Seizures semiology by CK

Views:
 
Category: Education
     
 

Presentation Description

Classification of the Seizures and seismology

Comments

Presentation Transcript

ILAE Classification of seizures:

By: Chaman Lal Karotia (CK) CNPT (AKUH), R.EEGT, BS.PT,MPPS(PAK) Member of AANEM & ASET (USA) CLINICAL NEUROPHYSIOLOGY DEPARTMENT AKUH, KARACHI. ILAE Classification of seizures

Study Outlines:-:

Study Outlines:- Definitions Purpose of the International Classification of Seizures and Epilepsies Recommended terminology for etiology Recognition of seizures Classification of Seizures pictorial division Descriptive details of seizures References Classification of Seizures By: CK 2

Definitions:-:

Definitions:- Seizure:- 1- An event of sudden abnormal excessive discharges of electrical activity within the brain, which leads to a change in movement, sensation or consciousness. 2- Its is an uncontrolled, synchronized paroxysmal excitation of cortical neurons in the brain that results in motor (body movements,) sensory (unusual sensation) & autonomic (altered perception, hallucination etc) manifestations. 3- A seizure is the manifestation of an abnormal, hypersynchronous discharge of a population of cortical neurons. This discharge may produce subjective symptoms or objective signs, in which case it is a clinical seizure, or it may be apparent only on an electroencephalogram (EEG), in which case it is an electrographic (or subclinical) seizure. 3 Classification of Seizures By: CK

Definitions cont’d . . . :

Definitions cont’d . . . Convulsions:- Convulsions are violent involuntary contractions of body musculature. In neurology, this term is limited to contractions produced by cerebral seizure activity. Epilepsy:- Epilepsy is defined as two or more recurrent seizures unprovoked by systemic or acute neurologic insults. Classification of Seizures By: CK 4

Definitions cont’d . . . :

Definitions cont’d . . . Aura:- It’s the initial event, signaling the beginning of seizure and it is part of the seizure. Epileptic prodrome:- Its change in mode or behavior before the seizure and could be in hours or days before the seizure event. Ictus or ictal phase:- It’s a synonym word for seizure event. Post-Ictus or Postictal Phase:- Its Time after a Seizure; may experience sensory, motor, or autonomic manifestations and it usually lasts longer than the seizure itself. 5 Classification of Seizures By: CK

Definitions cont’d . . . :

Definitions cont’d . . . Interictal period:- It’s the time period between two successive seizure events. Status Epilepticus:- 1. It is described as the recurrence of seizures by intervals too short to allow recovery of the condition that existed before the onset of the seizures. 2. *A n episode of more than 10 minutes of continuous seizure activity, or *Two or more sequential seizures spanning this period without full recovery between seizures. *American Epilepsy Society “Epilepsia USA” 6 Classification of Seizures By: CK

Definitions cont’d . . . :

Definitions cont’d . . . Epilepsia Partialis Continua:- Its continuous and rather stereotype repetition of one, fairly constant, type of epileptic activity, usually rhythmical jerking of a limb or of part of a limb, or lower face etc may be with mildly reduced alertness. It may be lasted for weeks, months or years. It may be interrupted by discrete partial or generalized seizures or may become less violent or more restricted and even disappear intermittently. Classification of Seizures By: CK 7

Purpose of the International Classification of Seizures and Epilepsies :

Purpose of the International Classification of Seizures and Epilepsies The seizers classification being most widely used is proposed by the Commission on classification and Terminology of the International League Against Epilepsy(ILAE) . Classification is necessary for; New terms & concepts with internationally accepted terminology Standardization of the seizures types description New concepts regarding Focal and generalized seizures Better adaptation of etiological terms Electro-clinical diagnosis for seizures etc Classification of Seizures By: CK 8

Cont’d. . . :

Cont’d. . . ILAE Defines; Seizures types only in terms of clinical manifestations & EEG findings, Its differ from previous classifications because it is based on the study of videotape recordings of simultaneously recorded EEG & clinical epileptic seizures. Classification of Seizures By: CK 9

Recommended terminology for etiology:

Recommended terminology for etiology ILAE emphasis the use of terms which mean what they say: Genetic Structural-Metabolic Unknown Previously used terms denoting old concepts: Idiopathic, cryptogenic, symptomatic Classification of Seizures By: CK 10

