EPILEPSY final.pptx

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    EPILEPSY/

    STATUS EPILEPTICUS

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    EPILEPSY

    Epilepsy is a paroxysmalneurological disorder and ischaracterized by recurrent episodesof convulsive movements or other

    motor activity, loss of consciousness,sensory disturbances, and otherbehavioral abnormalities.

    Because epilepsy occurs

    in more than 50 diseases,it is considered a syndromerather than a disease.

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    Convulsive seizures are the most common

    forms of attacks of epilepsy. Seizures occurwith abnormal electrical discharges from brain

    cells, and these discharges are caused by the

    movement of ions across the cell membrane.

    Although seizures are the dominant

    manifestation of epilepsy, patients can

    have a seizure and not have epilepsy.

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    Status epilepticusis a clinical or electricalseizure lasting at least 30 minutes, or a series

    of seizures without complete recovery over

    the same period of time.Pseudoseizures are the physical

    appearance of seizure activity without the

    cerebral electrical activity.

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    CAUSESA. Central nervous system (CNS) disorders

    1. potential mass effect (tumor, abscess, atrioventricular malformation,aneurysm, or hematoma)

    2. strokes, especially those that are embolic.

    B. Metabolic or systemic disorders

    1. acute overdose

    2. acute drug withdrawal (especially CNS depressants, alcohol,

    benzodiazepines, and barbiturates)

    3. febrile states

    4. Hypoxia

    5. Hyperosmolarity6. hypertensive encephalopathy

    7. Hyperthermia

    8. electrolyte disturbances

    C. Idiopathic origins

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    classifications

    I. PARTIAL (FOCAL, LOCAL)

    SEIZURES

    A. Simple partial seizures: No

    impairment of consciousness

    B. Complex partial seizures:

    Impaired consciousness,

    frequently include automatisms C. Partial seizures that

    secondarily generalize

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    II. SEIZURES: All have impairment of

    consciousness

    A. Absence (previously known as petitmal) of blank stare; generally in

    children

    B. Myoclonic seizures: Short, abrupt

    muscular contractions

    C. Clonic seizures: Muscle contractionand relaxation

    D. Tonic seizures: Abrupt increase in

    muscle tone

    E. Tonic-clonic seizures (previouslyknown as grand mal): quick, bilateral,

    severe jerking movements

    F. Atonic seizures (drop attacks):

    Abrupt loss of muscle

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    III. Unclassified epileptic seizures: Inadequate

    or incomplete data to identify classification

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    DIAGNOSTICS HIGHLIGHTSTest Normal

    Result

    Abnormality with

    Condition

    Explanation

    Magneticresonance

    imaging

    (MRI)

    Normalbrain

    structures

    Assesses the centralnervous system for

    changes in brain

    structure

    such as atrophy of

    certain areas or brain

    tumors

    Structural brain changes such assclerosis, tumors, infarcts, or atrophy

    can lead to seizures

    Electro-

    encephalo-

    gram

    (EEG)

    Normal

    patterns

    of

    electrical

    activity

    Assesses the central

    nervous system for

    changes in brain

    structure

    such as atrophy of

    certain areas or brain

    tumors

    Recording of electrical potentials

    based on distribution of waveforms

    generated by cerebral cortex

    of brain; waveforms demonstrate

    abnormal patterns during

    seizures; they are not useful inthe acute management of status

    epilepticus

    Other Tests: Computed tomography (CT) scans, positron emission tomography (PET),

    and skull x-rays; serum laboratory data to explore possible causes include glucose;

    calcium; blood urea nitrogen (BUN); and electrolyte, toxic, and metabolic screens

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    DIAGNOSTICS HIGHLIGHTS

    Medicatio

    n or

    Drug Class

    Dosage Description Rationale

    Anticonv

    ulsants

    Varies

    with

    drug

    Multiple drug

    therapies

    are available:

    Phenytoin

    sodium

    (Dilantin),

    phenobarbitol,

    lorazepam

    (Ativan),diazepam

    (Valium).

    Lorazepam (Ativan) or diazepam

    (Valium) may be used to stop seizures

    quickly. Phenytoin (Dilantin) is

    preferred

    maintenance anticonvulsant for

    status

    epilepticus. A newer drug,

    fosphenytoin

    (Cerebyx), has been developedthat is safer for parenteral

    administration.

    Phenobarbitol may be given if

    seizures occur after phenytoin

    loading.

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    Other: Thiamine 100 mg and 50 ml of 50% dextrose inwater may be administered in an emergency to rule

    out seizures because of thiamine deficiency orhypoglycemia.

    Other Information about Anticonvulsants: The primarytreatment for epilepsy is one or more of the multitudeof antiepileptic drugs (AED) or anticonvulsants. Thechoice of AED or combination of AEDs depends onseizure type, patient tolerance, and cost.

    Carbamazepine (Tegretol) is a widely used andcost-effective anticonvulsant. Valproic acid, primidone

    (Mysoline), clonazepam, and ethosuximide areprescribed, depending on the seizure type. Lamotrigine(Lamictal) is a new AED approved as adjunctive therapyand single therapy for partial seizures.

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    Surgical Treatment

    1. A proportion of the pts with intractable epilepsywill benefit from surgery.

    2. Epilepsy surgery procedures: Curative (removalof epileptic focus) and palliative (seizure-related

    risk decrease and improvement of the QOL)3. Curative (resective) procedures: Anteromesial

    temporal resection, selectiveamygdalohippocampectomy, extensive

    lesionectomy, cortical resection,hemispherectomy.

    4. Palliative procedures: Corpus callosotomy andVagal nerve stimulation (VNS).

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    STATUS EPILEPTICUS

    SE is a common medical and one of the

    most serious neurological emergency

    associated with high mortality and morbidity.

    SE refers to a condition in which there is a

    failure of the normal factors that serve to

    terminate a typical seizure. SE may be

    classifies based solely on the presence orabsence of convulsions into convulsive SE

    (CSE) and non-convulsive SE (NCSE).

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    ALGORITHM FOR TREATMENT OF

    CONVULSIVE STATUS EPILEPTICUS

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    fin.