1. Epilepsy, Light- headedness and Syncope Dr Mohamad Shehadeh Agha MD MRCP(UK) د. محمد شحاده آغا

2. To define the story inquire about Pre-attack Attack Post-attack

3. WITNESS

4. Seizures Pre-attack: no warning or aura Attack: tonic phase the respiration ceases, cyanosis Clonic phase jerking all four limbs tongue biting+/- incontinence Post attack: deep sleep diffuse bodily aching or stiffness

5. Syncope Pre-attack: nausea,dizziness, sweating,… Attack: gradual, fall, pale, occasionally shivering, if prolonged may progress to GTC Post-attack: rapid return to consciousness when flat on floor

6. Psychogenic attack Occurs in front of people No injury Prolonged attack Red in face Attempt to open the eyes may lead to voluntary contractions of the orbicularis oculi and upward deviation of the eyes. Allowing the limp hand to fall on the face may be resisted.

7. Epilepsy It is the consequence of focal or generalized epileptogenic discharges in the brain.

8. Classification of Epilepsy Generalized seizures 1. Absence attacks (petit mal) 2. Myoclonus 3. Clonic 4. Tonic 5. Tonic-Clonic (grand mal) 6. Atonic

9. Partial seizures A. Simple Partial (consciousness preserved) 1. Motor symptoms 2. Somatosensory symptoms 3. Autonomic 4. Psychic 5. Mixed forms

10. Partial seizures B. Complex Partial (consciousness impaired) 1. Motor symptoms 2. Somtosensory symptoms 3. Autonomic 4. Psychic 5. Mixed forms 6. Impaired consciousness alone

11. Partial seizures C. Partial seizures with secondary generalization

12. Syncope It is caused by sudden drop in blood flow to the brain.

13. This may lead to abrupt loss of consciousness either without any warning or with preceding symptoms.

14. Without any warning Syncope due to aortic stenosis or complete heart block.

15. Preceding symptoms Feeling of faintness LightheadednessDizziness Bilateral dimming or loss of vision General weakness Nausea Hot or cold feeling Sweating Sounds seem distant

16. Causes of syncope Vasovagal syncope Postural hypotension Cardiac arrhythmia Valsalva maneuver Structural cardiac disorders Acute circulatory failure Micturation syncope Cough syncope

17. Psychogenic attacks Panic attacks Functional overbreathing PseudoseizuresAgoraphobia