SEIZURE RECOGNITION:- :

SEIZURE RECOGNITION:- HOW TO RECOGNIZE SEIZURES:- Anatomical (patient history help us to locate the origin of discharge ) Pathological (infections or lesions help us to reorganization of Sz) Clinical (by self observation during seizure) Electro diagnostically (by the help of EEG+VEEG recording) 11 Classification of Seizures By: CK

PowerPoint Presentation:

Origin of symptoms and signs in focal seizures - Visual display over the dominant hemispheres Classification of Seizures By: CK 12

ILAE Classification of Seizures:

ILAE Classification of Seizures Classification of Seizures By: CK 13

PowerPoint Presentation:

Classification of Seizures By: CK 14 Classification of Seizures By: ML/CK 14

PowerPoint Presentation:

Partial Seizures:- Involve only part of one cerebral region or hemisphere and produce symptoms in corresponding parts of body or some related mental functions. 15 Classification of Seizures By: CK Seizures Partial Generalized Simple Partial Complex Partial Secondarily Generalized

Localization of Partial Seizure Focus:

16 Localization of Partial Seizure Focus 70% 10% 20% 16 Classification of Seizures By: CK

Simple partial Seizures:-:

Simple partial Seizures:- With somatosensory or special sensory symptoms Convulsion confine to single limb , Autonomic manifestations Psychic or experiential symptoms Symptoms with out LOC 17 Classification of Seizures By: CK Seizures Partial Generalized Simple Partial With somatosensory or special sensory symptoms With motor signs With autonomic symptoms or signs With psychic or experiential symptoms

PowerPoint Presentation:

18 Classification of Seizures By: CK

PowerPoint Presentation:

19 Classification of Seizures By: CK

Complex Partial Seizures:-:

Complex Partial Seizures:- Complex partial seizure Often called temporal lobe seizures. LOC Patient have no recollection or incomplete memory of events that occurred during seizures Partial Sz with secondary generalization . When a seizure start focally and spread to the whole limb or become generalized, it is called Jacksonian march or partial seizure with secondary generalization. 20 Classification of Seizures By: CK Seizures Partial Generalized Complex Partial Secondarily Generalized

PowerPoint Presentation:

21 Classification of Seizures By: CK

Generalized Seizures:

Generalized Seizures GENERALIZED SEIZURES. Seizures that occur on bilateral limbs and with out focal onset are grouped as generalized seizures. TYPES OF GENERALIZED SEIZURE. 1.Absence (Petit mal Seizures) Usually occur in childhood and rarely persist into adult hood Impairment of consciousness With mild clonic component With also atonic and tonic component With automatisms 22 Classification of Seizures By: CK

Petit mal epilepsy:

Petit mal epilepsy Classification of Seizures By: CK 23

Absence Sz’s Cont’d. . .:

Absence Sz’s Cont’d. . . Absence seizures:- Simple absence or typical seizure Complex absence or atypical seizure Simple absence or Typical seizures Impairment of consciousness Some patient retain awareness during the attacks but cannot respond with movement or speech. Attacks are triggered by hyperventilation and photic stimulation Seizures lasted in seconds Background usually normal during interictal phase. Typical EEG findings 3 Hz spike & waves discharges with abrupt onset and off set & clinically consistent with unresponsiveness and eyes staring or blinking. Findings are bilaterally symmetrical 24 Classification of Seizures By: CK

PowerPoint Presentation:

Classification of Seizures By: CK 25

Absence Sz’s Cont’d. . .:

Absence Sz’s Cont’d. . . Complex absence or Atypical seizures:- Brief episodes of LOC Including mild clonic component Reduction in body tone Seizures durations are in minutes EEG background usually abnormal during interictal phase. EEG findings are more heterogeneous, may include irregular spike-&-slow-wave complexes (2-4Hz), fast activity or other paroxysmal activity. Abnormalities are bilateral but often irregular and asymmetrical . 26 Classification of Seizures By: CK

PowerPoint Presentation:

27 Classification of Seizures By: CK

3.Myoclonous seizures:-:

