Epilepsy and Seizures  Definition of seizures and epilepsy ...

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Transcript of Epilepsy and Seizures  Definition of seizures and epilepsy ...

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  • Epilepsy and Seizures Definition of seizures and epilepsy Epidemiology Classification of seizures Examples Diferential diagnosis
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  • Clinical Definition of Seizure Paroxysmal uncontrolled discharges of neurons within the central nervous system (grey matter disease). These Paroxysmal episodes of brain dysfunction manifested by stereotyped alteration in behavior Clinical manifestations of a seizure based on anatomy of the brain that is seizing Symptoms: sensory, motor, autonomic with or without loss of consciousness Epilepsy is a disease in which recurrent and unprovoked seizures occur spontaneously
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  • What are seizures? Cellular definition: excessive or oversynchronized discharges of cortical neurons GABA receptor mediates inhibition responsible for normal termination of a seizure NMDA (Glutamate) receptor activation required for propagation of seizure activity Seizure NMDA Rcptr Activation Reduced GABA Rcptr function
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  • 0 20 40 60 80 100 120 140 160 Ya 45101520253035404550556065707580
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  • EEG interpretation !!
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  • Seizure Classification
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  • Seizure terms Ictal= during seizure Post-ictal= confusion following seizure Aura= abnormal sensation Automatisms= nonsensical involuntary movements Tonic= tonic contraction producing extension and arching Clonic= alternating muscle contraction- relaxation Partial= focal region involved Generalized= whole brain Convulsions= shaking
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  • Seizure Phenotypes think of anatomy!!
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  • Cortex Frontal Eye Field Brocass Speech Area Primary Auditory Cortex Sylvian Fissure Wernickes Speech Primary Visual Cortex Visual Assoc. Cortex Central Sulcus
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  • Partial Seizures Homunculus
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  • Frontal Lobe Frontal Eye Field (Brodmans 8) Lesion: deviation of eyes to ipsilateral side Sz: overstimulation->eyes to contralateral side Prefrontal Cortex (Brodmans 9-12,46,47) Lesion: deficits in concentration, judgment and behavior Sz: agitation, odd behavior Brocas Speech Area (Brodmans 44,45) Lesion/Sz: expressive nonfluent aphasias Primary Motor Cortex (Brodmans 4) Lesion: contralateral spastic paresis Sz: contralateral posturing/convulsions
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  • Temporal Lobe Hippocampal Cortex Bilateral lesions: inability to process short term to long term memory Sz: chronic seizures lead to deficits in short term memory Wernickes Speech area (Brodmans 22) Lesion/Sz: loss of receptive speech, fluent aphasia Anterior Temporal Lobe Bilateral lesions: Kluver-Bucy syndrome of visual agnosia, oral tendencies, hyperphagia, hypersexuality, docility Sz: pts freeze and might have oral automatisms Primary Auditory (Brodmans 41, 42) Bilateral lesion: cortical deafness Sz: auditory hallucinations Olfactory Bulb (Brodmans 34) Lesion: ipsilateral anosmia Sz: olfactory and gustatory hallucinations
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  • Limbic System Means border in Latin Border between cortex and hypothalamus Involved with emotional behavior Fear/anger/sexual behavior Short term memory Includes: Hippocampus Fornix Mammilary bodies Ant. Nucleus thalamus Cingulate cortex Seizures involving the hippocampus can have clinical symptoms of poor short term memory and abnormal mood
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  • Parietal and Occipital Lobe Primary Sensory Cortex (Brodmans 3,1,2) Lesion: contralateral hemihypestheisa and astereognosis Sz: contralateral sensory symptoms ie: tingling, heat Occipital lobe (Brodmans 17) Lesion: contralateral hemianopsia with macular sparing Sz: flashing or colored lights in contralateral visual field
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  • Psychogenic non-epileptic seizures -PNES Non-epileptic seizures May be manifestation of conversion disorder, factitious disorder or malingering Features that may distinguish from epileptic seizures Pre-attack preparation, absence of post-ictal confusion Disorganized movements, pelvic thrusting, thrashing Bilateral convulsions without loss of consciousness Violent or goal-directed behavior, obscene language, Forcefull eye closure Tongue biting Time!!!!! Video EEG may help to diagnose
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