1. DR ZULFIQAR ALI RIZVI
CONSULTANT PSYCHIATRIST
PIMH LAHORE

2. Changing concepts of EPILEPSY from ancient times to 21st century
What can be the biggest desire of patients suffering from epilepsy?
Who will help me back from exclusion to inclusion in society?
YES, IT IS
Our Executive director Dr Nusrat Habib Rana, with the team of Doctors of PIMH, Lahore have raised their hands and taken responsibility to create awareness about epilepsy and bring epilepsy patients back in society with sense of dignity and respect.

3. Epilepsy is one of the oldest disorders known to mankind
Epilepsy is one of the oldest disorders known to mankind. Over 50 million people worldwide.
No racial, social, cultural, economical ethnic and geographical boundaries.
In ancient times, associated with religious experiences and demonic possessions.
Hippocrates ( Greek Physician 500 BC) wrote the first book about epilepsy.
Saint Cyriakus

4. Actually what epilepsy is?
In 17th and 18th century,
In 20th century,
21st century and concept of epilepsy:.
Actually what epilepsy is?
Epilepsy is a neurological condition with tendency to recurrent seizures. At least two unprovoked seizures:
24 hours apart,
of cerebral origin
are necessary to make a diagnosis of epilepsy.

5. ETIOLOGY Life time prevalence of seizures: 5-10 %.
Prevalence of active epilepsy 1-2%.
ETIOLOGY
: About percent (two third) idiopathic
It is more common in 2-14 years age group
In symptomatic cases, one can find physical basis of seizures:
Younger and early adulthood patients:
Adults and elderly:

6. Pathophysiology
Multifactorial. Determining factor is the result of interaction between genetically determined seizure threshold, underlying pathological and metabolic conditions, and acute precipitating factors.

7. Reflex seizures Caused by certain stimuli in predisposed persons.
Precipitating stimuli for reflex seizures:
Visual stimuli- flickering light
Thinking
Music - certain frequencies
Reading

8. CLASSIFICATION The ILAE classification Partial-onset seizures
Generalized-onset seizures.

12. Generalized-onset Tonic-clonic seizures (grand mal) lasts 1-2 min
Absence seizures ( petit mal ) (10-30 seconds) with no postictal symptoms.
Clonic involve tonic clonic contractions.
Myoclonic
Tonic seizures( sustained contractions ) last sec.
Atonic
Partial onset
Simple partial
Complex partial

13. The origin of symptoms and signs in focal seizures

14. DIAGNOSIS 1)History and clinical findings 2)Physical evaluation.
3) Electroencephalography:
4) Lab Studies :
5) CT SCAN:.
6) MRI:
7)PET scanning

15. Principal of treatment
New cases, 2/3 of cases go into spontaneous remission. Only 1/3 of cases will have 2nd seizure in next 5 years
If left untreated, about 75% cases show 2nd seizure
A single drug, controls 60%.
If seizures are difficult to control ( in 30-40% ) , 2 or > 2 drugs may be required.
In intractable cases ( refractory) 20% 2 or > drugs.

16. Drug treatment 1) Primary generalized tonic-clonic seizures
First-line monotherapy
Carbamazepine
Phenytoin
Valproate ( epival )
Topiramate ( topamax )
2nd-line monotherapy or adjunctive therapy
Lamotrigine
Levetiracetam ( lerace )

17. 2) Partial seizures with or without secondary generalizations
First-line monotherapy
Carbamazepine( seiznil)
Lamotrigine ( lojin )
Oxcarbazepine (oxalepsy )
Topiramate
Levetiracetam
2nd-line monotherapy or adjunctive therapy
Gabapentin ( neogab )
Pregabalin
Valproate
3rd-line monotherapy or adjunctive therapy
Felbamate
Vigabatrin

18. 3) Absence seizures First-line monotherapy Ethosuximide Lamotrigine
Valproate
2nd-line monotherapy
Levetiracetam
Topiramate

19. MESSAGE
Epilepsy has nothing to do with mental disease or retardation. This has been proved beyond all doubt by the "epileptic geniuses", people who achieved great things in spite of suffering from epilepsy.

20. G. Julius Caesar Roman Statesman
Margaux Hemingway American Actress
G. Julius Caesar Roman Statesman
Alexander the Great Macedonian King
Alfred Nobel Swedish Chemist