seizures maan psych

8/2/2019 Seizures Maan Psych

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JI Mary Ann F. Malabanan


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Seizure - is a transient epileptic event, asymptom of disturbed brain function.

Convulsions:Seizures with prominentbody movement

Non-convulsive seizures : Seizures with

minimal or no body movement


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Epilepsy - is a chronic disorder, or group of chronicdisorders, in which the indispensable feature isrecurrence of seizures that are typically

unprovoked and usually unpredictable.

Epilepsy syndromes: Groups of epileptic patterns of varying cause but similar course and response to

treatment


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Prodrome - Mood or Behavior changethat precedes a seizure. Aura - Localized symptom that may be the first part of a seizure.Tonic - A sustained muscularcontraction.Clonic - Intermittent muscularcontractions and relaxation.


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The classification used today is the 1981 Classification of EpilepticSeizures developed by the International League Against Epilepsy (). Thissystem classifies seizures by clinical symptoms supplemented by EEGdata.


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I. Partial (focal) seizures

A. Simple partial seizures (consciousness not impaired) With motor signs (including jacksonian, versive, and postural)

With sensory symptoms (including visual, somatosensory, auditory, olfactory, gustatory, and vertiginous)

With psychic symptoms (including dysphasia, dysmensic, hallucinatory, and affectivechanges)

With autonomic symptoms (including epigastric sensation, pallor, flushing, pupillary changes)

B. Complex partial seizures (consciousness is impaired) Simple partial onset followed by impaired consciousness

With impairment of consciousness at onset With automatisms

C. Partial seizures evolving to secondarily generalized seizures

Adapted from Commission on Classification and Terminology of the International League Against Epilepsy.Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia

1981;22:489501


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II. Generalized seizures of nonfocal origin (convulsiveor nonconvulsive) A. Absence seizures With impaired consciousness only

With one or more of the following: atonic components, toniccomponents, automatisms, autonomic componentsB. Myoclonic seizures

Myoclonic jerks (single or multiple)C. Tonic-clonic seizures (may include clonic-tonic-clonicseizures)

D. Tonic seizuresE. Atonic seizures

III. Unclassified epileptic seizures


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Partial Seizures:SimpleComplex

Generalized Seizures:Tonic-clonicMyoclonic Atonic

Tonic Absence seizures (petitmal)


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A seizure is a temporary involuntary disturbance of brain function that may be manifested as impairedconsciousness, abnormal motoractivity, sensory disturbances or

autonomic dysfunction.


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Seizures are accompanied by abnormal electricaldischarges in the brain that can usually be detected by electroen- cephalography.Not a disease but a symptom.Common Denominator - increased permeability of neuronal cell membranes causes an increase inneuronal cell excitability.


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Simple partial seizures result when the ictaldischarge occurs in a limited and often circumscribedarea of cortex, the epileptogenic focus. Almost any symptom or phenomenon can be thesubjective (aura) or observable manifestation of asimple partial seizure, varying from elementary motor(jacksonian seizures, adversive seizures) and unilateralsensory disturbance to complex emotional,psychoillusory, hallucinatory, or dysmnesicphenomena.

Merritt's Neurology, 11th Edition


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Complex partial seizures , on the other hand, aredefined by impaired consciousness and imply bilateralspread of the seizure discharge, at least to basalforebrain and limbic areas.In addition to loss of consciousness, patients withcomplex partial seizures usually exhibit automatisms,such as lip-smacking, repeated swallowing, clumsy perseveration of an ongoing motor task, or some othercomplex motor activity that is undirected andinappropriate. for most of the remainder


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Generalized tonic-clonic (grand mal) seizures arecharacterized by abrupt loss of consciousness with bilateraltonic extension of the trunk and limbs (tonic phase), oftenaccompanied by a loud vocalization as air is forcedly expelled across contracted vocal cords (epileptic cry),followed by synchronous muscle jerking (clonic phase).In some patients, a few clonic jerks precede the tonic-clonic sequence; in others, only a tonic or clonic phase isapparent. Postictally, patients are briefly unarousable and

then lethargic and confused, often preferring to sleep.Many patients report inconsistent nonspecificpremonitory symptoms (epileptic prodrome) for minutesto a few hours before a generalized tonic-clonic seizure..


