80
rate per 100,000/year

Age
60
Rate

40

20

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Age
CAUSES OF EPILEPSY
A persons tendency to recurrent seizures
derives from the complex interrelation of
genetic factors and brain pathology
(localized, diffuse, static or progressive)
The relative contribution of genetic or
acquired pathology
Causes include, idiopathic, genetic, CNS
infections, birth trauma, vascular, neoplastic
Figure on causes
See figure
Depends on the complex
interrelation between genetic
G factors and brain pathology
e
n
e
ti
c
s
f
a
c
t
o
r
s
Normal Mild Moderate Severe

Brain pathology
Classification of epilepsies
Complex because includes several items, seizure type,
aetiology, precipitating factors, age of onset, severity, diurnal
and circadian cycling and sometimes prognosis
GENERALIZED
idiopathic, symptomatic, cryptogenic
LOCALIZATION-RELATED
idiopathic, symptomatic
UNDETERMINED WHETHER LOCAL OR
GENERALIZED
SPECIAL SYNDROMES
 Differential diagnosis of epilepsy
SYNCOPE
+Reflex syncope (vasovagal)
+Cardiac: heart disease, Arrhythmia, reduced cardiac output,
+Postural hypotension
Breath-holding spells
Sleep disorders including narcolepsy
TIAS
Migraine
Falls in the elderly
Psychogenic
 Management of epilepsy
An accurate diagnosis is per-requisite for good
management
A detailed history from both the patient and reliable
observer of the character of seizures and formal history
Clinical examination
Investigations(blood tests,imaging and EEG)
Treatment of symptoms i.e Seizures
*choice of AED type of seizure, efficacy, minimal
untoward effects, accessibility( affordability)
Treatment of the cause
Rehabilitation( 15-30% have handicap-mental/physical)
Electroencephalogram
Eeg waveform
EEG waveform
NEUROCYTICERCOSIS
neurocytercosis
Ctb ABSCES
 Principles of drug management

Type of seizure
Monotherapy(Pb, Pht,CBZ, VALP, ETHO. LAM.)
One drug gradually raised to maximum dose
Monitor untoward effects and serum levels
Drug interactions
Pregnancy and breast feeding
Add on therapy(vigabatrin, lamotrigine,
gabapentin ,topiramate, felbamate ect)
 Antiepileptic drugs AEDs
Mechanism of action of AEDs
1. Limit the sustained repetitive firing of neurones
through voltage Na+ channels
2. Enhance GABA mediated inhibition
3. Reduction of voltage sensitive Ca channels
4. Reduction of glutamate-mediated excitation
NOTE side effects, dizziness, ataxia, fatigue,
headache nausea and somnolence
 SOME AEDs
Monotherapy Add on therapy
Phenobarb 90-180mg/day
Phenytoin sod Topiramate 400-800mg/dy
100-400mg

Carbamazepine Gabapentine 1.2-1.8 g/day

300-1400mg
Sodium valporate vigabatrin 1g/day
lamotrigine 500mg/day lamotrigine
 Other things to note
NOTE
Most individuals with newly diagnosed
epilepsy enter prolonged remission and
have excellent prognosis
Early response to anti-epileptic drugs is a
good indicator for future control
 Follow up of pts
Once per month for first 3 months
Thereafter every 3-months
Changing of drugs if evidence of toxicity/maximum
dose monotherapy still pt has one or szs per month
Removal of drugs if drug toxicity is suspected
Stopping treatment if no Szs for 2 years- gradually
Referral to hospital pts on maximum tolerable dose
but Szs are not controlled >1 Szs/month over 3/12
period
 Advice to patients on AED
Pts should know the expected untoward effects
and if they develop should come to the clinic the
same week but they should continue treatment
Once stable, if Szs occur more frequently than
once per month they should return to the clinic,
even if its before their next scheduled appointment

THANK YOU FOR YOUR ATTENTION

NGWABEJA, NDAGA FIJO
 Case histories
1. A 20 year old college student reports episodes
of jerking of her angle of the mouth lasting for 5-
10minutes which comes and goes on average
twice a month, without loss of consciousness since
she was 18 years old. She was born at full term a
normal pregnancy and delivery. She has had
febrile convulsions from the age of 18 months up
to the age of 3 years some which were prolonged.
Nevertheless she had normal development and has
been doing well with her studies. Examination was
normal in all systems
 Questions related to case 1
Does this young woman suffer from epilepsy?
What type of seizure does she have?
What is the classification of her seizures?
If in one of the episode the facial twiching is
followed by generalized stretching, flinging
of the all limbs and grunting
How will you classify her now?
 THE END
THAK YOU FOR YOUR ATTENTION
Absence-3HZ per second