Definitie

• Reprezinta o boala cronica sau un grup de

boli cronice caracterizate prin aparitia de
crize recurente, neprevazute si de obicei
neprovocate.

• O criza de epilepsie este generata de o

descarcare electrica sincrona a creierului.
 Etiologie
• Idiopatica – conditionata genetic
• Secundara:
– Traumatisme
– Tumori
– A.V.C.
– Infectii
– Boli degenerative
 Canale ionice
• Canalele ionice sunt constituite din proteine care
formeaza pori la nivelul membranei celulare si
permit trecerea selectiva a anumitor ioni (Na, Ca, K,
Cl) contribuind astfel la mentinerea diferentei de
potential intra- extracelular si formarea curentilor
electrici transmembranari.

• Canalele ionice au deasemenea rol in semnalizarea

intercelulara, transportul transmembranar, reglarea
ph-ului si a volumului celular.
Canalul de Calciu
Canalul de Sodiu

Na channel
Canalul de Potasiu
 Clasificare
Partiale (focale) Generalizate
• Simple • Tonice
– Motorii • Atonice
– Senzitive • Clonice
– Vegetative • Tonico-clonice
– Psihice • Mioclonice
• Complexe • Absente
• Secundar generalizate Neclasificabile

International Classification of Seizures (ILAE, Epilepsia 1981)

 Epilepsy Primary Generalized Epilepsy Focal or Partial
Seizure Features
Auras Not present Present
Prodrome Occasionally present Occasionally present
Starting with LOC Present Present
Starting with automatisms Not usually present Present
Prolonged postical confusion
Not usually present Present
without generalization
Generalized tonic-clonic seizure Present Present
True versive head movements Not present Present
Focal motor clonic or
Not usually present Present
tonic seizures
Risk Factors for Epilepsy
Family history of seizures May be present Not usually present
History of CNS infections, head
truama, febrile seizures, CNS Not usually present May be present
tumors, vascular malformation
Examination Findings
Neurologic examination Usually normal May be abnormal
Neuroimaging Findings
Brain MRI Usually normal May be abnormal
EEG Findings
Generalized epileptiform activity
Copyright 2002 The Cleveland Clinic Foundation
Present Not present
Return to Epilepsy Article
• Epileptogeneza

• Descarcarea
anormala are ca
punct de plecare o
zona bine delimitata
– focar epileptic.
 Investigatii
• Electroencefalografia – analiza spectrala
• Computer Tomografia cerebrala (CT)
• Imageria prin rezonanta magnetica (IRM)
• Tehnici de imagerie functionala:
– PET
– fMRI
– SPECT
• Magnetoencefalografia
• Monitorizarea video - EEG
EEG - normal
Complexe virf-unda
fMRI
PET
 Magneto-
encefalograf
 Crize generalizate
• Crizele Grand Mal
• Crizele de absenta
• Crize tonice
• Crize atone
• Crize mioclonice
Epilepsia Grand Mal
Crizele de absenta
 Crize partiale motorii
• Crize somatice motorii (clonii pe jumatate
de corp)
• Crize Jacksoniene motorii
• Crize oculocefalogire
• Crize adversive
• Crize de arie motorie suplimentara
(vocalizari si contractiile membrelor)
• Crize tonice
• Crize miotonice
 Crize partiale senzitive
• Crize Jacksoniene senzitive
• Crize vizuale
• Crize auditive
• Crize vestibulare
• Crize olfactive si gustative
• Crize vegetative
 Crize partiale complexe
Afectarea ariilor de asociatie:
• Alterarea partiala a starii de constienta
• Starea de vis,
• Déjà vu,
• Jamais vu
• Crize de furie, frica, bucurie…
Crize partiale motorii si senzitive
Crize partiale complexe
• Medicamentos
• Dieta cetogena
• Chirurgical
• Stimulare vagala
 Principii de tratament
• Monoterapie
• Politerapie
• Titrare
• Oprirea medicatiei
Medicamente eficiente in crizele de
absenta

• Etosuximida
• Oxazolidindiona
 Medicamente eficiente in toate
crizele cu exceptia absentelor

• Fenobarbital
• Fenitoin
• Carbamaxepin
• Primidon
 Medicamente eficiente in toate
tipurile de crize

• Valproat de sodiu
• Clonazepam
 Status epileptic
• Crize subintrante
• Tratament injectabil cu :
– Clonazepam
– Diazepam
– Fenitoin
 Antiepileptice: Spectru de
activitate
Spectru larg Spectru ingust

• Sodium valproate • Phenytoin

• Levetiracetam • Carbamazepine
• Phenobarbital • Ethosuximide
• Benzodiazepines • Gabapentin
• Topiramate • Oxcarbazepine
• Lamotrigine • Tiagabine
• Zonisamide* • Pregabalin

* Based on preliminary evidence

 Antiepileptice moderne
• Topiramat • Gabapentin
• Vigabatrin • Pregabalin
• Oxcarbazepina • Tiagabin
• Lamotrigina • Levetiracetam
• Clobazam • Zonisamid
Efecte secundare ale tratamentului
antiepileptic
• Hipertrofie gingivala
• Hirsutism
• Ovar polichistic
• Carente de folat
• Boala Dupuytren
• Modificari ale metabolismului osos
 Tratament chirurgical
• Rezectia focarului epileptic
• Lobectomie
• Hemisferectomie
• Calosotomie
Stimularea vagala
• Electrozii de stimulare
sunt atasati pe nervul
vag
• Stimularea se face
intermitent
• Indicat in forme de
epilepsie refractara
 Particularitati
• Conducerea autovehiculelor
• Sporturi cu risc
• Anumite profesii
• Sarcina si alaptarea
 “People with epilepsy have
excelled in every area.”
Napoleon
Bonaparte

G. Julius
Caesar
Sokrates Gustave Flaubert

Hermann von Alfred Nobel

Helmholtz Margaux Jeanne d'Arc Lord Byron
Hemingway

Wladimir Iljitsch F.M. Dostojewskij

Vincent van Gogh Lenin
Kardinal Richelieu