1. Epilepsy
5.Year
Prof.Dr.S.Naz Yeni

2. Objectives and method
To learn general concepts about epilepsy and seizures
Learn how to diagnose and classify epilepsy
Brief rules regarding laboratory investigations
Brief rules regarding treatment
There will be a presentation of videos of different type of epileptic seizures

3. Definitions:
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.

4. Definitions
Acute 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

5. Epilepsy clasification etiology
Structural/metabolic (formerly symptomatic)
Genetic (formerly idiopathic)
Unknown (formerly cryptogenic)

6. Epidemiology
Incidence: / depending on the developing underdeveloped developed countries
There 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

7. Etiology Chidhood Perinatal hypoxia Perinatal insults CNS infections
Congenital malformations
Adulthood
Neoplasms
Vascular malformations
Head injury
Elderly
Cerebrovascular diseases
Degenerative diseases (Alzheimer disease)

8. ILAE (International League against Epilepsy) Classifications
Proposal 1981
Proposal 1989
Proposal 2001
Proposal 2010

9. ILAE 2010
Focal
Originating at some point within networks limited to one hemisphere
Generalised
Originating at some point within and rapidly engaging bilaterally distrubuted networks.
Unclassified

10. Focal seizures Focal seizure with
motor manifestations (with or without jacksonien march)
somatosensory manifestations
special sensory manifestations
adversive features
dysphasic manifestations
postural manifestations
dyscognitive features
hyperkinetic manifestations

11. Subtypes Characterizes accoeding to one or more features Aura Motor
Autonomic
Awareness/responsiveness: Altered (dyscogntive) or retained
May evolve into Bilateral convulsive seizure

12. Generalised seizures
Tonic-clonic
Absence
Tonic
Atonic
Myoclonic

13. Diagnosis
Detailed description of seizures from the patient and/or observers
The role of
EEG
CT /MR

14. Differential diagnosis
Depends on the seizure type
Frequenty misdiagnosed conditions
Seizures
Syncopes
Nonepileptic pyschogenic attacks

15. Epilepsy
Nonepileptic physogenic
Injury
Yes No
Sphinctary disturbance
Eyes
Open
Closed
Color
Cyanosis
Pallor?
Tongue bite
Rare (front)
During sleep
Duration
Short
Variable

16. EEG Does not diagnose epilepsy It is helpful in: diagnosis
classification seizure type
classification electroclinical syndromes
decision of starting and discontinuing treatment
for epilepsy surgery

17. Radiology
Emergency 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.

18. Treatment Rules and steps Start with monotheraphy
Increase the dose in case of recurrence of seizures
Increase 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 dose
If no response combine two (later three) effective drugs
If no response take a look at the diagnosis/classification of the seizures/syndrome
Think about epilepsy surgery

19. Treatment 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 retardation
Neurologic deficit
Lesions on MR
Difficult to stop the seizures at the beginning

20. Drugs Acting on focal seizures Carbamazepine Oxcarbazepine
Diphenyl hidantoin
Phenobarbital
Acting on generalised
seizures
Valproic acide
Lamotrigine
Levetiracetam
Topiramate