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EPILEPSY

Epilepsy is a group of neurological diseases characterized by epileptic seizures due


to abnormal excessive brain activity
Epilepsy is a central nervous system disorder (neurological disorder) in which nerve
cell activity in the brain becomes disrupted, causing seizures or periods of unusual
behavior, sensations and sometimes loss of consciousness.

ETIOLOGY:
epilepsy is caused by abnormal activity in brain cells,or produce by abnormal
discharges of neurons that may be cause by any pathological process that affects
the brain include:
Genetic influence
Head trauma. Head trauma as a result of a car accident or other traumatic injury
can cause epilepsy.
Brain conditions. Brain conditions that cause damage to the brain, such as brain
tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults
older than age 35.
Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral
encephalitis, can cause epilepsy.
Prenatal injury. Before birth, babies are sensitive to brain damage that could be
caused by several factors, such as an infection in the mother, poor nutrition or
oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
Hormonal change during pregnancy
CNS infection
Systemic metabolite disorder or electrolyte imbalance
Cerebrovascular disease
Alcohol abuse

SYMPTOMES:
Loss of consciousness
Temporary confusion
A staring spell
Uncontrollable jerking movements of the arms and legs
Psychic symptoms

PATHOPHYSIOLOGY:
A variety of different electrical or chemical stimuli can easily give rise to a seizure
in any normal brain

Neurons are interconnected in a complex network in which each individual neuron is


linked through synapses with hundreds of others
A small electric current is discharged by neurons to release neurotransmitters at
synaptic level to permit communication with each other
Neurotransmitter fall into two categories inhibitory or excitatory
Therefore a neuron discharge can excite or inhibit neurons connected to it .in this
manner information is conveyed transmitted and processed through out the CNS
If neurons are injured .damaged. or suffer a chemical or metabolic insult .a change
in the discharge pattern my develop
In case of epilepsy regular frequency discharge are replace by burst of hight
frequency discharge usually followed by periods of inactivity
There are multiple mechanisms that might contribute to synchronous
hyperexcitability including
Alteration in the distribution .number or type or biophysical properties of ion
channels in neurons cell
Biochemical modification of receptor
Change in extracellular ion concentration
Alteration in neurotransmitter uptake and metabolism in neurons cells
Imbalances between excitatory and inhibitory neurotransmitter

Seizures classification:
Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain,
they're called focal (partial) seizures. These seizures fall into two categories.

Focal seizures without loss of consciousness (simple partial seizures). These


seizures don't cause a loss of consciousness. They may alter emotions or change
the way things look, smell, feel, taste or sound. They may also result in involuntary
jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms
such as tingling, dizziness and flashing lights.
Focal dyscognitive seizures (complex partial seizures). These seizures involve a
change or loss of consciousness or awareness. During a complex partial seizure, you
may stare into space and not respond normally to your environment or perform
repetitive movements, such as hand rubbing, chewing, swallowing or walking in
circles.
Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures.
Six types of generalized seizures exist.

Absence seizures. Absence seizures, previously known as petit mal seizures, often
occur in children and are characterized by staring into space or subtle body
movements such as eye blinking or lip smacking. These seizures may occur in
clusters and cause a brief loss of awareness.
Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures
usually affect muscles in your back, arms and legs and may cause you to fall to the
ground.
Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle
control, which may cause you to suddenly collapse or fall down.
Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking
muscle movements. These seizures usually affect the neck, face and arms.
Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or
twitches of your arms and legs.
Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures,
are the most dramatic type of epileptic seizure and can cause an abrupt loss of
consciousness, body stiffening and shaking, and sometimes loss of bladder control
or biting your tongue.
Seizures are classified into two basic groups, partial and generalized
Partial seizures involve only a portion of the brain at the onset. They can be further
divided into two types:
simple partial, in which consciousness is not impaired
complex partial, in which consciousness is impaired
International Classification of Epileptic Seizures
I. Partial seizures
A.Simple partial seizures
1. With motor signs
2. With somatosensory or special-sensory symptoms
3. With autonomic symptoms or signs
4. With psychic symptoms
B. Complex partial seizures
1. Simple partial seizures at onset, followed by impairment of consciousness
a. With simple partial features
b. With automatisms

2. With impairment of consciousness at onset


a. With impairment of consciousness only
b. With automatisms
II. Generalized seizures
1. Absence seizures
2. Myoclonic seizures
3. Clonic seizures
4. Tonic seizures
5. Tonic-clonic seizures
6. Atonic seizures

DIAGNOSIS:
Electroencephalography (EEG) is an electrophysiological monitoring method to
record electrical activity of the brain.
Diagnostic imaging by CT scan and MRI
the testing of electrolyte, blood glucose and calcium level
Neurological examination.
Blood tests. Your doctor may take a blood sample to check for signs of infections,
genetic conditions or other conditions that may be associated with seizures.
Functional MRI (fMRI). A functional MRI measures the changes in blood flow that
occur when specific parts of your brain are working
Positron emission tomography (PET). PET scans use a small amount of low-dose
radioactive material that's injected into a vein to help visualize active areas of the
brain and detect abnormalities.

PHARMACOLOGICAL TREATMENT:
1:CLONAZAPAM
its ability to enhance the activity of gamma aminobutyric acid (GABA), the major
inhibitory neurotransmitter in the central nervous system.
Dose:0.5_5mg/day
2:VALPROIC ACID
increased brain concentrations of gamma-aminobutyric acid (GABA).and na channel
inactivation
Dose:2_2.5g/day
3:LAMOTRIGINE:
It is na channel inactivation

Dose :100_500mg/day
4:VIGABATRIN:
Inhibition GABA transaminase
Dose :2_4g/day
5:GABAPENTINE:
It is GABA agonist
Dose:100_400mg/day
6:PHENOBARBITONE
DOSE :60_120mg/day
6:PRIMIDONE
Convert in liver to phenobarbitone
100_200mg/day
7:PHENYTOIN
DOSE:5mg/kg/day
8:CARBAMAZEPINE
NA channel inactivation
Dose:200_600mg/day
9:ETHOSUXIMIDE:
Dose:500-1500mg/day