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Seizures Tutor: Professor V. Wong Presentation by: Daniel Tsang, Dragon Man, Michele Yuen.

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Presentation on theme: "Seizures Tutor: Professor V. Wong Presentation by: Daniel Tsang, Dragon Man, Michele Yuen."— Presentation transcript:

1 Seizures Tutor: Professor V. Wong Presentation by: Daniel Tsang, Dragon Man, Michele Yuen

2 Outline of Presentation 1. Some basic terminologies 2. Brief overview of seizures 3. Video demonstrations

3 Part 1: Basic Terminologies

4 Some stuff you probably know already…  Epilepsy:  group of syndromes  characterized by paroxysmal transient disturbances of the brain function  Seizure: a single episode of epilepsy

5 Consciousness  Consciousness: awareness or responsiveness to external stimuli  Awareness: contact with events during the period in question  Responsiveness: ability to carry out simple commands or willed movement

6 Drowsiness or somnolence  Drowsiness or somnolence: sleep state from which the patient can be aroused to make appropriate motor and verbal responses  Stupor: state from which the patient can be aroused by painful or other vigorously applied stimuli to make avoidance movements

7 Aura  component of seizure which occurs before consciousness is lost and for which memory is retained afterwards  In seizures that occur without lost of consciousness, the aura is the whole seizure

8 Automatisms  Involuntary motor activity occurring during the state of clouding of consciousness either in the course of, or after an epileptic seizure  Continuation of an activity that was going on when the seizure occurred vs. new activity developed in associated with the ictal impairment of consciousness  Related to discharge in the limbic system

9 Types of Automatisms 1.Eating automatisms 2.Automatisms of mimicry 3.Gestural automatisms 4.Ambulatory automatisms 5.Verbal automatisms → Absence seizures Complex partial + absence seizures

10 Part 2: Brief overview of seizures

11 Classification of seizures Seizure Partial Simple 1.Motor 2.Somatosensory 3.Special sensory 4.Autonomic 5.Psychic Complex 1.Simple partial at onset 1.Impairment of consciousness at onset Secondarily Generalized 1.Simple to generalized 2.Complex to generalized 1.Simple to complex to generalized Generalized 1.Absence 2.Myoclonic 3.Clonic 4.Tonic 5.Tonic-clonic 6.Atonic

12 Partial seizures Hemispheric involvement Consciousness Primarily unilateral; often bilateral in course of seizure Impaired Complex partial seizure Unilateral; Bilateral involvement rare Intact Simple partial seizure

13 Several types: 1.With motor signs 2.With somatosensory or special sensory symptoms 3.Seizures with autonomic symptoms 4.With psychic symptoms

14 Simple partial seizures with motor signs  Strictly focal  Spread to contiguous cortical area → sequential involvement of body parts  “Epileptic march” / Jacksonian seizure  Presentations:  Head turns to one side (usually contralateral to discharge)  Speech arrest / vocalization  Epileptic palilalia  Todd’s paralysis  Epilepsia partialis continua

15 Simple partial seizure with somatosensory or special sensory symptoms  Somatosensory  “pins-and-needles / numbness  Proprioception or spatial perception disorders  Special sensory  Visual: flashing lights, structured visual halluncinations  Auditory: crude auditory sensations, highly integrated functions (e.g. music)  Olfactory: unpleasant odours  Gustatory: crude (salty, sour, sweet, bitter), sophisticated (‘metallic’)  Vertiginous: falling in space, floating, totatory vertigo

16 Simple partial seizures with autonomic symptoms  Vomiting  Pallor  Flushing  Sweating  Piloerection  Pupil dilatation  Borborygmi  Incontinence

17 Simple partial seizure with psychic symptoms  Dysphasia: motor, sensory, global aphasia  Dysmnesic: distortion of time sense, deja-vu, jamais-vu, deja-entendu, jamais-entendu, panoramic vision  Cognitive disturbances: dreamy state, distortion of time sense, unreality, depersonalization  Affective: extreme pleasure or displeasure, fear, anger, rage  Illusions: objects appear deformed  Structured hallucination

