logging in or signing up Epilepsy mallaba Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1802 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: April 15, 2010 This Presentation is Public Favorites: 1 Presentation Description Epilepsy results from abnormal, sudden, excessive and rapid electrical discharges arising from cerebral neurons. These discharges are self-terminating but have a tendency to recur. Comments Posting comment... By: pwn12 (13 month(s) ago) nice presentation. Sir plz allow me to download this ppt.(pwn012@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: nuhtarwai (14 month(s) ago) really useful Saving..... Post Reply Close Saving..... Edit Comment Close By: maheshkund (17 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: sonu9311 (19 month(s) ago) hey i want this ppt please Saving..... Post Reply Close By: mallaba (14 month(s) ago) hello send me ur email so that I can email you back many thanks Saving..... Edit Comment Close By: chris120 (19 month(s) ago) great Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Epilepsy : Epilepsy Neurology Department Luo Guogang Slide 2: Julius Caesar (100 BC~ 44 BC) Great dictator, politician and general of the Roman republic, was assassinated in March 44 BC. Introduction : Introduction —Epilepsy results from abnormal, sudden, excessive and rapid electrical discharges arising from cerebral neurons. These discharges are self-terminating but have a tendency to recur. —Epileptic seizure can be defined clinically as an intermittent, stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation, arising from abnormal neuronal discharges. ---Epilepsy is the condition in which seizures recur, usually spontaneously. Classification : Classification In 1981, the International classification of Epileptic Seizures (ICES) was proposed. Partial seizures (Seizures beginning focally) Simple (consciousness not impaired) With motor symptoms With somatosensory or special sensory symptoms With autonomic symptoms With psychic symptoms Complex (with impairment of consciousness) : Complex (with impairment of consciousness) ---beginning as a simple partial seizure and progressing to a complex partial seizure ---impairment of consciousness at onset. partial seizure becoming secondarily generalized. Generalized seizure : Generalized seizure Absence seizure Typical Atypical Myoclonic seizure Clonic seizure Tonic seizure Tonic-clonic seizure (grand mal) Atonic seizure Aetiology : Aetiology Epilepsy is a symptom of numerous disorders, but in over 50% of patients with epilepsy, no apparent cause is found, despite full investigation. Vascular disease (stroke), alcohol abuse, cerebral tumors and head injury are the most common symptomatic causes in adults. Predisposed factors : Predisposed factors 1. Family history ---There is an increased liability to seizures in relatives of patients with epilepsy. ---The mechanism probably involves factors that alter membrane structure or function, leading to a lowered seizure threshold. 2. Prenatal and perinatal factors : 2. Prenatal and perinatal factors Intrauterine infections Maternal drug abuse Perinatal trauma Anoxia 3. Trauma and surgery Severe closed or open head trauma surgery to the cerebral hemispheres (about 10%). 4. Metabolic causes : 4. Metabolic causes Electrolyte disturbance cause neuronal irritability, such as uraemia; Hepatic failure; Acute hypoxia. 5. Toxic causes Phenothiazines, monoamine oxidase inhibitor Withdrawal of antiepileptic medication Chronic alcohol abuse Carbon monoxide, lead, mercury poison 6. Infectious and inflammatory causes : 6. Infectious and inflammatory causes Encephalitis Meningitis Cerebral abscess Neurosyphilis 7. Vascular causes Up to 15% of patients with cerebrovascular disease experience seizures, especially with large areas of infarction or haemorrhage. 8. Intracranial tumours : 8. Intracranial tumours Sudden onset of seizures in adult life, especially if partial, should always raise the possibility of an intracranial tumour 9. Hypoxia During or following respiratory or cardiac arrest as a result of anoxic encephalopathy. Clinical features : Clinical features 1. Tonic-clonic seizures (grand mal) Tonic phase ---Lasts for about 10-30 seconds. ---Start with a loss of consciousness. ---The body is stiff and arching of the body in apparent opisthotonos, the elbows are flexed and the legs extended, breathing stops. Bladder and bowel function may be lost at the end of this phase. Clonic phase (alternating muscle contraction and relaxation) : Clonic phase (alternating muscle contraction and relaxation) ---lasts for about 1~2 minutes. ---Violent generalized shaking ---Eyes roll ---The tongue may be bitten ---Tachycardia ---Breathing recommences at the end of this phase, and cyanosis clears. Recovery phase : Recovery phase Regain consciousness Recovery the patient is often unarousable for variable period and awakes with confusion and headache. Full orientation commonly takes 10-30 minutes. Todd’s paralysis: transient unilateral weakness (hemiparesis) in the postictal period suggests a focal brain lesion Usually physical examination is normal except transiently plantar extensor response . 2. Simple partial seizures : 2. Simple partial seizures Involve focal symptoms, most commonly motor or sensory, arising in the frontal motor or parietal sensory cortex and affecting the contralateral face, trunk or limbs. No loss of consciousness A structural brain lesion must be excluded. 