1. Seizures
Dr.Nathasha Luke

2. Overview Definition Classification Clinical Features
Differential Diagnosis
Treatment
Cases

3. Brain Electrical activity Neurotransmitters
Balance of electrical activity

4. Definitions
Seizure: episode of abnormal neurologic function caused by inappropriate electrical discharge of brain neurons.
Epilepsy: clinical condition in which an individual is subject to recurrent seizures.

6. Generalized Seizures
Caused by a activation of the entire cerebral cortex

7. Partial seizures
Due to electrical discharges in a localized structural lesion of the brain.
Affects whatever physical or mental activity that area controls.

8. Partial (focal) seizures
Simple partial no alteration of consciousness
Complex partial consciousness impaired
Partial seizures (simple or complex) with secondary generalization

9. Classification of Seizures
Generalized seizures (consciousness always lost)
Tonic clonic seizures (grand mal)
Absence seizures (petit mal)
Myclonic seizure
Clonic seizures
Atonic seizures

10. Seizures can occur
Due to epilepsy
Due to secondary causes

11. Causes: secondary seizures
Trauma (recent or remote)
Intracranial hemorrhage
Eclampsia-increased blood pressure in pregnancy causing fits
Hypertensive encephalopathy
Structural abnormalities
Vascular lesion (aneurysm, AV malformation)
Mass lesion
Degenerative disease
Congenital abnormalities

12. Causes: secondary seizures
Toxins and drugs
Anoxic brain injury
Metabolic disturbances
Hypo or hyperglycemia
Hypo or hypernatremia
Hyperosmolar states
Uremia
Hepatic failure
Hypocalcemia, hypomagnesemia (rare)

14. Features: Tonic clonic seizures
Abrupt loss of consciousness and loss of postural tone
May then become rigid
With extension of the trunk and extremities
Apnea
Cyanosis
Urinary incontinence

15. Features: tonic clonic seizures
As the tonic (rigid) phase subsides, clonic (symmetric rhythmic) jerking of the trunk and extremities develop
Episode lasts from seconds
Consciousness returns gradually
Postictal confusion may persist for several hours

18. Features : absence seizures
Brief, usually lasting only a few seconds.
Loss of consciousness without losing postural tone.
Appear confused or withdrawn, and current activity ceases.
May stare and have twitching of their eyelids.
Do not respond to voice or other stimulation
Are not incontinent.
End abruptly, and there is no postictal confusion

19. Absence seizures Common in children
May keep on repeatedly asking what was said
School children may present with poor school performance
May get even or more than 50 episodes a day

21. Myoclonic seizures
Brief, shock-like jerks of a muscle or a group of muscles. "Myo" means muscle and "clonus" means rapidly alternating contraction and relaxation—jerking or twitching—of a muscle.

23. Simple partial seizures
Remain localized and consciousness is not affected.

24. Clinical features of simple partial
Remain localized and consciousness is not affected.
types
Unilateral tonic or clonic movements limited to one extremity suggest a focus in the motor cortex, while tonic deviation of the head and eyes suggest a front lobe focus.
Visual symptoms often result from an occipital focus, while olfactory or gustatory hallucinations may arise from the medial temporal lobe
Sensory phenomena, or aura are often the initial symptoms of attacks.

25. Complex partial seizures
These seizures usually start in a small area of the brain. They quickly involve other areas of the brain that affect alertness and awareness. So even though the person's eyes are open their consciousness is lost
Some people can have seizures of this kind without realizing that anything has happened.
Some of these seizures start with an aura, a warning sign.
Examples for Auras
odd feeling in the stomach
move their mouth, pick at the air or their clothing/ perform other purposeless actions.
repeat words or phrases, laugh, scream, or cry.
Déjà vu and jamais vu

26. Differential diagnosis-what can mimic seizures
Syncope
Complex migraine
Movement disorders
Narcolepsy
Pseudo-seizures

27. Investigations
EEG
Can record the abnormal electrical activity of the brain
Can confirm the diagnosis of fits and identify the type of fits
However a normal EEG cant exclude the diagnosis of fits

29. Other investigations
Particularly important in looking for a secondary cause
Blood glucose
Electrolytes
Renal and liver functions
Full blood count LP
CT and MRI scans

30. Management- first aid
Note duration of fits

31. Most fits subside spontaneously with out treatment
Rarely fits can be prolonged and in this case treatment is needed

32. Treatment: Airway:
Oxygen
Maintain airway

33. Treatment: Breathing: Circulation: IV access
Suction
Circulation: IV access
IV glucose if confirmed hypoglycemia

34. First Line Medication: Benzodiazepines
Ex-Midazolam
Diazepam
If not resolving can give other drugs

35. For unresolving fits:
ICU Care and General anesthesia

36. Why are fits bad?
Prolonged fit can cause permanent brain damage…

37. How to treat epilepsy They are given anti epileptic drugs
Ex- carbamezapine
They have to be on long term treatment
Special advice given regarding
-treatment
-what to do when fitting
-advice for safety

38. Status epilepticus
Continuous seizure activity lasting for at least 30 min Or
Two or more seizures without intervening return of conciousness

39. Seizures in children
Fits are commoner in children with underlying brain abnormality and those who have suffered ischemic injury at birth.
Simple febrile convulsions occur in 3-4% of children and this is the commonest cause of fits in childhood

40. Febrile seizures: Fits occurring with fever
In children Aged 3 month to 5 years
Family history increases risk.
Usually occurs when fever is rising
IT is extremely important to exclude brain infection in children who have fever with fits
Most children become free of fits as they grow up

41. Febrile seizures Managed by finding cause and treating fever
Parents should be reassured and given information about febrile fits
They must be told about the first aid measures

42. Questions??