18 Complex partial seizure  Gradual impairment of consciousness (c.f. abrupt impairment in absence seizures)  Presentations:  Limited to impairment of consciousness  With additional psychic, motor and autonomic symptoms

19 Complex partial seizure - Types Complex partial seizure Temporal Start with an empty stare + Clouding of consciousness ↓ Automatism (oral, mimic, gestural, verbal) Extratemporal Frontal type: Fronto- cingular epilepsy

20 Generalized seizures

21 Absence seizures  Sudden in onset, interruption of ongoing activities, blank stare  Non-responsive  Vanish in second  Atypical  Can associate with other components  Tonus, clonus, automatism

22 Myoclonic seizures  Sudden, brief  Generalized to individual muscle group  Ddx  Spinal cord, brainstem and cortices lesions

23 Clonic seizure  Generalized seizure sine tonic component  Postictal phase is usually short  May progress to tonic phase, clonic-tonic- clonic seizure

24 Tonic seizures  Rigid, violent muscular contraction fixing the limbs in some strained position  Deviated eyes, head towards one side, alteration in posture  Pale, flushed and ultimately livid

25 Tonic-clonic seizures  Vague ill-described warning  Tonic phase:  Sudden, sharp, tonic contraction of muscles (+ stridor), cyanosis  Fall on ground, tongue bitten, urine incontinence  Clonic phase:  Grunting  drooling  Deep respiration, all muscle relax, remain unconscious for variable time,  Awake with soreness and drowsiness, deep sleep

26 Atonic seizures  Sudden reduction in muscle tone  Head drop, slacking of jaw, dropping of limb or slumping to the ground  Drop attack  Ddx: brainstem ischaemia, narcolepsy

27 Part 3: Video Demonstrations

28 CS 2  D:\HMR_ROM1\AVI\CS2.AVI D:\HMR_ROM1\AVI\CS2.AVI

29 CS 2: Simple partial seizure with motor signs and march  No loss of consciousness  Rhythmic twitching of the fingers of the left hand, spreading through arm to shoulder  He held his affected hand  Simple partial seizure with motor signs  Focal

30 CS 12  D:\HMR_ROM1\AVI\CS12.AVI D:\HMR_ROM1\AVI\CS12.AVI

31 CS 12: Simple partial seizure with psychic symptoms and dysphasia  With dysphasic symptoms  Clicking of tongue, mumbling incomprehensible words and smiles  Fully understand commands but unable to speak properly

32 CS 15  D:\HMR_ROM1\AVI\CS15.AVI D:\HMR_ROM1\AVI\CS15.AVI

33 CS 15: Complex partial seizure, simple partial onset, impairment of consciousness  Slight loss of postural tone  Preserved orientation reflex  Impaired consciousness

34 CS 17  Patient was asked to hyperventilate in the beginning  D:\HMR_ROM1\AVI\CS17.AVI D:\HMR_ROM1\AVI\CS17.AVI

35 CS 17: Complex partial seizure vs generalized absence  Patient suddenly stopped hyperventilating  Motionless and blank facial expression  Regain consciousness with told nurse her had vague stomach sensation  EEG: localized right frontal activity pre and postictally favours a partial seizure

36 CS 19  Patient with right frontal ganglioglioma  D:\HMR_ROM1\AVI\CS19.AVI D:\HMR_ROM1\AVI\CS19.AVI

37 CS 19: Complex partial seizure, impairment of consciousness at onset  Sudden sat up and started to roll about  Lying on his belly  Manipulated his genitals (frontal automatism)

38 CS 20  D:\HMR_ROM1\AVI\CS20.AVI D:\HMR_ROM1\AVI\CS20.AVI

39 CS 20: Simple partial seizure with secondary generalization  Left arm started jerking  Still responsive  Coarse jerking of arms, stretching of back, tonic contraction of face, open mouth  Loss of consciousness  Twitching of all limbs and head  Relaxation and postictal sleep

