EPILEPSI

1. Group – I

2.  Seizure type and frequency
 History
 Examination
 Laboratory findings
 EEG findings
 Imaging studies
 Consciousness

3.  Partial ( focal,
local) seizures
◦ Simple Partial Seizures
(consciousness not
impaired)
 motor
 sensory
 autonomic
 psychic symptoms
◦ Complex Partial Seizures
(consciousness impaired)
◦ Partial seizures with
secondary generalization
 Generalized
seizures
◦ Tonic – clonic seizures
(Grand mal)
◦ Absence seizures (Petit
mal)
◦ Tonic seizures
◦ Atonic seizures
◦ Myoclonic seizures
 Unclassified
seizures
 Neonatal seizures
 Infantile spasms

4. HISTORY
 History obtained
◦ Patient
◦ witnesses
 Describe events
◦ Before
◦ During the seizure
◦ After
 Family history

5.  Personal history
◦ Birth trauma
◦ Head injuries
◦ h/o febrile seizures
◦ CNS infections
◦ Middle ear and sinus
infections
◦ Alcohol
◦ Drug use
◦ Earlier auras or
seizures not
recognized
 Precipitating events
◦ Sleep deprivation
◦ Systemic diseases
◦ Electrolyte disturbances
◦ Metabolic derangements
◦ Acute infections
◦ Drugs that lower seizure
threshold
 Β lactam antibiotics
 Quinolones
 INH
 Acyclovir
 Theophylline

6.  Airway, breathing, circulation – vital signs
 Signs of infection or systemic illness
 Neurocutaneous markers
◦ Neurofibromatosis
◦ Tuberous scleroses
◦ Liver and kidney disease
◦ Subcutaneous nodules
 Organomegaly
◦ Storage disorders
 Limb asymmetry
◦ Brain injury early in development
 Auscultation of heart and carotid arteries
◦ Predisposition to cerebrovascular disease
 Signs of injury
◦ Head injury
◦ Tongue, Lip bite
◦ Fractures and soft
tissue injury

7. The Differential Diagnosis of Seizures
Syncope
Vasovagal syncope
Cardiac arrhythmia
Orthostatic hypotension
Psychological disorders
Psychogenic seizure
Hyperventilation
Panic attack
Metabolic disturbances
Alcoholic blackouts
Delirium tremens
Hypoglycemia
Hypoxia
Transient ischemic attack (TIA)
Sleep disorders
Migraine
Movement disorders
Special considerations in
children
Breath-holding spells
Apnea
Night terrors
Sleepwalking

8.  Blood investigations
◦ Blood sugar
◦ Acidosis
◦ Electrolytes
◦ Serum creatine kinase activity
◦ Serum prolactin
 Increased in Generalized and Complex partial
seizures
 Not increased in Absence and Myoclonic seizures
◦ Rise in ACTH and cortisol
 Post ictal phase

9.  Screen for toxins
◦ Blood
◦ Urine
 Lumbar puncture
◦ Indicated
 if there is suspicion of meningitis or encephalitis
 All HIV infected persons even in the absence of
signs and symptoms of infection
◦ In 15% patients after a seizure -
 WBCS – 10 – 50 /mm3
 Slight increase in protein content

10.  Diagnosis of epilepsy
 Classification of seizures / epilepsy
 Selection of AEDs
 Prognosis

11.  PROLONGED RECORDINGS
◦ Ambulatory EEG recordings
◦ Inpatient evaluation with continuous video and
EEG monitoring
 INTRACRANIAL MONITORING
 MAGNETO – ENCEPHALOGRAPHY

12. Indications –
 New onset seizures
 A fixed focal deficit
 Failure of seizure control with first line
AEDs
 Recurrence of seizures after a stable
control of seizures with continued AEDs
 Change in seizure pattern
 Worsening of seizures

13.  Computed Tomography
 Magnetic Resonance Imaging (FLAIR)
 Functional Magnetic Resonance Imaging
◦ Positron Emission Tomography
◦ Single – Photon Emission Computed
Tomography

14.  It means the state of the patient’s awareness of
self and environment and his responsiveness to
external stimulation and inner need.

15.  ABCDE approach;
 Airway
 Breathing
 Circulation
 Disability
 Exposure

16. Assess level of consciousness: by GLASGOW
COMA SCALE
Signs of meningeal irritation-
• meningitis
•SAH
Fundus
•Raised ICP
•SAH
• Hypertensive encephalopathy

17.  Pupil size and response to light
 Occular movements
 Posture and limb movement

18. Three components .score derived by adding the
score for each component.
Eye opening (4points)
Verbal response (5 points)
Best motor response(6 points)