Epilpesy.pptx

Epilpesy Yul Orozco Morales

Definition

 Etymology: From the greek word Epilepsia. Epi meaning upon and Lepsis meaning seizure. In ancient times epilepsy was known as the sacred disease.  Definition: Epilepsy is a disorder of the brain characterized by an enduring predisposition to epileptic seizures

 WHO: Two or more unprovoked seizures. A chronic noncommunicable disorder of the brain that affects people of all ages.

Pathology  It depends mainly on different ions:  Sodium  Calcium (not represented here)  Magnesium

 Also on neurotransmitters  GABA  Glutamate

Causes of epilepsy include:  Stroke  Brain tumor

 Brain infection  Past head injury  Metabolic problems  Other neurological conditions 

Genetic factors

Clasification of SEIZURES

A seizure may appear as: A sudden cry and fall, followed by  Convulsive movements of all limbs  Shallow/interrupted breathing - cyanosis  Loss of bowel/bladder control

 Slow return to consciousness, postseizure confusion and/or fatigue

This is a generalized tonic-clonic or “grand mal” seizure.

or a seizure may be… 

Blank staring, chewing, other repetitive purposeless movements

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Wandering, confusion, incoherent speech

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Crying, screaming, running, flailing

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A sudden loss of muscle tone and fall

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Picking at clothes, disrobing

This is one type of partial seizure known as a complex partial seizure.

Or also as…

 Rhythmic movements isolated twitching of arms, face, legs  Sensory symptoms tingling, weakness, sounds, smells, tastes, feeling of upset stomach, visual distortions  Psychic symptoms déjà vu, hallucinations, feelings of fear or anxiety Usually last less than one minute May precede a generalized seizure

Anti-epileptic Medications Depakote (Valproic acid) • Felbatol (felbamate) • Neurontin (gabapentin) • Gabatril (tiagabine) • Tegretol (carbamezepine) • Keppra • Trileptal (oxcarbazepine) (levetiracetam) • Topamax (topiramate) • Lamictal (lamotrigine) • Zonegran (zonisamide) • Dilantin (phenytoin) • Lyrica (pregabalin) • phenobarbitol •

Pre-hospital Treatment – Complex Partial Seizure (CPS) May be reported as drunkenness/illegal drug use medical conditions such as a stroke or diabetic reaction “person acting strangely” •

Look for sudden loss of awareness and automatic, purposeless behaviors such as picking at clothes, chewing, mumbling or wandering.

Pre-hospital Treatment – Generalized tonic-clonic seizure  Assure scene safety  If trauma is not suspected, place patient in recovery position  Protect head/limbs from injury  Follow A B C protocol: Maintain airway – suction PRN Administer O2 Monitor cardio-respiratory status

During GTC seizure, assess for:  Traumatic injury  Possible aspiration (seizure in water)  Elderly, pregnant or diabetic patient Check blood glucose

 Seizure lasting longer than 5 minutes, or occurring in a series

When present, activate ALS and/or rapidly transport to receiving facility

Status Epilepticus

What is prognosis for this?

 Is very complex and have a ton of possibilities.  Is not the attack, all the cares are fundamental  The age, the syndromes and the evolution play together trough patients life  Many of the cases has to take medications for life

bibliography

 Daroff RB, Jankovic J, Mazziotta JC, Pomeroy S, eds. Bradley’s Neurology in Clinical Practice. 7th ed. Elsevier; 2016; 2348 pp