Epilpesy

Yul Orozco Morales

Definition

 Etymology: From the greek word Epilepsia. Epi meaning upon and Lepsis meaning seizure.
In ancient times epilepsy was known as the sacred disease.
 Definition: Epilepsy is a disorder of the brain characterized by an enduring predisposition to
epileptic seizures
 WHO: Two or more unprovoked seizures. A chronic noncommunicable disorder of the
brain that affects people of all ages.
Pathology

 It depends mainly on different ions:

 Sodium
 Calcium (not represented here)
 Magnesium
 Also on neurotransmitters
 GABA
 Glutamate
 Causes of epilepsy include:
 Stroke
 Brain tumor
 Brain infection
 Past head injury
 Metabolic problems
 Other neurological conditions
 Genetic factors
Clasification of SEIZURES
A seizure may appear as:

A sudden cry and fall, followed by

 Convulsive movements of all limbs
 Shallow/interrupted breathing - cyanosis
 Loss of bowel/bladder control
 Slow return to consciousness, post-
seizure confusion and/or fatigue

This is a generalized tonic-clonic or

“grand mal” seizure.
or a seizure may be…

 Blank staring, chewing, other repetitive

purposeless movements
 Wandering, confusion, incoherent speech
 Crying, screaming, running, flailing
 A sudden loss of muscle tone and fall
 Picking at clothes, disrobing

This is one type of partial seizure known as a

complex partial seizure.
Or also as…

 Rhythmic movements -
isolated twitching of arms, face, legs
 Sensory symptoms -
tingling, weakness, sounds, smells, tastes,
feeling of upset stomach, visual distortions
 Psychic symptoms -
déjà vu, hallucinations, feelings of fear or
anxiety

Usually last less than one minute

May precede a generalized seizure
 Anti-epileptic Medications

• Depakote (Valproic
acid)
• Felbatol (felbamate) • Neurontin (gabapentin)

• Gabatril (tiagabine)
• Tegretol (carbamezepine)
• Keppra
• Trileptal (oxcarbazepine)
(levetiracetam)
• Topamax (topiramate)
• Lamictal (lamotrigine)

• Dilantin (phenytoin)
• Zonegran (zonisamide)
• phenobarbitol • Lyrica (pregabalin)
 Pre-hospital Treatment – Complex
Partial Seizure (CPS)

May be reported as
drunkenness/illegal drug use
medical conditions such as a stroke or diabetic reaction
“person acting strangely”

• Look for sudden loss of awareness and

automatic, purposeless behaviors such as
picking at clothes, chewing, mumbling or
wandering.
Pre-hospital Treatment – Generalized
tonic-clonic seizure

 Assure scene safety

 If trauma is not suspected,
place patient in recovery position
 Protect head/limbs from injury
 Follow A B C protocol:
Maintain airway – suction PRN
Administer O2
Monitor cardio-respiratory status
During GTC seizure, assess for:

 Traumatic injury
 Possible aspiration (seizure in water)
 Elderly, pregnant or diabetic patient
Check blood glucose
 Seizure lasting longer than 5 minutes,
or occurring in a series

When present, activate ALS and/or

rapidly transport to
receiving facility
Status Epilepticus
What is prognosis for this?

 Is very complex and have a ton of possibilities.

 Is not the attack, all the cares are fundamental
 The age, the syndromes and the evolution play together trough
patients life
 Many of the cases has to take medications for life
bibliography

 Daroff RB, Jankovic J, Mazziotta JC, Pomeroy S, eds. Bradley’s Neurology in Clinical
Practice. 7th ed. Elsevier; 2016; 2348 pp