3. Complex partial seizures usually originate in the temporal lobe and involve complex auras and partial clouding of consciousness. 4. Absence seizures : 4. Absence seizures onset between 4 and 12 years of age, may occur several times a day, with a duration of 5~15 seconds. Patient stares vacantly, may be eye blinking and myoclonic jerks. Often complaints about an inattentive child with a deteriorating performance at school. Diagnosis procedure : Diagnosis procedure 1. Differentiate from pseudoseizures: hysterical seizures is psychogenic, not organic, rarely harm the body or incontinent during clonic phase without loss of consciousness no abnormal clinical signs EEG doesn’t show seizure activity. 2. Determine the seizure type: based on clinical manifestation, EEG (abnormal spikes, polyspikes dischsrge and spike-wave complexes). 3. Search for causes: blood test. CT, MR scans. Treatment Principle : Treatment Principle --- Establish the diagnosis of epilepsy before starting drug therapy. --- Therapy should be directed toward the cause if known, eg massive lesion, systemic disorders, alcohol withdrawal. --- Choose the right drug for the seizure type. (eg,absence seizures do not response to most drugs for complex partial or generalized tonic-clonic seizures. --- Monitoring the efficacy and side-effects of drug --- Gradual withdrawal when fits free have been for two years. Choose the right drug : Choose the right drug GTCS and partial seizures: Phenytoin, carbamazepine in adults Phenobarbitals or carbamazepine for children. Absence attacks: Ethosuximide or valproic acid. Myoclonic seizure: Valproic acid, clonazepam. Status epilepticus : Status epilepticus Status epilepticus is defined artificially as seizures that continue for more than 30 minutes without ceasing spontaneously, or which recur so frequently that full consciousness is not restored between successive episodes. It’s a medical emergency because it can lead to permanent brain damage from hyperpyrexia, circulatory collapse, or excitotoxic neuronal damage, if untreated. Stop seizure immediately : Stop seizure immediately Diazepam is preferred: --10mg i.v over 2 minutes (0.1mg/kg i.v at rate, not greater than 2mg/min), --repeat it in 10 minutes if ineffective. --Attention: abrupt respiratory depression. If diazepam is ineffective, may choose phenytoin 1000~1500mg (20mg/kg) i.v slowly. Support & Symptomatic therapy : Support & Symptomatic therapy Ensure airway is patent and prevent aspiration of stomach contents. Hyperthermia must be treated with a cooling blanket. Mild or moderate hyperthermia may not require specific intervention. Infection should be excluded and treated with antibiotics. Intravenous infusion with glucose, lactic acidosis resolves spontaneously over 1 hour. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Epilepsy mallaba Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 1802 Category: Education License: All Rights Reserved Like it (2) Dislike it (0) Added: April 15, 2010 This Presentation is Public Favorites: 1 Presentation Description Epilepsy results from abnormal, sudden, excessive and rapid electrical discharges arising from cerebral neurons. These discharges are self-terminating but have a tendency to recur. Comments Posting comment... By: pwn12 (13 month(s) ago) nice presentation. Sir plz allow me to download this ppt.(pwn012@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: nuhtarwai (14 month(s) ago) really useful Saving..... Post Reply Close Saving..... Edit Comment Close By: maheshkund (17 month(s) ago) nice presentation Saving..... Post Reply Close Saving..... Edit Comment Close By: sonu9311 (19 month(s) ago) hey i want this ppt please Saving..... Post Reply Close By: mallaba (14 month(s) ago) hello send me ur email so that I can email you back many thanks Saving..... Edit Comment Close By: chris120 (19 month(s) ago) great Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript Epilepsy : Epilepsy Neurology Department Luo Guogang Slide 2: Julius Caesar (100 BC~ 44 BC) Great dictator, politician and general of the Roman republic, was assassinated in March 44 BC. Introduction : Introduction —Epilepsy results from abnormal, sudden, excessive and rapid electrical discharges arising from cerebral neurons. These discharges are self-terminating but have a tendency to recur. —Epileptic seizure can be defined clinically as an intermittent, stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation, arising from abnormal neuronal discharges. ---Epilepsy is the condition in which seizures recur, usually spontaneously. Classification : Classification In 1981, the International classification of Epileptic Seizures (ICES) was proposed. Partial seizures (Seizures beginning focally) Simple (consciousness not impaired) With motor symptoms With somatosensory or special sensory symptoms With autonomic symptoms With psychic symptoms Complex (with impairment of consciousness) : Complex (with impairment of consciousness) ---beginning as a simple partial seizure and progressing to a complex partial seizure ---impairment of consciousness at onset. partial seizure becoming secondarily generalized. Generalized seizure : Generalized seizure Absence seizure Typical Atypical Myoclonic seizure Clonic seizure Tonic seizure Tonic-clonic seizure (grand mal) Atonic seizure Aetiology : Aetiology Epilepsy is a symptom of numerous disorders, but in over 50% of patients with epilepsy, no apparent cause is found, despite full investigation. Vascular disease (stroke), alcohol abuse, cerebral tumors and head injury are the most common symptomatic causes in adults. Predisposed factors : Predisposed factors 1. Family history ---There is an increased liability to seizures in relatives of patients with epilepsy. ---The mechanism probably involves factors that alter membrane structure or function, leading to a lowered seizure threshold. 