Epilepsy Seizure Disorders

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What is epilepsy?

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brain disorder characterized by transient but recurrent seizures

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What is seizure?

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sudden, expessive and highly synchronous discharge of neurons in the CNS

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Status Epilepticus

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prolonged seizure, usually longer than 30 minutes, a continuous state of seizure activity

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Hippocrates

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correct in saying that epilepsy is natural and originates in brain rather than from gods.
incorrectly believed it was caused by cold phlegm

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Galen

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First to formally note there is a preceding aura

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Alexandros of Tralleis

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noted alcohol increases risk of seizure

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Renaissance Period

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decreased emphasis on faith in epilepsy, witch hunt

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Samuel Auguste Tissot

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suggests difference in idiopathic and symptomatic epilepsy

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John Hughlings Jackson

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"Jacksonian March" - not all seizures lead to loss of consciousness (partial) but they could progress to whole body convulsions/loss of consciousness (generalized)

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Victor Horsley

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first surgery, removed cortex, no more seizures nor memories

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Hans Berger

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invented EEG to measure electron potentials in brain

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Seizure/Epilepsy Incidence

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3% of living people will be diagnosed with epilepsy
highest incidence in young children and elderly
Normal brain tissue maybe be recruited from a seizure focal point

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Partial Seizures

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originate in small groups of neurons "seizure focus"
symptomatology depends on seizure focus w/in brain

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Simple Partial Seizures

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no loss of conscious
lasts <2 minutes
preceded by aura (symptom of fear, rising abdomen, sensory)

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Subtypes of Partial Seizures:
Motor
Sensory
Autonomic
Psychic

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cause a change in motor activity
perceptual changes in senses (not reality)
sudden changes in systems under autonomic control
changes in thought, feelings, experience

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Complex Partial Seizures

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impair consciousness and short term memory
30-120 seconds, but may leave patient tired/confused with hours of recovery
may involve movements
seizure focus in temporal/frontal lobe

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Evolving vs Non-Evolving Complex Partial Seizures

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Evolving - progress to generalized
"Secondary Generalized
Seizures"

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Generalized Seizures

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do not begin with discrete focal point, involve both hemispheres

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Convulsive vs Non-convulsive Generalized Seizures

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convulsive: involve tonic or clonic movements
-tonic - increase muscle tone
-clonic - alteration btwn contraction and relaxation

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Simple/Typical Absence Seizures

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Petit mal, staring spells, <10-20 seconds, begin and end abruptly, awareness and responsiveness impaired, don't realize they've had seizure

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Complex Absence Seizure

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simple + changes in muscle activity
-blinking of eyes
-slight movements of mouth
-rubbing of the hands
-contraction/relaxation of muscles
often last more than 10 seconds

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Atypical Absence Seizure

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brief staring episodes
longer, begin and end gradually, patient more aware of events during seizure, may or may not have motor movements, likely to be associated with low intelligence/cognitive impairments/more likely to last lifetime

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Myoclonic Seizures

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generalized/convulsive
brief shock like jerks
often experienced w/out epilepsy (falling asleep)
last a second or two

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Atonic Seizures

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generalized/convulsive
all muscles suddenly relax
last less than 15 seconds
remains conscious
injuries due to falling
last into adulthood

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Tonic Seizures

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muscle tone increased, muscles stiffen
less than 20 seconds
preserved consciousness
occur during sleep
fall if standing

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Clonic Seizures

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rhythmic jerking of arms and legs
length is variable
rare
not followed by tiredness/confusion

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Tonic-Clonic

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common form of seizure
grand mal, tonic followed by clonic
2-3 minutes, consciousness lost
following seizure: tired, sleepy, agitated, confused

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Epilepsy Syndromes

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defined by cluster of features such as:
type(s) of seizures
age of onset
cause(s)
area of brain
factors that promote seizures
severity, frequency, time
EEG

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Febrile Seizures

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tonic-clonic in young children when they have high fever
occurs in 2-5% of children
familial
do not have seizures w/out fever after 5

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Childhood Absence Epilepsy

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absence seizures in 4-8 year olds precipitated by exercise
tonic-clonic (w or w/out fever)
2-8% of all patients w/epilepsy
genetic

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Juvenile Myoclonic Epilepsy

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presents as myoclonic seizures in juveniles
early morning/shortly after waking
7% of all cases
photosensitive seizures

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Temporal Lobe Epilepsy

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Partial epilepsy arising from temporal lobe of brain
seizures often include aura of many types (motor, sensory, autonomic, psychic)
SIMPLE AND COMPLEX PARTIAL SEIZURES and EVOLVING are common
mild memory deficits

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Frontal Lobe Epilepsy

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2nd most common partial seizure (temporal first)
both simple and complex
AUTOMATISMS - inappropriate expression of coordinated muscle
usually requires eegs

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Symptoms of Epilepsy

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head trauma, drug intoxication/withdrawal, cerebral infection, stroke, brain tumors

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Idiopathic epilepsies

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unknown, usually genetic, inheritance not conforming to mendelian genetics

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Seizure Treatment

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Partial - carbamazepine/phenytoin
Tonic-clonic - valproate/primidone/phenobarbital
Atonic - highly resistant

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Surgical Treatment

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common target - amygdala/anterior hippocampus/entorhinal cortex