40 CS 23  D:\HMR_ROM1\AVI\CS23.AVI D:\HMR_ROM1\AVI\CS23.AVI

41 CS 23: Typical absence seizure  Slight loss of tone in neck muscle when stop hyperventilation  Seizure started  Mild eyelid clonus  Regain responsiveness later

42 CS 29  D:\HMR_ROM1\AVI\CS29.AVI D:\HMR_ROM1\AVI\CS29.AVI

43 CS 29: Generalized atypical absence seizure  Head drop gradually  Not responsive  Later responded to staff and gradually regain upright position

44 CS 30  D:\HMR_ROM1\AVI\CS30.AVI D:\HMR_ROM1\AVI\CS30.AVI

45 CS 30: Generalized myoclonic seizure  Brief repetitive movements of the limbs

46 CS 32  D:\HMR_ROM1\AVI\CS32.AVI D:\HMR_ROM1\AVI\CS32.AVI

47 CS 32: Generalized clonic seizure  Opening of eyes and massive myoclonic jerks  Continuous clonic movement of limbs  Repetitive vocalization with clonic movement of the chest

48 CS 33  D:\HMR_ROM1\AVI\CS33.AVI D:\HMR_ROM1\AVI\CS33.AVI

49 CS 33: Tonic seizure  Gradual elevation of both hands and stopped walking  Took 2 steps and then passed urine  Bent body strongly forward but kept standing  Dropped handkerchief

50 CS 34  D:\HMR_ROM1\AVI\CS34.AVI D:\HMR_ROM1\AVI\CS34.AVI

51 CS 34: Tonic clonic seizure  Suddenly bent forward with extended arm and legs  Twitching in face and body  Tonic stretching of arms and legs

52 CS 35  D:\HMR_ROM1\AVI\CS35.AVI D:\HMR_ROM1\AVI\CS35.AVI

53 CS 35: Atonic seizures  Sudden relaxation of muscles  Head drop, floppy limbs and slumping to the ground

54 Some more videos if we have time Otherwise, THE END.

55 CS 27  D:\HMR_ROM1\AVI\CS27.AVI D:\HMR_ROM1\AVI\CS27.AVI

56 CS 27: Absence seizure  With automatism  Not necessarily specific for complex partial seizures

57  D:\HMR_ROM1\AVI\CS24.AVI D:\HMR_ROM1\AVI\CS24.AVI

58 Absence with mild clonic component

59  D:\HMR_ROM1\AVI\CS26.AVI D:\HMR_ROM1\AVI\CS26.AVI

60 Absence with tonic component  Head mainly affected

61 CS 3  D:\HMR_ROM1\AVI\CS3.AVI D:\HMR_ROM1\AVI\CS3.AVI

62 CS 3: Partial seizure with motor signs and march  Complex partial seizure → partial motor seizure with secondary generalization  Not a Jacksonian seizure: consciousness was impaired before the march starts

63 CS 4  D:\HMR_ROM1\AVI\CS4.AVI D:\HMR_ROM1\AVI\CS4.AVI

64 CS 4: Simple partial seizure with motor signs and versive movements  Sudden start of seizure from sleep  Version of trunk towards the right  Left arm bent at the elbow, fingers forcefully stretched  Right arm beats on arm of chair to warn nurse  Tonic contraction of face and eyes  EEG: not interpretable due to artifacts (pseudospike waves)

65 CS 13  D:\HMR_ROM1\AVI\CS13.AVI D:\HMR_ROM1\AVI\CS13.AVI

66 CS 13: Simple partial seizure with psychic, dysmnesic and affective symptoms and hallucinations  Happily talking  Deja-vu  Spontaneous hyperventilation  Facial expression of suffering with weeping and crying  No loss of contact; can give age, date and name of objects  Cries and yells; feels very bad and asks for help; weeps – affective sympoms

67 THE END Questions?


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