Department of clinical biochemistry.

University of kashmir.

Presentation on:
Presented by:

Mumtaz.

Epilepsy

Raashid

EPILEPSY

Epilepsy is a brain disorder in which a fit occurs

It is characterized by loss of consciousness

due to disturbance in the electrical

activity of the brain.

which is often accompanied by repeated jerky

movements called convulsion.

Raashid
Mumtaz

ku

2015

Different types of seizures

1.Partial seizure : Its caused by electrical discharge restricted to
limited part of cortex of one cerebral hemisphere.
.Types of partial seizure
A. Simple partial seizures: cause motor, sensory, autonomic, or
psychic symptoms
.Consciousness is not lost during partial seizure.
. Shows jacksonian march i.e. If seizure originates from a restricted
part after then it may spread to the whole part.
B. Complex partial seizure. This type of seizure occurs in temporal
lobe of the brain.

Raashid Mumtaz

ku 2015

. Consciousness is usually lost during this seizure.

.The ictal phase of this type begins with automatism and motionless stare .
.The

behavioural arrest is usually accompanied by automatisms.

Automatisms may consist of very basic behaviours such as chewing, lip

smacking, Crying ,laughing .

C.

Partial Seizures with Secondary Generalization

Partial seizures can spread

produce a generalised seizure.

Raashid Mumtaz ku 2015

to

involve both cerebral hemispheres and

Epileps
y

2.Generalised

seizures

.These seizures involve both sides of the brain.

.There is loss of consciousness and a postictal phase
after the seizures.
Types of generalised
seizure
A. Absence seizures (Petit mal)
.These seizures involves brief, altered loss of
consciousness.
.Persons posture is maintained during the seizure.
.The mouth or face may twitch or the eyes may blink
rapidly.
.No convulsion.
B. Grand mal seizure
.Characterized by sudden loss of consciousness

The body ,arms and legs will contract and straighten out during

tonic phase followed by a clonic period (contraction and relaxation of the

muscles) and postictal period.
.Patient may express loud moan or loud scream also known as ictal cry due to
forcefulness of air expelled from lungs. However during the entire period tongue may
get bitten due to contraction of jaw muscle.
C. Myoclonic seizures
. This type refers to quick movements or sudden jerking of a group of muscles.
. These seizures tend to occur in clusters.
D. Atonic seizure
.With this seizure , there is sudden loss of muscle tone and persons may fall from
standing positions.
.During this seizure , the person is limp and unresponsive.
.No post ictal confusion.

Raashid Mumtaz

ku 2015

Basic mechanism underlying

seizures: Glutamate hypothesis

.Glutamate is the major excitatory neurotransmitter in the brain.

.It has an ionotropic receptor called NMDA.

It is permeable to Na+ and K+ ions.

NMDA receptor also has Ca++ channels that is blocked by Mg ions in the resting

state.

.During depolarisation Mg + is displaced and channel becomes permeable to ca++.

.Influx of ca++ further causes depolarisation and is also thought to contribute ca ++
mediated neuronal injury under conditions of excessive neuronal activation.

Raashid
Mumtaz ku 2015

Glutamate-Glutamine cycle

GABA: Inhibitory role

GABA-A receptors are permeable to Cl- ions; upon

activation Cl-

influx hyperpolarizes the membrane and inhibits action potentials.

Therefore, substances which are GABA-A receptor agonists, such as
barbiturates and benzodiazepines, are well known to suppress seizure
activity.

GABA-B receptors are associated with opening of K+ channels leading

to a hyperpolarizing current. Certain GABA_B agonists, such as baclofen,

have been reported to exacerbate hyperexcitability and seizures.

Raashid Mumtaz

ku 2015

.Causes
The causes of most cases of epilepsy is unknown , although some people develop
epilepsy as the result of:

Brain injury
Brain tumour
Drugs
Alcohol
Hypoglycemia

Symptoms

General symptoms of a seizure are:

Jerking movement of the arms and legs

Loss of consciousness
Appearing confused or in a haze
Periods of rapid eye blinking and staring

Raashid Mumtaz ku 2015

.Diagnosis
Epilepsy is often diagnosed by EEG ,PET scan etc.

Treatment

Anticonvulsants are given:

Anticonvulsants can be divided into large group based on their
mechanism:
.Blockers of repetitive activation of sodium channel.
Phenytoin , Carbamazepine
.Enhancers of slow inactivation of sodium channel.
Cosamide , Rufinamide

people who are not benefited or whose seizures are

not being
well controlled with seizure medication may
benefit from a procedure called vagus nerve
stimulation.

Raashid Mumtaz

ku 2015

Thank you.