1. E P I L E P S Y Ma. Tosca Cybil A. Torres, RN

9. A. Partial Seizures - those seizures where initial onset arises from a localized area of brain. - caused by localized injury to brain and diagnostic evaluation for the presence of a focal lesion (i.e., tumor, vascular malformation, stroke, trauma, neurodegenerative disease) is required. - further subdivided based on whether consciousness is maintained (i.e., simple partial) or impaired (i.e., complex partial) - most common type experienced by adults

10. 1. Simple Partial Seizures a. No loss of consciousness patient is alert and able to respond to questions or commands and afterwards remembers what happened during the seizure may precede complex partial or secondarily generalized seizures (referred to asAURA) b. Clinical manifestations of simple partial seizure usually relate to the particular area of brain involved, and thus a wide variety of symptoms are possible, including motor, sensory, autonomic, and psychic manifestations. For any given patient, symptoms will be same with each seizure. c. Motor seizures reflect involvement of the motor or supplementary motor cortex and cause a change in muscle activity may be restricted to one body part or spread to other muscles on same side or both sides (secondary generalization) of the body Most Common : Tonic Movements (neck stiffening, sustained deviation of eyes to one side) Clonic (Jerking) Movements

26. Drugs of Choice for Specific Seizure Types + Not approved for primary generalized tonic-clonic seizures * Not approved in U.S. for these indications Ketogenic Diet Ethosuximide Clonazepam Felbamate* Lamotrigine* Valproic Acid Atypical Absence, Atonic, Myoclonic Clonazepam Valproic Acid Lamotrigine* Ethosuximide Absence Felbamate + Primidone Clonazepam Phenobarbital Phenytoin Tiagabine + Lamotrigine + Valproic Acid Topiramate + Gabapentin + Carbamazepine Primary or Secondarily Generalized Tonic-Clonic Felbamate Clonazepam Topiramate Tiagabine Lamotrigine Primidone Valproic Acid Phenytoin Phenobarbital Gabapentin Carbamazepine Simple or Complex Partial Others Alternatives Second-Line Drugs First-Line Drugs Seizure Type

27. End of discussion