patho epilepsy1

8/7/2019 patho epilepsy1

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PATHOPHYSIOLOGY OF

EPILEPSY

BY-ANKUSH CHOURASIA

PHARMACEUTICAL MARKETING

ROLL NO.-100606011


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DefinitionofSeizures

jTime-limited paroxysmal eventsthatresultfrom abnormal, involuntary, rhythmicneuronal

dischargesinthe brainjSeizures areusuallyunpredictable

jSeizuresusually brief( < 5 minutes) andstopspontaneously

jConvulsion, ictus, attackandfit areusedtorefertoseizures


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EtiologyofSeizures

j Seizures areeitherprovokedorunprovoked

j Provoked Seizures: Triggered bycertainprovokingfactorsinotherwisehealthy brain

Metabolic abnormalities (hypoglycemia andhyperglycemia,

hyponatremia, hypocalcemia)

Alcohol withdrawal

Acuteneurological insult (infection, stroke, trauma)

Illicitdrugintoxication andwithdrawal

Prescribedmedicationsthat lowerseizurethreshold(theophylline, TCA)

Highfeverinchildren

j Unprovoked Seizures: Occurinthesettingofpersistent brain pathology.


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DefinitionofEpilepsy

j A diseasecharacterized byspontaneousrecurrenceofepilepticseizures (2 ormore)unprovoked by any

immediateidentifiablecause .

j Ifmultipleseizuresoccurwithin 24 hourthenitis

taken asoneevent.

j Seizures aresymptoms, whileepilepsyis a disease,

sothosetermsshouldnot beusedinterchangeably.

j Alsoepilepsyistheclinical manifestationofabnormal andexcessivedischargefrom a setof

brainneurons.


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Manifestationofepilepsy-

jSuddentransient phenomenonwhichmay

include alterationofconsciousnessor

motor, sensory, autonomicorpsychicevents perceived by individual oran

observer.


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EPIDEMIOLOGY-

jFordevelopingcountries 100 cases per

100,000 people andindeveloped 40-

70/100,000.jMore prevalenceinmale.

jHigherprevalencein lowersocioeconomic

group.


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TYPES

EPILEPSY ONBASIS OF

RECURRENCE

Active

At least 1 seizuresin5 years

Inactive

Noseizuresinmorethan 5 years

EPILEPSY ONBASIS OF

ETIOLOGICALFACTOR

Idiopathic

Geneticpredisposition.

Cryptogenic

Noetiological factor

has beenidentified


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ON BASIS OF INVOLVEDBRAIN AREA

FRONTALLOBE

PRONEPOSITION

TEMPORALLOBE

SENSATIONS

REGULATIONDISTURBED

PARIETALLOBE

BODYPOSITIONDISTURBED

OCCIPETAL

LOBE

VISUALDISTURBANCE


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IN EPILEPSY THE FUNCTION OF EACH LOBE

GET DISTURBED


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ILAE ClassificationofSeizuresPartial Seizures Generalized

Seizures

A) SIMPLE PARRTIAL-

- WITH MOTOR SYMPTOMS

- WITH SP. SENSORY SYMPTOMS

- WITH AUTONOMIC SYMPTOMS

- WITH PSYCHIC SYMPTOMS

B) COMPLEX PARTIAL-

1- BEGNNING AS SIMPLE PARTIAL SEIZURE AND

PROGRESSING TO IMPAIRMENT OF

CONSCIOUSNESS

2- WITH IMPAIRMENT OF CONSCIOUSNESS

C)PARTIAL SEIZURES EVOLVING TO

SECONDARY GENERALISED SEIZURE-

-SPS TO GS

-CPS TO GS-SPS TO CPS TO GS

A) Tonic-Clonic

(primarytonic-

clonic)

B) Absence

C) Myoclonic

D) ClonicE) Tonic

F) Atonic


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PATHOPHYSIOLOGY-

jORIGINATION CORTICAL SITES

jPS- BEGINE FOCALLY IN CORTEX

jGS -WIDESPREAD CORTICALINVOLVEMENT FROM START.


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IN BRAIN IMBALANCEIN

NEUROTRANSMISSION

EXCITATORY INHIBITORY

(GABA)


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ABSENCE SEIZURES

jTHALAMOCORTICAL CIRCUIT IS

RESPONSIBLE.

PYRAMIDALNEURONS


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CAUSES

jGENETIC

j IDIOPATHY

jCORTICAL MALFORMATIONjTRAUMA

jTUMOR

j INFECTION

jALCOHOL

jMETABOLIC DISORDER


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PRECIPITANTS

j INADEQUATE SLEEP

jALCOHOL ABUSE

jDRUGS ABUSE


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Signs and Symptoms of

EpilepsyjSymptoms of Simple Partial Seizures

jMotorsignsincludethefollowing:

jAlternatingcontraction andrelaxationofmusclegroups

jEyemovements andturningoftheheadto

thesamesidejAsymmetrical posturingofthe limbs

jSpeech arrest


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jSensory symptoms includethefollowing:

jSeeingflashesoflightsorcolors, illusions

andhallucinationsjHearinghumming, buzzing, hissingnoises

jExperiencingunpleasantodors andtastes

jDizziness, lightheadedness


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j Autonomic signs and symptoms includethefollowing:

j Borborygmi (rumblingnoises produced bygasinthe

intestines)

j Flushingj Incontinence

j Nausea, vomiting

j Pupillarydilation

j Sweating

j Tachycardia (rapidheartrate)


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j Psychic symptoms includethefollowing:

j Detachment, depersonalization

j Dreamystate

j Memorydistortion: deja vu (feelingthatonehasseensomething before), deja entendu (feelingthatonehasheard

something before), jamaisvu (feelingthatonehasnever

seensomethingthatisfamiliar), jamaisentendu (feeling

thatonehasneverheardsomethingthatisfamiliar),

panoramicvision (rapidrecall ofpastevents)

j Timedistortion

j Unprovokedemotion:fear, pleasure, displeasure,

depression, anger,


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Symptoms of Complex Partial Seizures

j Alimentary:chewing, increasedsalivation,

borborygmi (rumblingnoisescaused bygasinthe

intestines)

j Mimetic:facial expressionsoffear, discomfort,tranquility, laughter, crying

j Gestural:repetitivemovementsofthehands,

fingers, sexual gestures

j wandering, running

j Verbal:repeatedshort phrasesorswearing


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Symptoms of Tonic-Clonic (formerly called

Grand Mal) Seizures

j Fall

j Lossofconsciousness

j Yell or"toniccry"

j Extensionofarms, legs, and/orface

j Fingers andjawclenched

j Autonomicsymptoms:increased blood pressure

andheartrate, increased bladderpressure,flushing, sweating, increasedsalivation, increased

bronchial secretion, apnea (cessationofbreathing)


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Symptoms of Absence (formerly called

Petit Mal) Seizures

jAutomatisms (e.g., lickingthe lips,

chewing, scratching, )

j

BlankstaringjChangeinfacial expression

jLackofawareness, responsiveness, memory

j Jerkingmovementsoftheextremities


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j Symptoms of Myoclonic Seizures

j These briefseizurescause a suddenonsetof

musclecontractionsthatmayoccurthroughoutthe

bodyormay be limitedtocertain areasofthebody (e.g., face, oneormoreextremities,

individual orgroupsofmuscles).


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j Symptoms of Clonic seizures

j Rhythmicjerking limb movements

j Lossofbodyfunction

j Alteredconsciousnessj Confusionfollowingepisode

j Symptoms of Atonic seizure

j Sudden lossofmuscletone

j Brieflossofconsciousness


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THANK YOU

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