Pemicu 1 Neurology

Charlie 405100005
 Seizures
All paroxysmal electrical discharges of the
brain
Epilepsy recurrent unprovoked seizures
 Partial focal or localized onset
Simple conscious
Complex consciousness impaired
Generalized seizures appear to begin
bilaterally
Convulsive tonic-clonic (grand mal)
Primary widespread EEG abnormalities at the onset
Secondary begins as a focal/partial generalized
Non-convulsive absence (petit mal)
 Grand mal
Initial motor signs tonic phase clonic
phase terminal phase
Initial motor Tonic phase Clonic phase Terminal
Brief flex of trunk Protracted Mild generalized All movements
extension tremor ended
Opening mouth & Start from back Repetitive Pupils reactive to
eyelids and neck relaxation of the lights,
tonic contraction
Upward deviation Arms and legs 8mps 4mps Breathing quiet or
of eyes brief violent flexor stertorous
Arms elevated May be a piercing Face violaceous After opening his
and abducted cry and grimace eyes, look
confused
Elbows semiflexed Breathing Rapid pulse, high sometimes,
suspended, skin BP, dilated pup, becomes drowsy
and lips cyanotic salivation and and fall asleep.
sweating
Hands pronated Pupils dilated, About 30s, A sore, bitten
unreactive to remains apneu tongue, aching
light, last 10-20s during, muscles
 Petit mal
Brevity
Paucity of motor activity
Frequency ( child > juvenile )
Myoclonic movement of eyelids, facial muscles, or
fingers or small synchronous movement of both
arms, all at rate of 3mps
They dont fall
Last 2-10s or longer then resumes their activity
 Lennox-Gastaut Syndrome
onset between 2 and 6 years of age
atonic, or astatic, seizures (i.e., falling attacks),
often succeeded by various combinations of minor
motor, tonic-clonic, and partial seizures
progressive intellectual impairment
slow (1- to 2-Hz) spike-and-wave EEG pattern
Prematurity, perinatal injury, and metabolic
diseases of infancy are the most common
underlying conditions
 Focal or partial
often the product of a demonstrable focal
lesion or EEG abnormality in some part of the
cerebral cortex
Simple partial seizures most often arise from
foci in the sensorimotor cortex
Complex partial seizures most often have their
focus in the temporal lobe on one side or the
other, but a frontal localization is also well
known
 Frontal Lobe Partial Seizures (Focal
Motor)
a turning movement of the head and eyes to
the side opposite the irritative focus
often associated with a tonic contraction of
the trunk and limbs on that side
Seizures that begin with forceful, sustained
deviation of the head and eyes, and
sometimes of the entire body contraversive
and ipsiversive
 Jacksonian
begins with a tonic contraction of the fingers of one
hand, the face on one side, or the muscles of one foot
movements may remain localized or spread (march)
from the part first affected to other muscles on the
same side of the body
Consciousness is not lost if the sensorimotor
symptoms remain confined to one side
transient paralysis of the affected limbs Todds
paralysis persists for minutes or at times for hours
after the seizure
 Somatosensory, Visual, and Other
Types of Sensory Seizures
indicative of a focus in or near the
postrolandic convolution of the opposite
cerebral hemisphere
described as numbness, tingling, pins-and-
needles feeling and occasionally as a
sensation of crawling (formication), electricity,
or movement of the part
 Visual seizures visual sensations of darkness or sparks and flashes
of light
Gowers red, followed by blue, green, and yellow
Auditory hallucinations buzzing or roaring
Vertiginous sensations vertigo is followed by an auditory sensation
Olfactory hallucinations perceived odor is exteriorized, i.e.,
projected to someplace in the environment, and is described as
disagreeable or foul
Gustatory hallucinations salivation and a sensation of thirst may be
associated
 Complex Partial Seizures (Psychomotor
Seizures, Temporal Lobe Seizures)
the aura (i.e., the initial event in the seizure)
may be either a focal seizure of simple type or
a hallucination or perceptual illusion,
indicating (usually) a temporal lobe origin
instead of a complete loss of control of
thought and action, there is a period of
altered behavior and consciousness, for which
the patient is later found to be amnesic.
