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= Seizuve — — coused oy an _alonomal + excasive elechical discrowp — - from the caveloral neuvons Epilepsy — landency > have seizuver — ¢ = Condition in which on individual hor recurvent seizurer due + _Chvonic. Undertying, POCO om) geyser edn Epilepsy may -be_primany ov idiopathic -_ O42 ANG he’) secondlony o \diopathic fox -_Pimory Epilapsy > eqn _blw Syrs. = 20 yrs no specific couse , 0 fea atonoreriG Ia “9 10) Secandavy Epilepsy : camer B > Genchor, conggnites tenonraliien. 4 perinala! injuvien | oe > Meboloic, disudeyy + hyperglycemia. , nypoguycamio snepolic faire, renal ive. t © Heodov Birth Iniuyy :, Lume ov atlney space muri (ning. ‘ & Norcular, diseauer,: Srohe _, AN malfamaten - 2 © Infections + meningilis , enuephalitis , covetyol oloseem , AIDS , Te. oy S An{lannmaliny, dicaues + _SLE , roulliple sclerosis, Soveordosis , varculikis - » Penicillin, IH enehoriducl Quinotoner, cxglosporin, Lithium etc. alcohol, loarbilivala, , benzadiozepinen q teiti PAPERWORK rr > Classification St Seizuver > broadly wito 2 groups © Povtial oy Leal ceizuver, — seiuve activity | (ouccieGed w structural olorovmatitier ob ibrodr <4 scovs ylumors , AY en ormelons etc) is Yettriclad_to one port O_carelorurn . * Generalised Seizuver — involve diffuse veqiars Gf lootin hennisphores _sirnultomenAe: 2 syndnvonously - (verult Avom coludoy , biochemical ov shu chiral clonomraikied ) (Pata Seinureal [Generated stizwer | ~ Sinnple = portal (no consciouanen impime) - Sbosenca_seizuwer (gett neh) © Jorhsnicrr seizuver * Uypicad absenca ~ Complex pavhal (impoived conscieusnen) + atypical absence 2-0) psychomotor epilepsy, wt ayer? j_« pak ciaanaeaeg geal: = tayoclonic_seiz ures. 2a a Secondavy Genorabiced _ Seizuven. e g lonic - clonic ( “Sovandmal)) Seizuver - Pionic_Seizuven. wW Paena Sezures > => _ Simple povtial ISP, ay! nit > pallient yemains Conscioua- may praent w_ motor , Seniory gulieeatn ov poubia Symptoms OA: 10) Povtiol_M ot ae : : uy 93 patiewns C4) Tock sonian Mave —> jevly. mow ee in na voy ralvicled _avea (eq angle df mouth | thumb x index fi ev) which eventually involves {he whole Limb® win seconda. (H) Todd § Roulis = \ocohised povais {os miner Jo hous following Jock sonian Seizures 5 sae a 194 98d 94) 498) at ost oad) ant soaame 188 if ee lel a W Genernricen Seizures ——— © stovt oy actuation of groups of neurontin lovge ave 6} toth hemispherea Sault aneouley © Apical Posence Seizuver (Petit Mal) S disorder 4 childhood . S child Stops_ockivily 1 Stover, racy blink | voll eyen 1 doen t vespond to Commands, © _loats for o few seconda . ® Alypicat Alesence Seizuve S mavled Changea in Aone. © adaths mon have o move gradua) onsek « Cminofion © Mypoctonic __ Seizuver & Sinole w multiple myoclonic (eva invdiving one povt oy entve beady. © AMonic_Sewy S_suddlon loss 6 postuvod musle tone locating \-2. second, G consciousner_is boviefly impaived . © Toric _Clonic (Gvand Mad) Ceizyver . ! prota >» Bndiomal Poe (hs da foe) ~ oneaa tig _* Aura -£ specific feelings, anticipalion , Afactory hodlucinalion, epigaabic Cliscomfort deja vw p gevbiing of one lnb . sgnic Phase — vapid clischami Coats 10-30 