Jesly Problem 3A KGD

8/18/2019 Jesly Problem 3A KGD

1/27

PROBLEM 3A JESLY CHARLIES405100171

Group 10, Emergency Medicine Block


2/27

Emergencie!!!

• "ei#ure $ecome emergencie %&en '• (n indi)idu(l i ei*&er in d(nger o+ &(rming *&emel)e

• ei#ure con*inue +or ( long period o+ *ime

immedi(*e medic(l (**en*ion i nece(ry


3/27


4/27

Roo, (ren L 6eurology Emergency

• Early / impending status epilepticus• con*inuou or in*ermi**en* ei#ure l(*ing more *&(n 5

min, %i*&ou* +ull reco)ery o+ concioune $e*%eenei#ure

• Refractory status epilepticus• "ei#ure l(*ing 8 &our 9 ei#ure recurring (* ( r(*e o+

*%o or more epiode per &our %i*&ou* reco)ery *o$(eline $e*%een ei#ure, depi*e *re(*men* %i*&con)en*ion(l (n*iepilep*ic drug


5/27



6/27

Epidemiology


• 3 million c(e in *&e %orld%ide

• :"A 150000 c(e• 50000 ; oung c&ildren ? 1 yo

• Elderly @5 yo

• M(le ' +em(le 1,58 ' 1


7/27

Cl(i/c(*ion



8/27

E*iology



9/27

P(*&op&yiology

• Dol(*ed ei#ure *(*u epilep*icu• m(rked c&(nge in ionic c&(nnel, (denoine

+orm(*ion9rele(e, elec*ric(l ync&roni#(*ion, +(ilure o+GABAmedi(*ed in&i$i*ion

•

(ilure o+ *ermin(*ing mec&(nim• $lock(de o+ 6me*&yl d (p(r*(*e 6MA2 c&(nnel $y

m(gneium

• (c*i)(*ion o+ F conduc*(nce

• repol(ri#(*ion o+ neuron (nd neuropep*ide >

•

c&(nge in GABAA recep*or• epreion o+ procon)uli)e neuropep*ide u$*(nce P,

neurokinin B2



10/27

• Hime dependen* p&(rm(corei*(nce• (l*er(*ion in *&e +unc*ion(l proper*ie o+ GABA recep*or

preen* in *&e &ippoc(mp(l den*(*e gr(nule cell• po*ency o+ $en#odi(#epine decre(e $y 80 *ime %i*&in 30

min o+ el+u*(ining *(*u epilep*icu• Hr(nloc(*ion o+ c(lmodulin +rom *&e mem$r(ne *o *&e

cy*ool• p&eny*oin rei*(nce

• "ei#ureinduced neuron(l inIury J de(*&• 6euronpeci/c enol(e, ( m(rker o+ neuron(l de(*& in

*&e erum o+ p(*ien* (+*er *(*u epilep*icu

• ecei)e neuron(l /ring *&roug& eci*o*oicmec&(nim



11/27

Clinic(l preen*(*ion

Roo, (ren L 6eurology emergency


12/27

• mo* common (nd eriou +orm o+ *(*uepilep*icu

• u$*le GC"E '• pro+ound com( %i*&

• con)uli)e (c*i)i*y limi*ed *o ny*(gmoid mo)emen* o+ *&eeye or

• in*ermi**en* $rie+ clonic *%i*c&e o+ *&e e*remi*ie or *runk,

• (nd $il(*er(l ic*(l dic&(rge on *&e EEG

•

Generalized myoclonic status epilepticus

common in c&ildren

Clinic(l preen*(*ioncon)uli)e E


13/27

• Con)uli)e simple partial status epilepticus ( ie ,epilepsia partialis continua) i c&(r(c*eri#ed• repe(*ed p(r*i(l mo*or ei#ure,

• Preer)ed concioune,

• preer)ed neuro)ege*(*i)e regul(*ion

• Repe(*ed clonic Ierk %i*& loc(li#(*ion dependingon *&e loc(li#(*ion o+ *&e epilep*ogenic leion in

*&e prim(ry mo*or cor*e (re *&e c(rdin(l clinic(l+e(*ure


14/27

• 6eg(*i)e ymp*om• com(, c(*(*oni(, (p&(i(, con+uion2

• poi*i)e ymp*om• (gi*(*ion, (u*om(*im, delirium, deluion, pyc&oi2

• 6C"E i (pplied *o p(*ien* %&o (re e)erelyo$*unded or com(*oe %i*& minim(l or no mo*ormo)emen*

Clinic(l preen*(*ionnon con)uli)e "E


15/27

• 6C"E &ould include'• 12 uneKui)oc(l elec*rogr(p&ic ei#ure (c*i)i*y,

• 82 periodic epilep*i+orm dic&(rge or r&y*&mic dic&(rge%i*& clinic(l ei#ure (c*i)i*y,

• 32 r&y*&mic dic&(rge %i*& ei*&er clinic(l orelec*rogr(p&ic repone *o *re(*men*


16/27

• Typical absence status epilepticus• prolonged ($ence (**(ck %i*& con*inuou or

dicon*inuou 3=# pike (nd %()e occurring in p(*ien*%i*& prim(ry gener(li#ed epilepy

•

Dol(*ed imp(irmen* o+ concioune, (* *ime %i*& u$*le Ierk o+ *&e eyelid een*i(l ymp*om


17/27

• complex partial status epilepticus implie (prolonged epilep*ic epiode in %&ic& +oc(luc*u(*ing or +reKuen*ly recurring elec*rogr(p&icepilep*ic dic&(rge, (riing in *empor(l or e*r(

*empor(l region con+uion(l *(*e %i*& )(ri($leclinic(l ymp*om• Clinic(l +e(*ure '

• clouding o+ concioune,

•

)(riou (u*om(*im oro(limen*(ry, ge*ur(l2,• l(ngu(ge di*ur$(nce


18/27

• Electrical status epilepticus during sleep ic&(r(c*eri#ed $y• pike(nd%()e dic&(rge in @5;100 o+ nonr(pid eye

mo)emen* REM2 leep

• (oci(*ed %i*& cer*(in epilepy yndrome uc& (L(nd(u;leNner (nd Lenno;G(*(u* yndrome

R L 6 l E


19/27

Complic(*ion



20/27

• Dn)e*ig(*ion (re done *o /nd '• *&e e*iology o+ *&e *(*u epilep*icu,

• *o de/ne *&e *ype o+ *(*u epilep*icu yndrome

• *o diNeren*i(*e +rom o*&er (cu*e neurologic condi*ion *&(*

c(n imul(*e comple p(r*i(l *(*u epilep*icu, e '• in*oic(*ion, encep&(li*i, me*($olic diorder,

peudo*(*u2

Dn)e*ig(*ion


21/27


22/27

Hre(*men*


23/27

Roo (ren L 6eurology Emergency


24/27

Hre(*men*


Roo (ren L 6eurology Emergency


25/27



26/27


27/27

Re+erence

• Roo L' Emergency 6eurology, "pringer' 8018

Documents

Jesly Problem 3A KGD