2Objectives and methodTo learn general concepts about epilepsy and seizuresLearn how to diagnose and classify epilepsyBrief rules regarding laboratory investigationsBrief rules regarding treatmentThere will be a presentation of videos of different type of epileptic seizures
3Definitions:Epileptic seizure is a transitory clinical manifestation as a result of an abnormal excessive hypersynchronous discharges arising from a group of neurons. Manifestations consist of transitory motor sensory pyschic phenomena and/or loss of consiousness.Epilepsy: epilepsy is a chronic condition. Seizures are spontaneous and recurrent.
4DefinitionsAcute symptomatic seizures: these seizures are provoked as a result of a metabolic/infectious/traumatic events. Acute symptomatic seizures are not as a result of primarily nervous system lesions.Examples: febrile seizures seizures during acute head injury
6EpidemiologyIncidence: / depending on the developing underdeveloped developed countriesThere is a bimodal distribution. The first peak in the first 2 decades and the second peak is after the age 65.Prevalence: 6-18/1000
8ILAE (International League against Epilepsy) Classifications Proposal 1981Proposal 1989Proposal 2001Proposal 2010
9ILAE 2010FocalOriginating at some point within networks limited to one hemisphereGeneralisedOriginating at some point within and rapidly engaging bilaterally distrubuted networks.Unclassified
10Focal seizures Focal seizure with motor manifestations (with or without jacksonien march)somatosensory manifestationsspecial sensory manifestationsadversive featuresdysphasic manifestationspostural manifestationsdyscognitive featureshyperkinetic manifestations
11Subtypes Characterizes accoeding to one or more features Aura Motor AutonomicAwareness/responsiveness: Altered (dyscogntive) or retainedMay evolve into Bilateral convulsive seizure
16EEG Does not diagnose epilepsy It is helpful in: diagnosis classification seizure typeclassification electroclinical syndromesdecision of starting and discontinuing treatmentfor epilepsy surgery
17RadiologyEmergency room: CT scan (helps to reveal acute lesions such as intracranial hematoma fractures of the skull etc.Each patient with a diagnosis of epilepsy has a right to have at least one cranial MR scan to understand the underlying etiology.
18Treatment Rules and steps Start with monotheraphy Increase the dose in case of recurrence of seizuresIncrease the dose until the patient can not tolerate to side effects.If there is no response switch the drug (monotherapy)If no response increase the doseIf no response combine two (later three) effective drugsIf no response take a look at the diagnosis/classification of the seizures/syndromeThink about epilepsy surgery
19Treatment If there is a good response to treatment: The drug may be withdrawn after a seizure-free period of 2-5 years. In some cases treatment is lifelong.Patients with a high risk of recurrence:Mental retardationNeurologic deficitLesions on MRDifficult to stop the seizures at the beginning
20Drugs Acting on focal seizures Carbamazepine Oxcarbazepine Diphenyl hidantoinPhenobarbitalActing on generalisedseizuresValproic acideLamotrigineLevetiracetamTopiramate