 violence and aggression that are said to
characterize patients with temporal lobe
seizures usually take this form of nondirected
oppositional resistance in response to
restraint during the period of automatic
behavior
Etiology
 SPECIAL EPILEPTIC SYNDROMES
Benign Childhood Epilepsy with Centrotemporal
Spikes (Rolandic Epilepsy, Sylvian Epilepsy) and
Epilepsy with Occipital Spikes
Infantile Spasms (West Syndrome)
Febrile Seizures
Reflex Epilepsy
Epilepsia Partialis Continua
Hysterical Seizures
 Hysterical Seizures
psychogenic not caused by an abnormal neuronal
discharge
symptom of hysteria in the female (Briquet disease) sham
seizures and pseudoseizures
completely asynchronous thrashing of the limbs and repeated
side-to-side movements of the head; striking out at a person
who is trying to restrain the patient; hand-biting, kicking,
trembling, and quivering; pelvic thrusting and opisthotonic
arching postures; and screaming or talking during the ictus
 tend to occur in the presence of other people
precipitated by emotional factors
tongue-biting, incontinence, hurtful falls, or
postictal confusion are lacking
serum creatine kinase and prolactin levels are
normal after hysterical seizures distinguish
between the real convulsion
 Epilepsia Partialis Continua
persistent rhythmic clonic movements of one
muscle group
fairly regular intervals every few seconds and
continue for hours, days, weeks, or months
without spreading to other parts of the body
 Reflex Epilepsy
Forster has classified these seizures in accordance with
their evocative stimuli into five types :
visualflickering light, visual patterns, and specific colors
(especially red), leading to rapid blinking or eye closure
auditorysudden unexpected noise (startle), specific
sounds, musical themes, and voices
somatosensoryeither a brisk unexpected tap or sudden
movement after sitting or lying still, or a prolonged tactile or
thermal stimulus to a certain part of the body
writing or reading of words or numbers
eating
 Infantile Spasms (West Syndrome)
most cases appears during the first year of life
Char:
recurrent, single or brief episodes of gross flexion movements of
the trunk and limbs and, less frequently, by extension movements
child matures seizures diminish (disappear by the fourth
to fifth year)
hypsarryhtmia
treatment with ACTH, corticosteroids, or clonazepam
apparently normal when the seizures mentally impaired.
Infantile spasms part of the Lennox-Gastaut syndrome
 Pathology of Epilepsy
secondary epilepsies definable lesions
zones of neuronal loss and gliosis (scars)
Porencephaly
Heterotopia
dysgenetic cortex
Hamartoma
vascular malformation
Tumor
 Treatment
Antiepileptic drugs
Surgical excision of epileptic foci and other
surgical measures
Removal of causative and precipitating factor
Regulation of physical and mental activity
 Status Epilepticus
Recurrent generalized convulsions at a
frequency that prevents regaining of
consciousness in the interval between seizures
(grand mal status)
Life threatening sequences Hyperthermia,
acidosis, hypotension, and renal failure from
myoblobinuria
Treatment
 nonconvulsive status epilepticus and epilepsia
partialis continua trials of sequential oral or
sometimes parenteral AEDs without resorting
to barbiturate coma or overmedication that
could result in respiratory compromise
 Ketogenic Diet
Lefevre and Aronson
can be effective in refractory cases of epilepsy in
childhood
some benefit persists even after the diet has been
stopped
 Regulation of Physical and Mental
Activity
Oversolicitude and overprotection should be
discouraged
moderate amount of physical exercise is
desirable
a person with incompletely controlled epilepsy
should not be allowed to drive an automobile,
operate unguarded machinery, climb ladders,
or take tub baths behind locked doors
 Febrile Seizures
seizures that occur between the age of 6 and
60 mo with a temperature of 38C or higher,
not the result of central nervous system
infection or any metabolic imbalance
that occur in the absence of a history of prior
afebrile seizures.
 Classification
simple febrile seizure
primary generalized tonic-clonic
attack associated with fever, lasting for a maximum
of 15 min, and not recurrent within a 24-hour period
Complex febrile seizure
prolonged (>15 min), is focal, and/or recurs within 24
hr
Febrile status epilepticus
febrile seizure lasting >30 min
 generalized epilepsy with febrile seizures plus
(GEFS+)
Onset early childhood, remission mid-childhood
Multiple febrile seizures and several types of
afebrile generalized seizures, including generalized
tonic-clonic, absence, myoclonic, atonic, or
myoclonic astatic seizures with variable degrees of
severity
 Dravet syndrome
onset is in the 1st yr of life
febrile and afebrile unilateral clonic seizures recurring
every 1 or 2 mo
more prolonged, are more frequent, and come in clusters
subsequently start to occur with lower fevers and then
without fever
2nd yr of life, myoclonus, atypical absences, and partial
seizures occur frequently and developmental delay
usually follows.
Risk Factor
 Febrile seizures often occur in the context of
otitis media, roseola and human herpesvirus 6
(HHV6) infection, shigella, or similar infections,
 seizure lasts for >5 min, then acute treatment
with diazepam (pr),
lorazepam, or midazolam is needed
Iron deficiency has been shown to be
associated with an increased risk of febrile
seizures