Epilepsy

(I) Definition :Epilepsy is a recurrent paroxysmal disturbance of brain function (psychic, somatic and autonomic) of sudden onset and sudden offset with or without impairment of consciousness and abnormal electrical activity of the brain (EEG change)

() Aetiology:
1-Symptomatic 2-Idiopathic where the cause is unknown?

Local 1-Congenital anomalies e.g AVM 2-Trauma of skull 3-Inflammatory e.g brain abscess 4-Vascular e.g stroke 5-Degenerative 6-S.O.L

Systemic 1-Toxic e.g. strychnine 2- Anoxic e.g. asphyxia 3-Metabolic e.g. Hepatic coma 4-Endocrine e.g. Parathyroid tetany 5-Febrile convulsion 6-Latrogenic e.g. ECT

(III) Classification of epilepsy

International classification

Partial Simple Complex With secondary generalization

Generalized Tonic clonic Tonic Atonic Myoclonic Infantile spasm Absence

(IV) Common types of epilepsy

1-Tonic Clonic (grand male) A- Pre-convulsion symptom: occur few hours before attack which include, depression,irritability or myoclonic twitch. B-Aura (warning of attack): occur few minutes before attack and it is occurs in 3/5 of cases.

:Common types of aura

(a) Complex mental state Dejavu: a feeling of famility Jamaisvu: a feeling of unreality (b) Unexplain fear with running (cursive epilepsy) (c ) Olfactory, gustatory, auditory and visual hallucination (d) Vertigo.

(e) Sensory Aura: Sensation of numbness, tingling, electric shocks, rarely pain in apart of the body, abnormal visceral sensation e.g epigastric pain or sensation of butterflies in the stomach. (f) Motor aura: e.g. turning of head or the whole body to one side, smacking of the lips or chewing and flexion of U.L.

C- The fit or the convulsion:

v

It may be start with epileptic cry (rare). Loss of consciousness and falling to the ground. Tonic spasm of the muscle including the respiratory muscles with apnea and cyanosis. Clonic phase: short interrupted jerks with tongue biting. foaming (frothing) at the mouth my be with blood stained saliva from injured tongue.

Incontinence of urine and feaces some time. Subconjunctival or cutaneous peteacheal hemorrhage and perfuse sweating. Dilated pupils with lost light reflex. Lost corneal reflex in severe fits. Abolished tendon jerks and extensor plantar responses may by found.

D- post convulsive phase:

The sequences ( sleepiness for several hours, post epileptic automatism, performing complex phase, Todds paralysis, hysterical attack, confusion and excitement or mania).

(2) Status epilepticus : Successive attacks of convulsions with no recovery of consciousness in between it may be lead to deep coma hyperpyrexia, and even death.

(3) Absence (petit male) epilepsy: Consisted of transient minor absence with starring blankly into space. The patient stops talking and working with upward rolling of eyes and a brief myoclonic jerk of limbs occur. Then the patient continuous his talk or work with unawareness of the fit, its duration few second and its number may be 100 fits per day.

(4) Myoclonic epilepsy: Brief shock like contraction, which may involve few muscle fibers, whole muscle or a group of muscle with or without resultant violent movement.

(5) Motor jaksonian, sensory jaksonian, epilepsia partilis continua ,adverse fits &akinetic. (6) Reflex epilepsy: Acoustic, music, photic, T.V, self induced like in petit male the child move his fingers between his eyes and light lead to provocation of fits.

(7) Infantile spasm. Temporal lobe epilepsy. (8) (9) Autonomic epilepsy:
a-Autonomic motor seizures : e.g. paroxysmal attacks of abdominal colic and diarrhea. b- Autonomic sensory seizures: e.g . paroxysmal of palpitation, dyspnea, headache and fever.

N.B

(after the age of 30 y) is commonly symptomatic

*Epilepsy of late onset

&should be fully investigated particularly when changes are present.

symptoms of I. C .T & focal clinical findings& EEG

(V) Diagnosis:
Careful history taking and EEG D.D. Hysterical fits: 1- Occur in the presence of audience. 2- Gradual onset. 3- No actual loss of consciousness and the patient can be aroused by painful stimuli.

4- No tongue biting or incontinence of urine and no self injuries. 5- Hysterical convulsions are not clonic jerks as in epilepsy. 6- Secondary gain may appear to be aimed by hysterical patients.

(VI) Treatment of Epilepsy

(1)

Medical treatment Sodium Valporate Lamotrigen Clonazepam Phonobarbiton

Carbamezapin Phenyton Topiramate Levetricetam

(2) Vagal nerve stimulation.

(3) Different surgical procedure a-Mesial temporal epilepsies surgical treatment (Anterior temporal lobectomy) b-Extramesial temporal epilepsies surgical treatment Neocortical resection Neocortical lesionectomy ( Hemispherictomy (functional hemispherictomy

Thank you.