2. Prenatal and perinatal factors : 2. Prenatal and perinatal factors Intrauterine infections Maternal drug abuse Perinatal trauma Anoxia 3. Trauma and surgery Severe closed or open head trauma surgery to the cerebral hemispheres (about 10%). 4. Metabolic causes : 4. Metabolic causes Electrolyte disturbance cause neuronal irritability, such as uraemia; Hepatic failure; Acute hypoxia. 5. Toxic causes Phenothiazines, monoamine oxidase inhibitor Withdrawal of antiepileptic medication Chronic alcohol abuse Carbon monoxide, lead, mercury poison 6. Infectious and inflammatory causes : 6. Infectious and inflammatory causes Encephalitis Meningitis Cerebral abscess Neurosyphilis 7. Vascular causes Up to 15% of patients with cerebrovascular disease experience seizures, especially with large areas of infarction or haemorrhage. 8. Intracranial tumours : 8. Intracranial tumours Sudden onset of seizures in adult life, especially if partial, should always raise the possibility of an intracranial tumour 9. Hypoxia During or following respiratory or cardiac arrest as a result of anoxic encephalopathy. Clinical features : Clinical features 1. Tonic-clonic seizures (grand mal) Tonic phase ---Lasts for about 10-30 seconds. ---Start with a loss of consciousness. ---The body is stiff and arching of the body in apparent opisthotonos, the elbows are flexed and the legs extended, breathing stops. Bladder and bowel function may be lost at the end of this phase. Clonic phase (alternating muscle contraction and relaxation) : Clonic phase (alternating muscle contraction and relaxation) ---lasts for about 1~2 minutes. ---Violent generalized shaking ---Eyes roll ---The tongue may be bitten ---Tachycardia ---Breathing recommences at the end of this phase, and cyanosis clears. Recovery phase : Recovery phase Regain consciousness Recovery the patient is often unarousable for variable period and awakes with confusion and headache. Full orientation commonly takes 10-30 minutes. Todd’s paralysis: transient unilateral weakness (hemiparesis) in the postictal period suggests a focal brain lesion Usually physical examination is normal except transiently plantar extensor response . 2. Simple partial seizures : 2. Simple partial seizures Involve focal symptoms, most commonly motor or sensory, arising in the frontal motor or parietal sensory cortex and affecting the contralateral face, trunk or limbs. No loss of consciousness A structural brain lesion must be excluded. 3. Complex partial seizures usually originate in the temporal lobe and involve complex auras and partial clouding of consciousness. 4. Absence seizures : 4. Absence seizures onset between 4 and 12 years of age, may occur several times a day, with a duration of 5~15 seconds. Patient stares vacantly, may be eye blinking and myoclonic jerks. Often complaints about an inattentive child with a deteriorating performance at school. Diagnosis procedure : Diagnosis procedure 1. Differentiate from pseudoseizures: hysterical seizures is psychogenic, not organic, rarely harm the body or incontinent during clonic phase without loss of consciousness no abnormal clinical signs EEG doesn’t show seizure activity. 2. Determine the seizure type: based on clinical manifestation, EEG (abnormal spikes, polyspikes dischsrge and spike-wave complexes). 3. Search for causes: blood test. CT, MR scans. Treatment Principle : Treatment Principle --- Establish the diagnosis of epilepsy before starting drug therapy. --- Therapy should be directed toward the cause if known, eg massive lesion, systemic disorders, alcohol withdrawal. --- Choose the right drug for the seizure type. (eg,absence seizures do not response to most drugs for complex partial or generalized tonic-clonic seizures. --- Monitoring the efficacy and side-effects of drug --- Gradual withdrawal when fits free have been for two years. Choose the right drug : Choose the right drug GTCS and partial seizures: Phenytoin, carbamazepine in adults Phenobarbitals or carbamazepine for children. Absence attacks: Ethosuximide or valproic acid. Myoclonic seizure: Valproic acid, clonazepam. Status epilepticus : Status epilepticus Status epilepticus is defined artificially as seizures that continue for more than 30 minutes without ceasing spontaneously, or which recur so frequently that full consciousness is not restored between successive episodes. It’s a medical emergency because it can lead to permanent brain damage from hyperpyrexia, circulatory collapse, or excitotoxic neuronal damage, if untreated. Stop seizure immediately : Stop seizure immediately Diazepam is preferred: --10mg i.v over 2 minutes (0.1mg/kg i.v at rate, not greater than 2mg/min), --repeat it in 10 minutes if ineffective. --Attention: abrupt respiratory depression. If diazepam is ineffective, may choose phenytoin 1000~1500mg (20mg/kg) i.v slowly. Support & Symptomatic therapy : Support & Symptomatic therapy Ensure airway is patent and prevent aspiration of stomach contents. Hyperthermia must be treated with a cooling blanket. Mild or moderate hyperthermia may not require specific intervention. Infection should be excluded and treated with antibiotics. Intravenous infusion with glucose, lactic acidosis resolves spontaneously over 1 hour.