3.Myoclonous seizures:- In Myoclonic seizures clinically single or multiple repetitive jerks are noted It mainly occur during sleep and when patient wake up from sleep early in morning. It consists of isolated or Gen. body jerks for few seconds EEG findings include spikes, polyspikes, sharp-&-slow waves complexes are seen. Absence component may be present in the seizures manifestation Generally hyperventilation & especially photic stimulation activation maneuvers are provoking measures of ictal or interictal abnormalities . 28 Classification of Seizures By: CK

PowerPoint Presentation:

Classification of Seizures By: CK 29

PowerPoint Presentation:

30 Classification of Seizures By: CK

SALAAM ATTACKS:-:

SALAAM ATTACKS:- 4.Infantile spasm/ salaam spells Sudden flexor spasm of trunk, Extension of arm, Drawing up of legs, quick nodding or jack-knife movements of the body are noted. Usually occur in the age of 3-9months Last up till the age of 3yrs After that patient became mentally retarded. EEG findings showed chaotic background, with multifocal, independent and burst suppression like epileptic form complexes. Hypsarrythmic EEG pattern is seen in the EEG recording. 31 Classification of Seizures By: CK

PowerPoint Presentation:

Classification of Seizures By: CK 32

PowerPoint Presentation:

Classification of Seizures By: CK 33

PowerPoint Presentation:

34 Classification of Seizures By: CK

CLONIC SIZURES:-:

CLONIC SIZURES:- 5.Clonic seizures Clonic seizures consist of generalized rhythmical myoclonic movements which usually last for 1 min or more and are associated with loss of consciousness. These seizures commonly occur as febrile Seizures in childhood EEG findings may include spikes, polyspikes-&-wave complexes in ictal or interictal period. 35 Classification of Seizures By: CK

PowerPoint Presentation:

36 Classification of Seizures By: CK

Tonic seizures:-:

Tonic seizures:- 6.Tonic seizures Tonic means stiffening Tonic seizures consist of contractions of the axial musculature of the entire body and produce flexor positions. They usually last up to 1 min & are associated with loss of consciousness. EEG background is often abnormal for age. Rhythmic discharges are seen in ictal or interictal phase. 37 Classification of Seizures By: CK

Tonic clonic seizures (grand mal seizures):-:

Tonic clonic seizures (grand mal seizures):- 7. Tonic clonic seizures (grand mal seizures) Tonic clonic seizures are the most severe form of Generalized seizure in adults They begin suddenly with loss of consciousness & sometime preceded by shrill cry Frothing, up rolling of eyes, jerking of limbs, urinary & fecal incontinence may occur in these seizures. EEG findings may include rhythmic decreasing in frequency and increasing in amplitude during tonic phase, interrupted by slow waves during clonic phase. 38 Classification of Seizures By: CK

Atonic seizures:-:

Atonic seizures:- 8. Atonic seizures;- Consists of sudden loss of muscle tone. Sudden droop or fall attack May be associated with Myoclonic jerks to form Myoclonic atonic seizures Possible EEG findings:- Generalized spikes, polyspikes, sharp and slow waves complexes. Epileptic burst suppression pattern could be found in EEG recording during , between or after seizure event. 39 Classification of Seizures By: CK

PowerPoint Presentation:

Classification of Seizures By: CK 40

10-second EEGs: Seizure Evolution:

10-second EEGs: Seizure Evolution Normal Pre-Seizure Seizure Onset Post-Seizure 41 Classification of Seizures By: CK

Identify the EEG patterns:

Identify the EEG patterns Classification of Seizures By: CK 42

PowerPoint Presentation:

Classification of Seizures By: CK 43

PowerPoint Presentation:

Classification of Seizures By: CK 44

PowerPoint Presentation:

Classification of Seizures By: CK 45

References:-:

References:- Fisch & Spehlmann’s EEG Primer By Bruce J.Fisch, M.D ILAE Classification of Seizures Journal “Epilepsia”. A Clinical Approach to the Classification of seizures & the epileptics Syndromes by Luder & R.Lesser (Eds). Primer of EEG With a Mini-Atlas By James Rowan M.D Classification of Seizures By: CK 46

PowerPoint Presentation:

Thanks for the patience Classification of Seizures By: CK 47

authorStream Live Help