dr zulfiqar ali rizvi consultant psychiatrist consultant psychiatrist pimh lahore pimh lahore
TRANSCRIPT
DR ZULFIQAR ALI RIZVI DR ZULFIQAR ALI RIZVI
CONSULTANT PSYCHIATRIST CONSULTANT PSYCHIATRIST
PIMH LAHOREPIMH LAHORE
Changing concepts of EPILEPSY from ancient times to 21st century
What can be the biggest desire of patients suffering from epilepsy?
Who will help me back from exclusion to inclusion in society?YES, IT IS
Our Executive director Dr Nusrat Habib Rana, with the team of Doctors of
PIMH, Lahore have raised their hands and taken responsibility to create
awareness about epilepsy and bring epilepsy patients back in society with
sense of dignity and respect.
Epilepsy Epilepsy is one of the is one of the
oldest disorders known to oldest disorders known to mankind. Over 50 million mankind. Over 50 million people worldwide. people worldwide.
No racial, social, cultural, No racial, social, cultural, economical ethnic and economical ethnic and geographical boundaries.geographical boundaries.
In ancient times,In ancient times, associated with religious associated with religious experiences and demonic experiences and demonic possessions.possessions.
Hippocrates Hippocrates ( Greek ( Greek Physician 500 BC) wrote Physician 500 BC) wrote the first book about the first book about epilepsy. epilepsy.
Saint Cyriakus
IInn 17th and 18th century17th and 18th century, , In 20th centuryIn 20th century,,2121stst century and concept of epilepsy: century and concept of epilepsy:. .
Actually what epilepsy is?Actually what epilepsy is?EpilepsyEpilepsy is a neurological condition with tendency is a neurological condition with tendency
to recurrent seizures. At least two unprovoked to recurrent seizures. At least two unprovoked seizuresseizures::
• 24 hours apart, 24 hours apart, • of cerebral origin of cerebral origin are necessary to make a diagnosis of epilepsy.are necessary to make a diagnosis of epilepsy.
Life time prevalence of seizures: 5-10 %. Life time prevalence of seizures: 5-10 %.
Prevalence of active epilepsy 1-2%. Prevalence of active epilepsy 1-2%.
ETIOLOGYETIOLOGY: About 60-65 percent (two third) idiopathic: About 60-65 percent (two third) idiopathic
It is more common in 2-14 years age groupIt is more common in 2-14 years age group
In symptomatic cases, one can find In symptomatic cases, one can find physical basis of seizures:physical basis of seizures:
Younger and early adulthood Younger and early adulthood patientspatients::
Adults and elderlyAdults and elderly::
PathophysiologyPathophysiology
MultifactorialMultifactorial. . Determining factor is Determining factor is the result of the result of interactioninteraction between between genetically determined seizure genetically determined seizure threshold, underlying pathological threshold, underlying pathological and metabolic conditions, and acute and metabolic conditions, and acute precipitating factors. precipitating factors.
Reflex seizuresReflex seizures
Caused by certain stimuli in Caused by certain stimuli in predisposed persons.predisposed persons.
Precipitating stimuli for reflex seizuresPrecipitating stimuli for reflex seizures::
Visual stimuli- flickering lightVisual stimuli- flickering light
ThinkingThinking
Music - certain frequenciesMusic - certain frequencies
ReadingReading
CLASSIFICATIONCLASSIFICATION
TheThe ILAE ILAE classification classification
• Partial-onset seizures Partial-onset seizures
• Generalized-onset seizures.Generalized-onset seizures.
Generalized-onsetGeneralized-onset• Tonic-clonic seizuresTonic-clonic seizures (grand mal) lasts 1-2 min (grand mal) lasts 1-2 min
• Absence seizuresAbsence seizures ( petit mal ) (10-30 seconds) ( petit mal ) (10-30 seconds) with no postictal symptoms. with no postictal symptoms.
• Clonic Clonic involve tonic clonic contractions.involve tonic clonic contractions.
• MyoclonicMyoclonic
• Tonic seizuresTonic seizures( sustained contractions ) last 10-( sustained contractions ) last 10-15 sec.15 sec.
• AtonicAtonic
Partial onsetPartial onset
• Simple partial Simple partial
• Complex partialComplex partial
The origin of symptoms and signs in focal seizuresThe origin of symptoms and signs in focal seizures
DIAGNOSISDIAGNOSIS
1)History and clinical findings1)History and clinical findings
2)Physical evaluation. 2)Physical evaluation.
3) Electroencephalography: 3) Electroencephalography:
4) Lab Studies : 4) Lab Studies :
5) CT SCAN:5) CT SCAN:..
6) MRI:6) MRI:
7)PET scanning7)PET scanning
Principal of treatmentPrincipal of treatment
• New cases, New cases, 2/32/3 of cases go into of cases go into spontaneous remission. Only spontaneous remission. Only 1/3 1/3 of of cases will have 2nd seizure in next 5 cases will have 2nd seizure in next 5 years years
• If left untreated, about 75% cases show If left untreated, about 75% cases show 22ndnd seizure seizure
• A single drug, controls 60%.A single drug, controls 60%.• If seizures are difficult to control ( in 30-If seizures are difficult to control ( in 30-
40% ) , 2 or > 2 drugs may be required. 40% ) , 2 or > 2 drugs may be required. • In intractable cases ( refractory) 20% 2 In intractable cases ( refractory) 20% 2
or > drugs. or > drugs.
Drug treatmentDrug treatment
1) Primary generalized tonic-clonic seizures1) Primary generalized tonic-clonic seizures First-lineFirst-line monotherapy monotherapy Carbamazepine Carbamazepine Phenytoin Phenytoin Valproate ( epival )Valproate ( epival ) Topiramate ( topamax ) Topiramate ( topamax ) 2nd-line monotherapy or adjunctive therapy2nd-line monotherapy or adjunctive therapy Lamotrigine Lamotrigine Levetiracetam ( lerace )Levetiracetam ( lerace )
2) Partial seizures with or without 2) Partial seizures with or without secondary generalizationssecondary generalizations
First-line monotherapyFirst-line monotherapy Carbamazepine( seiznil) Carbamazepine( seiznil) Lamotrigine ( lojin )Lamotrigine ( lojin ) Oxcarbazepine (oxalepsy ) Oxcarbazepine (oxalepsy ) Topiramate Topiramate LevetiracetamLevetiracetam 2nd-line monotherapy or adjunctive 2nd-line monotherapy or adjunctive
therapytherapy Gabapentin ( neogab )Gabapentin ( neogab ) PregabalinPregabalin Valproate Valproate 3rd-line monotherapy or adjunctive 3rd-line monotherapy or adjunctive
therapytherapy Felbamate Felbamate VigabatrinVigabatrin
3) Absence seizures3) Absence seizures
First-line monotherapyFirst-line monotherapy Ethosuximide Ethosuximide Lamotrigine Lamotrigine ValproateValproate
2nd-line monotherapy2nd-line monotherapy Levetiracetam Levetiracetam Topiramate Topiramate
MESSAGEMESSAGE• Epilepsy has nothing to do with Epilepsy has nothing to do with
mental disease or retardation. This mental disease or retardation. This has been proved beyond all doubt by has been proved beyond all doubt by the the "epileptic geniuses""epileptic geniuses", people , people who achieved great things in spite of who achieved great things in spite of suffering from epilepsy. suffering from epilepsy.
G. Julius CaesarG. Julius CaesarRoman StatesmanRoman Statesman
Alfred NobelSwedish Chemist
Alexander the Great Macedonian King
Margaux Hemingway American Actress