#ثريد
راح نتكلم اليوم عن
Seizures and epilepsy
للمختصين في المجال الصحي
كوب القهوة معاك ☕️ واستمتع ❤️
راح نتكلم اليوم عن
Seizures and epilepsy
للمختصين في المجال الصحي
كوب القهوة معاك ☕️ واستمتع ❤️
Def:
It’s a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness.
It’s a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements or feelings, and in levels of consciousness.
Note 📝 Having two or more seizures at least 24 hours apart that aren't brought on by an identifiable cause is generally considered to be epilepsy.
Etiology:
Came in mnemonic “VITAMIN D E”
1-Vascular
Acute ischemic stroke.
Intracerebral hemorrhage.
Subarachnoid hemorrhage.
Posterior reversible encephalopathy syndrome.
Anoxic brain injury.
Came in mnemonic “VITAMIN D E”
1-Vascular
Acute ischemic stroke.
Intracerebral hemorrhage.
Subarachnoid hemorrhage.
Posterior reversible encephalopathy syndrome.
Anoxic brain injury.
2-Infections
Meningitis.
Brain abscess.
Encephalitis.
Meningitis.
Brain abscess.
Encephalitis.
3-Trauma
Epidural hematoma.
Subdural hematoma.
Epidural hematoma.
Subdural hematoma.
4-Autoimmune
Systemic lupus erythematosus.
Paraneoplastic syndromes.
Systemic lupus erythematosus.
Paraneoplastic syndromes.
5-Metabolic
Decrease vitamin B1 (thymine) that cause wernicke's encephalopathy.
Hypoglycemia.
Electrolytes imbalance.
Increase urea.
Increase NH3.
Hyperthyroidism.
Decrease vitamin B1 (thymine) that cause wernicke's encephalopathy.
Hypoglycemia.
Electrolytes imbalance.
Increase urea.
Increase NH3.
Hyperthyroidism.
6-Idiopathic
Pt with Hx of epilepsy and he stopped Anti-epileptic drugs.
West syndrome.
Lennox gastaut syndrome.
Juvenile myoclonic epilepsy.
Pt with Hx of epilepsy and he stopped Anti-epileptic drugs.
West syndrome.
Lennox gastaut syndrome.
Juvenile myoclonic epilepsy.
7-Neoplasm
Glioblastoma.
Meningioma.
Glioblastoma.
Meningioma.
8-Drugs
Opioids.
Tricyclic anti-depressant.
Isoniazid.
Salicylate toxicity (too much aspirin).
Cocaine.
Amphetamines.
Metronidazole.
Opioids.
Tricyclic anti-depressant.
Isoniazid.
Salicylate toxicity (too much aspirin).
Cocaine.
Amphetamines.
Metronidazole.
9-Everything else
Eclampsia (pregnant has HTN and seizures).
Fever (Ex viral infection called roseola that caused febrile seizure).
Genetic causes
Eclampsia (pregnant has HTN and seizures).
Fever (Ex viral infection called roseola that caused febrile seizure).
Genetic causes
Pathophysiology:
1-decrease inhibitory pathway (GABA) cause no chloride inter (no negative charge inside)=increase action potentials.
Or
2-increase stimulatory pathway (glutamate) cause more + ions inter (more positive charges inside)= increase action potentials.
1-decrease inhibitory pathway (GABA) cause no chloride inter (no negative charge inside)=increase action potentials.
Or
2-increase stimulatory pathway (glutamate) cause more + ions inter (more positive charges inside)= increase action potentials.
Types of seizures:
1-focal seizure
Occur in one side cerebral hemisphere
2-generalized seizure:
All the brain involved
1-focal seizure
Occur in one side cerebral hemisphere
2-generalized seizure:
All the brain involved
Types of focal seizures:
1-focal motor (frontal).
2-focal sensory:
A-parital (somatic).
B-occipital (visual).
C-temporal (auditory and primitive).
3-Autonomic symptoms (ANS) & psychological symptoms (temporal with insula).
1-focal motor (frontal).
2-focal sensory:
A-parital (somatic).
B-occipital (visual).
C-temporal (auditory and primitive).
