Presentation on theme: "Definition of Terms Seizure Epileptic Seizure Epilepsy"— Presentation transcript:
1Definition of Terms Seizure Epileptic Seizure Epilepsy Paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of CNS neuronsEpileptic Seizure Transient occurrence of signs and/or symptoms due to abnormal excessive or synchronnous neuronal activity in the brainEpilepsyHistory of at least one seizureEnduring alteration in the brain that increases the likelihood of future seizuresAssociated neurobiologic, cognitive, psychological and social disturbances
2Definition of Terms Stroke Post stroke seizure Post-stroke Spilepsy rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brainneurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hoursPost stroke seizuresingle or multiple convulsive episode/s (fit/s) after stroke and thought to be related to reversible or irreversible cerebral damage due to stroke regardless of time of onset following the strokePost-stroke Spilepsyrecurrent seizures following stroke with confirmed diagnosis of epilepsy
3Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009
4Tonic Clonic SeizuresThe seizure usually begins abruptly without warningTonic Phasetonic contraction of muscles throughout the bodyTonic contraction of the muscles of expiration and the larynx at the onset will produce a loud moan or “ictal cry.”Respirations are impaired, secretions pool in the oropharynx, and cyanosis develops.Contraction of the jaw muscles may cause biting of the tongue.marked enhancement of sympathetic toneincreases in heart rate, blood pressure, and pupillary size.Clonic Phase (After 10–20 ssuperimposition of periods of muscle relaxation on the tonic muscle contraction.Progressively increase until the end of the ictal phase, which usually lasts no more than 1 min. TPostictal Phaseunresponsiveness, muscular flaccidity, and excessive salivationPatients gradually regain consciousness over minutes to hoursPatients subsequently complain of headache, fatigue, and muscle ache that can last for many hoursThe EEG during the tonic phase of the seizure shows a progressive increase in generalized low-voltage fast activity, followed by generalized high-amplitude, polyspike discharges.In the clonic phase, the high-amplitude activity is typically interrupted by slow waves to create a spike-and-wave pattern.
5AbsenceCharacterized by sudden, brief lapses of consciousness without loss of postural control.Lasts for only secondsusually accompanied by subtle, bilateral motor signsusually begin in childhood (ages 4–8) or early adolescenceProvoked by hyperventilationThe electrophysiologic hallmark: Generalized,symmetric, 3-Hz spike-and-wave discharge that begins and ends suddenly, superimposed on a normal EEG background.
6Atypical Absence Lapse of consciousness is usually of longer duration Less abrupt in onset and cessationSeizure is accompanied by more obvious motor signs that may include focal or lateralizing features.Atypical absence seizures are usually associated with diffuse or multifocal structural abnormalities of the brain.Less responsive to anticonvulsantsThe EEG shows a generalized, slow spike-and-wave pattern with a frequency of ≤2.5/s, as well as other abnormal activity.
7Atypical Absence with Special Features Myoclonic AbsenceThe manifestations are abrupt onset of absences accompanied by bilateral rhythmic myoclonic jerks of severe intensityThe seizure mainly involves muscles of the shoulders, arms, and legs; facial muscles are less involved.May last from 10 to 60 secondsHyperventilation, awakening, and stimulation by intermittent light can precipitate the attack.
8Atypical Absence with Special Features Eyelid MyocloniaThe eyelid myoclonia consists of rapid 4 to 6 Hz jerking of the eyelids, which, if brief, may occur in isolation or proceed to an absence also associated with rapid jerking of the eyelidsSeizures are brief, 3 to 6 seconds, occurring mainly after eye closure, photic stimulation, or bothOnset is usually in early childhood, 5 to 8 years of ageConsist of eyelid myoclonia that persists through the attack with or without absencesPhotosensitivity
9MyoclonicMyoclonus is a sudden and brief muscle contraction that may involve one part of the body or the entire bodyMyoclonic seizures or twitches are brief contractions, or relaxations, of a muscle or muscle group, resulting in a sudden, jumpy movement.Positive myoclonus - muscular contractionNegative myoclonus - muscular relaxation.Consciousness does not usually seem to be impairedduration of <1 secondThe EEG may show bilaterally synchronous spike-and-wave discharges synchronized with the myoclonus, although these can be obscured by movement artifact.Myoclonic seizures usually coexist with other forms of generalized seizure disorders
10ClonicConsists of rhythmic jerking movements of the arms and legs, sometimes on both sides of the body.Rapidly alternating contraction and relaxation of a muscleMovements cannot be stopped by restraining or repositioning the arms or legs EEG: high-amplitude activity is typically interrupted by slow waves to create a spike-and-wave pattern.
11Tonic Often occur during sleep Flexion at the waist and neck, abduction and flexion or extension of the upper extremities, and flexion or extension of the lower extremitiesTypical duration is 5–20 seconds.Tonic seizures are generalized, involving bilateral musculature in a symmetric or nearly symmetric mannerEEG usually shows generalized, low-voltage, fast polyspikes.
12AtonicAtonic seizures are characterized by sudden loss of postural muscle tone lasting 1–2 sUsually no postictal confusionThe EEG shows brief, generalized spike-and-wave discharges followed immediately by diffuse slow waves that correlate with the loss of muscle tone.
13Revised terminology and concepts for organization of seizures and epilepsies: Report of the ILAE Commission on Classification and Terminology, 2005–2009