**Seizures and EpilepsybyA/rahman Ahmed muhumed(Warfaa)

M. Miqdady, M.D.

* M. Miqdady, M.D.*Group 31.A/fatah Ahmed husein2.Hawa moh,ed A/lahi3.A/shakur saleban warsame4.A/rahman Ahmed warfaa

M. Miqdady, M.D.

* M. Miqdady, M.D.*Goals of this talkDefinitionsEpidemiology Febrile seizuresSeizure vs epilepsy .partial seizures .generalised seizures

. Re-feeding syndrome

M. Miqdady, M.D.

* M. Miqdady, M.D.*Epidemiology

Incidence of epilepsy: 40 /100,000 children / yr About 1 % of children will have at least one afebrile seizure by age 14 yrs 0.4 %-0.8 % (4/1000- 8/1000) will have epilepsy by age 11 yrs

M. Miqdady, M.D.

Osce station fibrile seizure* M. Miqdady, M.D.*

M. Miqdady, M.D.

* M. Miqdady, M.D.*

Febrile Seizures

Definition: A seizure in association with fever of minimum (38.4 C) in absence of other causes, associated with genetic and viral predisposition.It occurs in the b/w 6 months and 6 years with a peak in 2 years of life.

M. Miqdady, M.D.

Febrile Seizure Febrile seizures are the most common seizure disorder in childhood, affecting 2 - 5% of children between the ages of 6 months and 5 years

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* M. Miqdady, M.D.*

febrile seizure

1. It is a diagnosis of EXCLUSION of other causes of fever and convulsions for ex brain infections, epilepsy electrolyte imbalanceetc.2. Its occurrence differs from a country to another occurring 2-4% in western countries, 6.5% in Jordan and the highest incidence is in India and East Asian territories.3. It has seasonal variations, i.e. mostly in specific times of the year mainly in winter when there is an increase in respiratory infections.4. Febrile seizures are the COMMONEST neuro-disorders in INFANTS

M. Miqdady, M.D.

* M. Miqdady, M.D.*Febrile seizures classification:Typical :generalized tonic clonic seizure, 15minutes,more than one in a day, and focal findings.

M. Miqdady, M.D.

What are the conditions to reach a diagnosis of febrile seizure?

Age: b/w 6 months and 6 years. It is rare outside this range.Fever: The presence of fever of course. Some studies suggest that the sharp rise in temperature is what causes the seizures not the actual upper limit of the fever.Post ictal events: ABSENT.

* M. Miqdady, M.D.*

M. Miqdady, M.D.

Genetic predisposition:If there is a positive family history of febrile seizures in siblings and both parents then the probability the child has also increases* M. Miqdady, M.D.*

M. Miqdady, M.D.

Febrile seizures are associated with infections other than of the brain so we should always excluded meningitis by doing an LP. They are most commonly associated with viral infections mainly upper respiratory tract infections * M. Miqdady, M.D.*

M. Miqdady, M.D.

Treatment:

In simple seizures do not interfere because it will resolve alone.Air way managementAntipyretics paracetamolRectal diazepam as necessary.* M. Miqdady, M.D.*

M. Miqdady, M.D.

* M. Miqdady, M.D.*I am just a 6th year medical student!!Student!

M. Miqdady, M.D.

* M. Miqdady, M.D.*

seizure vs Epilepsy

A seizure is a sudden, involuntary, time-limited alteration in neurologic function (movement, behavior) secondary to abnormal discharge of neurons in the CNS Epilepsy is a chronic condition characterized by 2 or more unprovoked seizures. Therefore we have recurrent seizures. In some textbooks it is stated as 2 attacks of unprovoked seizures and in others it is stated as 3 or more attacks of unprovoked seizures.

M. Miqdady, M.D.

* M. Miqdady, M.D.*Epilepsy is considered as a clinical diagnosis. Therefore when someone has 2-3 attacks of unprovoked seizures (not precipitated by fever, hypocalcaemia, hypoglycemia, etc) this person is diagnosed as having epilepsy. Seizures provoked by the above factors are simply called secondary seizures and NOT epilepsy. Thus epilepsy is now said to be idiopathic or gene-related.