sec) © fopi ions Om flexed orm), exlonded lan -YEAP- mugcle spam, Qyomosis , loss & conscigwinem. SClmic Phase — leu vapid, slow discharge of cov Beal calli (torts 1-5 min.) & violent tang d} foce + Limbs , tongue | bitmo, 1 incontinence . ® Yost - ictal 1’ | | PRINCIPAL CAUSES OF SEIZURES BY AGE OF ONSET Neonatal Developmental insufficiency or brain injury Infantile Congenital malformations, perinatal injury, metabolic disorders Children and | Mainly genetic adolescents Adults over | Some genetic otherwise cerebral 20 neoplasm, drug or alcohol withdrawal, | brain trauma, stroke, infection or | surgery. Inve & to vwle_ovk _mekaloolic [infechiou comer: © Blood COC © Sevum urea, crechinine , eleclvo ug * Rarer _tlooel cuca > Sevum Glcium + Magnesium, ° LETs. © Geveen fv toring n_folood x vying (if tonicity is suspects) © Lumbar punctuve if meningitis ov enaphalitis is__supechd - o £EG = E lechoencephalepraphy - oA sels “G rosy help estolovsh _ond_choverlovize the Uype 4} epilopsis. & in epilepsy, Shhouss # spiher or spile. ond wave poVivn . OCT or MEN scot etyg Sa & uaely_ ie defining or exclucting, structural couse lor seizures 2-4 infckony or Lamon - & MRI is superior to CT in delecking, Coveloval \uions auocialtd w epilepsy ty CT 40 be done in emargencer if_CNS Meninfeckion or nau is dalicledl . © PET and SPECT i | Vf, Management & immeciofe cave = Move _pt_oway Fin danger = ally convulsion cease , turn ints semi prory ( ‘vecovens' )_poci tion. ~ensuve alvwou As Ae + medicol cove —ensuve iv wi Clee ee _ = Qive Ox OQ. +0 a areteel hypoxia 7 = give _IN_onticonvulsant (eg 10 ma, Diazegar) i if convulsions are Contiquou = Aglie lood for anticonvulsant levela_( if known — > oweidance: Sh __precipitaking, factors ; (24, Seep ae) — oo © Weatment ol underlain peer ge io fel M = = — + considoyed offiy two seizuver_ —— + dose 6 dwg, is ayoctund nevus voll seizuver ove conbled + moniker for side effect — oe +_meoauring plasma concenkemaen anti ere ‘dvug, ove. + withdvawad 6 anticonvulsant therapy = © aliGy © 2-3 yen seiemne, free Peron, ———___ & doy, veduction_should_begraduoy - over 25% myntins. * All__ antiepileptic drugs ove. sesolege ric. & should be wed ak siownurn affective dose _daving pregnancy, > dua ove rot fo toe Stopped since ceizuver are move haymfyl than choncon 6, congenital dues > folic ariel Sm a @ i reducus visu 6) suma fetal abnormalities. 191] PAPERWORK \N | ICE: National Institute for Health and Care Excell cellence | Epilepsy type First-line Se 1 | econd-line Third-line Focal onset and/or Lamotrigi . gine (Lamictal A secondary generalized tonic ) Carbanaep ee Clobazam clonic Levitiracetam Gabapentin Sodium valproate Oxcarbazepine Topiramate Phenobarbital Zonisamide Phenytoin Lacosamide Pregabalin Primidone Tiagabine [dierent OSS he | Generalized tonic clonic Sodium valproate Lamotigine Carbamazepine (Epival) Topiramate Phenytoin Levitiracetam Zonisamide Primidone (Lumark) Phenobarbita Acetazolamide | eee ee | ie es ee ee a i Lamotrigine Absence Ethosuximide Sodium valproate amotrigu 7 Clonazepam: (Zarontin) : Se | fre eee er i Lamotrigine 1am Myoconic Sodium valproate Levitirace! an 5 Clonazepam Phenobarb! (Epival) EE ae tee ee ee 