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Absence (petit mal) seizures are momentary lapses inawareness that are accompanied by motionless staring andarrest of any ongoing activity. Absence seizures begin and end abruptly; they occur without warning or postictal period.Mild myoclonic jerks of the eyelid or facial muscles, variable loss of muscle tone, and automatisms may accompany longer attacks.

Atypical absences are seen most often in retarded children with epilepsy or in epileptic encephalopathies, such as theLennox-Gastaut syndrome.


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Myoclonic seizures - are characterized by rapid brief muscle jerks that can occur bilaterally, synchronously or asynchronously, or unilaterally.

Myoclonic jerks range from isolated small movementsof face, arm, or leg muscles to massive bilateral spasmssimultaneously affecting the head, limbs, and trunk.


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Atonic (astatic) seizures, also called drop attacks, arecharacterized by sudden loss of muscle tone, whichmay be fragmentary (e.g., head drop) or generalized,resulting in a fall.

When atonic seizures are preceded by a brief myoclonic seizure or tonic spasm, an acceleratory force

is added to the fall, thereby contributing to the highrate of self-injury with this type of seizure.


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I. Idiopathic epilepsy syndromes (focal orgeneralized) A. Benign neonatal convulsions

1. Familial2. Nonfamilial

B. Benign childhood epilepsy 1. With central midtemporal spikes2. With occipital spikes

C. Childhood/juvenile absence epilepsy D. Juvenile myoclonic epilepsy (including

generalized tonic-clonic seizures on awakening)E. Idiopathic epilepsy, otherwise unspecified

Merritt's Neurology, 11th Edition


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II. Symptomatic epilepsy syndromes (focal orgeneralized)

A. West syndrome (infantile spasms)B. Lennox-Gastaut syndrome

C. Early myoclonic encephalopathy D. Epilepsia partialis continua1. Rasmussen syndrome (encephalitic form)2. Restricted form

E. Acquired epileptic aphasia (Landau-Kleffner syndrome)

F. Temporal lobe epilepsy G. Frontal lobe epilepsy H. Post-traumatic epilepsy I. Other symptomatic epilepsy, focal or generalized, not specified


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III. Other epilepsy syndromes of uncertain or mixedclassification A. Neonatal seizuresB. Febrile seizuresC. Reflex epilepsy D. Other unspecified


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Seizures are characterized by sudden flexor or extensorspasms that involve the head, trunk, and limbssimultaneously. The attacks usually begin before 6months of age. The EEG is grossly abnormal, showingchaotic high-voltage slow activity with multifocalspikes, a pattern termed hypsarrhythmia.


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This disorder begins most often between the ages of 4and 12 years and is characterized predominantly by recurrent absence seizures, which, if untreated, canoccur literally hundreds of times each day.EEG activity during an absence attack is characterizedby stereotyped, bilateral, 3-Hz spike-wave discharges.Generalized tonic-clonic seizures also occur in 30% to50% of cases. Most children are normal, bothneurologically and intellectually.


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This term is applied to a heterogeneous group of childhood epileptic encephalopathies that arecharacterized by mental retardation, uncontrolledseizures, and a distinctive EEG pattern.The syndrome is not a pathologic entity, becauseclinical and EEG manifestations result from brainmalformations, perinatal asphyxia, severe head injury,CNS infection, or, rarely, a progressive degenerative ormetabolic syndrome.


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The JME subtype of idiopathic generalized epilepsy most often begins in otherwise healthy individualsbetween the ages of 8 and 20 years. The fully developed syndrome comprises morning myoclonic jerks, generalized tonic-clonic seizures that occur justafter waking, normal intelligence, a family history of similar seizures, and an EEG that shows generalizedspikes, 4- to 6-Hz spike waves, and multiple spike(polyspike) discharges.The myoclonic jerks vary in intensity from bilateralmassive spasms and falls to minor isolated muscle jerks that many patients consider nothing more thanmorning clumsiness


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seizures maan psych

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