M. Miqdady, M.D.

Seizure ClassificationsTypes of symptoms:1) Motor* - head/eye deviation, jerking, stiffening2) Autonomic# - pupils dilatation, drooling, pallor, change in heart rate or respiratory rate3) Somatosensory+ - smells, alteration of perception (dj vu)*

GeneralizedPartialComplexSimpleInvolves BOTH hemispheres of the brainMay have aura No impaired consciousnessAlways involves loss of consciousnessInvolves motor* or autonomic# symptoms with altered level of consciousnessCan involve motor,* autonomic# or somatosensory+ symptoms

Types: Tonic or clonic movements or combination (grand mal) Absence (petit mal) Myoclonic Atonic (e.g., drop attacks) Infantile spasmsMay generalizeMay generalize

Partial seizures Simle seizuresAsynchronous tonic clonic movement,most of the face,neck and extremities,average duration 10-20 seconds.Some have an uara and my verbalise during the attack,no postical period,EEG spike and sharp waves.Treatment:phenytoin and other anticonvulsants.

* M. Miqdady, M.D.*

M. Miqdady, M.D.

Complex seizuresImpaired consciousness at same point, one-third with aura.Automatisms common after loss of conciousness(lip-smacking ,chewing,swallowing,increase salivation.EEG:anterior tomporal lobe shows sharp waves.Treatment:carbamazepine

* M. Miqdady, M.D.*

M. Miqdady, M.D.

* M. Miqdady, M.D.*Student!

M. Miqdady, M.D.

Generalised absence(petit mal)Sudden cessation of motor activity or speech with blank star flickering eyesMore common in girls,uncommon

Tonic-clonic seizuresMay have aura,loss of conciousness, eye roll back,tonic contraction,apnea.Then clonic rhythmic contraction alternating with relaxation of all muscle groups.Tongue biting,loss of bladder control.Semicomatose for up to 2hrs afterward with vomiting and bilateral fronta HA.Treatment:valproic acid ,phenobarbital.phenytoin.carba,

* M. Miqdady, M.D.*

M. Miqdady, M.D.

Myoclonic seizuresRepetitive seizures-brief,symmetric muscle contractions and loss of body tone and falling forward.Five types with variable severity,morbidity and prognosis.Treatment valproic acid and others.* M. Miqdady, M.D.*

M. Miqdady, M.D.

Infantile spasmsSymmetric contraction of neck ,trunk and exteremities.Pathophysiology:increased corticotropin-releasing hormones(CRH) neonatal hyperexcitability.Began typicaly at 4-8 months of age.

* M. Miqdady, M.D.*

M. Miqdady, M.D.

TypesCryptogenic:infant is normal prior to seizure with normal neurologic examination development and good prognosis.Symptomatic:disease present prior to seizure,poor control and mental retardation Treatment:adrenocorticotropin hormone (ACTH) and prednisolone

* M. Miqdady, M.D.*

M. Miqdady, M.D.

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M. Miqdady, M.D.

**Febrile seizures are the most common seizure disorder in childhood, affecting less than five percent of children between the ages of six months and five years. *Weaned to low protein diet*I am just a 4th year medical student!!*Marasmus: wasting of muscle mass and fatKwashiorkor: anasarca with flaky, peeling skin and rashesCommonly found in combination (wasting with edema)

*Increased caloric loss: malabsorption, IBD, CFIncreased caloric needsinfection, ch. Ilnesses, hyperthyroid , cong. Heart disease Decreased intake: anorexia, ilnesses

*Seizures are classified with respect to where the abnormal neuronal activity occurs. With generalized seizures, both hemispheres of the brain are involved and there is loss of consciousness. Movements are tonic or clonic or a combination. Absence seizures are also generalized. Partial seizures involve only one hemisphere of the brain. There is NO loss of consciousness, however, there may be transient cognitive impairments. Movements begin with a single muscle group and then spread to contiguous groups. Partial seizures may be simple or complex.