3-Autonomic symptoms (ANS) & psychological symptoms (temporal with insula).
1-Focal motor seizures:
Atonic (muscle relaxed)
Tonic (muscle stiffing)
Clonic (quick shivering of muscle)
Myoclonic (very rapid movement of muscle)
Jacksonian march (seizure starts distally to proximally).
Atonic (muscle relaxed)
Tonic (muscle stiffing)
Clonic (quick shivering of muscle)
Myoclonic (very rapid movement of muscle)
Jacksonian march (seizure starts distally to proximally).
Note 📝 in focal motor you gonna see pt moves unilateral limb or eyes or head goes contra-lateral side of the effect side in the brain.
2-Focal sensory seizures:
Feel pain and/or paresthesias
Visual hallucinations
Hear abnormal sounds
Abnormal smells
Abnormal taste
Feel pain and/or paresthesias
Visual hallucinations
Hear abnormal sounds
Abnormal smells
Abnormal taste
3-Focal Autonomic symptoms (ANS) & psychological symptoms:
A-ANS symptoms (increase BP & HR, urine incontinence, increase salvation and sweating).
B-psychological symptoms:
Emotional (angry, hyper-sexual).
Deja vu
Depersonalization
A-ANS symptoms (increase BP & HR, urine incontinence, increase salvation and sweating).
B-psychological symptoms:
Emotional (angry, hyper-sexual).
Deja vu
Depersonalization
Generalized seizure:
1-motor:
Tonic, Atonic, Clonic, Myoclonic and (Tonic-clonic) most common.
2-non motor:
Absence seizures (petit mal)
involves a brief loss of awareness, which can be accompanied by blinking (staring) or mouth twitching.
1-motor:
Tonic, Atonic, Clonic, Myoclonic and (Tonic-clonic) most common.
2-non motor:
Absence seizures (petit mal)
involves a brief loss of awareness, which can be accompanied by blinking (staring) or mouth twitching.
Drugs acts on glutamate cycle:
1- Sodium channel blockers
Valproate
fosphenytoin
Topiramate
lamotrigine
carbamazepine
1- Sodium channel blockers
Valproate
fosphenytoin
Topiramate
lamotrigine
carbamazepine
2- calcium channel blockers
gabapentin
ethosuximide (treat absence seizure)
3- SV2A blocker
levetiracetam (kepra)
4- ketamine
Use prevent Glutamate form binding to (nmda) receptor
gabapentin
ethosuximide (treat absence seizure)
3- SV2A blocker
levetiracetam (kepra)
4- ketamine
Use prevent Glutamate form binding to (nmda) receptor
Drugs acts on GABA cycle:
1- GABA-A agonist
Benzodiazepines (lorazepam, diazepam, midazolam).
phenobarbital.
Propofol
2-GABA reuptake inhibitor
tiagabine (binds to recognition sites associated with the GABA uptake carrier).
1- GABA-A agonist
Benzodiazepines (lorazepam, diazepam, midazolam).
phenobarbital.
Propofol
2-GABA reuptake inhibitor
tiagabine (binds to recognition sites associated with the GABA uptake carrier).
Status epilepticus:
-Seizure more or equal 5min.
Or
-seizure without return to baseline.
-Seizure more or equal 5min.
Or
-seizure without return to baseline.
How to manage status epilepticus:
-ABC’s
Assess hypoxia
Control HTN and tachycardia.
-treat reversible causes
For example (B1 low give thiamine infusion).
-give Benzodiazepines
Lorazepam 4mg IV push.
If there is not IV line give midazolam 10mg IM.
-ABC’s
Assess hypoxia
Control HTN and tachycardia.
-treat reversible causes
For example (B1 low give thiamine infusion).
-give Benzodiazepines
Lorazepam 4mg IV push.
If there is not IV line give midazolam 10mg IM.
If still seizing give more anti-epileptic drugs:
levetiracetam
phenytoin
valproate
If still seizing intubate pt and start AED iv with maintenance doses:
Propofol
Midazolam
Ketamine
levetiracetam
phenytoin
valproate
If still seizing intubate pt and start AED iv with maintenance doses:
Propofol
Midazolam
Ketamine
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