Epilepsia

Definitie • Reprezinta o boala cronica sau un grup de boli cronice caracterizate prin aparitia de crize recurente, neprevazute si de obicei neprovocate. • O criza de epilepsie este generata de o descarcare electrica sincrona a creierului.

Etiologie • Idiopatica – conditionata genetic • Secundara: – Traumatisme – Tumori – A.V.C. – Infectii – Boli degenerative

Canale ionice • Canalele ionice sunt constituite din proteine care formeaza pori la nivelul membranei celulare si permit trecerea selectiva a anumitor ioni (Na, Ca, K, Cl) contribuind astfel la mentinerea diferentei de potential intra- extracelular si formarea curentilor electrici transmembranari. • Canalele ionice au deasemenea rol in semnalizarea intercelulara, transportul transmembranar, reglarea ph-ului si a volumului celular.

Canalul de Calciu

Canalul de Sodiu

Na channel

Canalul de Potasiu

Clasificare Partiale (focale)

Generalizate

• Simple

• • • • • •

– Motorii – Senzitive – Vegetative – Psihice

• Complexe • Secundar generalizate

Tonice Atonice Clonice Tonico-clonice Mioclonice Absente

Neclasificabile

International Classification of Seizures (ILAE, Epilepsia 1981)

Epilepsy

Primary Generalized Epilepsy

Focal or Partial

Seizure Features Auras

Not present

Present

Occasionally present

Occasionally present

Present

Present

Starting with automatisms

Not usually present

Present

Prolonged postical confusion without generalization

Not usually present

Present

Present

Present

Not present

Present

Not usually present

Present

Prodrome Starting with LOC

Generalized tonic-clonic seizure True versive head movements Focal motor clonic or tonic seizures

Risk Factors for Epilepsy Family history of seizures History of CNS infections, head truama, febrile seizures, CNS tumors, vascular malformation

May be present

Not usually present

Not usually present

May be present

Examination Findings Neurologic examination

Usually normal

May be abnormal

Neuroimaging Findings Brain MRI

Usually normal

May be abnormal EEG Findings

Copyright 2002 The Cleveland Clinic Foundation Generalized epileptiform activity

Return to Epilepsy Article

Present

Not present

• Epileptogeneza • Descarcarea anormala are ca punct de plecare o zona bine delimitata – focar epileptic.

Investigatii • • • •

Electroencefalografia – analiza spectrala Computer Tomografia cerebrala (CT) Imageria prin rezonanta magnetica (IRM) Tehnici de imagerie functionala: – PET – fMRI – SPECT

• Magnetoencefalografia • Monitorizarea video - EEG

EEG - normal

Complexe virf-unda

fMRI

PET

Magnetoencefalograf

Crize generalizate • • • • •

Crizele Grand Mal Crizele de absenta Crize tonice Crize atone Crize mioclonice

Epilepsia Grand Mal

Crizele de absenta

Crize partiale motorii • Crize somatice motorii (clonii pe jumatate de corp) • Crize Jacksoniene motorii • Crize oculocefalogire • Crize adversive • Crize de arie motorie suplimentara (vocalizari si contractiile membrelor) • Crize tonice • Crize miotonice

Crize partiale senzitive • • • • • •

Crize Jacksoniene senzitive Crize vizuale Crize auditive Crize vestibulare Crize olfactive si gustative Crize vegetative

Crize partiale complexe Afectarea ariilor de asociatie: • Alterarea partiala a starii de constienta • Starea de vis, • Déjà vu, • Jamais vu • Crize de furie, frica, bucurie…

Crize partiale motorii si senzitive

Crize partiale complexe

• Medicamentos • Dieta cetogena • Chirurgical • Stimulare vagala

Principii de tratament • Monoterapie • Politerapie • Titrare • Oprirea medicatiei

Medicamente eficiente in crizele de absenta • Etosuximida • Oxazolidindiona

Medicamente eficiente in toate crizele cu exceptia absentelor • Fenobarbital • Fenitoin • Carbamaxepin • Primidon

Medicamente eficiente in toate tipurile de crize • Valproat de sodiu • Clonazepam

Status epileptic • Crize subintrante • Tratament injectabil cu : – Clonazepam – Diazepam – Fenitoin

Antiepileptice: Spectru de activitate Spectru larg

Spectru ingust

• Sodium valproate

• Phenytoin

• Levetiracetam

• Carbamazepine

• Phenobarbital

• Ethosuximide

• Benzodiazepines

• Gabapentin

• Topiramate

• Oxcarbazepine

• Lamotrigine

• Tiagabine

• Zonisamide*

• Pregabalin

* Based on preliminary evidence

Antiepileptice moderne • • • • •

Topiramat Vigabatrin Oxcarbazepina Lamotrigina Clobazam

• • • • •

Gabapentin Pregabalin Tiagabin Levetiracetam Zonisamid

Efecte secundare ale tratamentului antiepileptic • Hipertrofie gingivala • Hirsutism • Ovar polichistic • Carente de folat • Boala Dupuytren • Modificari ale metabolismului osos

Tratament chirurgical • Rezectia focarului epileptic • Lobectomie • Hemisferectomie • Calosotomie

Stimularea vagala • Electrozii de stimulare sunt atasati pe nervul vag • Stimularea se face intermitent • Indicat in forme de epilepsie refractara

Particularitati • Conducerea autovehiculelor • Sporturi cu risc • Anumite profesii • Sarcina si alaptarea

“People with epilepsy have excelled in every area.” Napoleon Bonaparte

G. Julius Caesar

Gustave Flaubert

Sokrates

Hermann von Helmholtz

Vincent van Gogh

Alfred Nobel Margaux Hemingway

Lord Byron

Jeanne d'Arc

Wladimir Iljitsch Lenin

F.M. Dostojewskij Kardinal Richelieu