seizures clincal presentation
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GTC / Grandmal Seizures
Sudden loss of consciousness Tonic Phase Clonic Phase Seizure last for 1-2 mins Post Ictal Phase – 30 mins to many
hours Prodrome in small percentage Aura + or - .......?? Recall ......??
Absence / Petitmal
Usual Age – 5-8 yrs Female preponderance Impairment of consciousness Very short duration ( 5-10 Sec) Abrupt onset and cessation Brief interruption, Dropping, Unresponsiveness,
Blinking of eye lids No Recognization of events 10 to Hundreds per day Hyperventilation 1/3 to 1/4th .....GTC/ Juveline Myoclonic Epilepsy Atypical Absence
Myoclonic
Infantile Spasm- Salaam seizures Head Drop and Arm Felxion Few to hundred per day
Benign Myoclonic Epilepsy – Infancy to 3 yrs, Myoclonic Jerks ( Face, Upper extremity), during day/ light sleep, disappears during sleep
Juveline Myoclonic Epilepsy – 8 to 18 yrs, Myocloinc jerks- awaeking / sleep deprivation, Alchol and mensturation,3 Types coexist- Myocloinc, Absence and GTC
Simple Partial Seizures
Aura +nt Jerky movements usually one side of
body Somato Sensory- Visual, Auditory,
Olfactory, Vertiginous Motor- Activity of fixed pattern of face
and hands Autonomic- Pallor, Sweating, Flushing,
Pupillary dilatation, piloerection Psychiatric- Illusions, Hallucinations
Complex Partial / temporal lobe epilepsy
Impairment of consciousness With changes in perception and
sensation All mentioned types of simple partial Eyes- Dazed look Mouth- Lip Smacking, Drooling Abdomen- Nausea, Vomiting No recall Complex Partial to secondary
genralized seizures
Benign Partial Seizures
Benign Focal epilepsy with Centrotemporal spikes
Manifestation of simple partial seizures
4-13 yrs ...stops at 15 yrs Neurologically normal Nocturnal seizures- Face Grimacing/
Vocalizations Sensation of paraesthesia
Benign Partial Seizures
Benign Focal Epilepsy with occipital paroxysms
Manifestation of complex partial First decade of life Occipital lobe related manifestations Neurologicaaly normal Association with Migrane Simple visual hallucinations & transient
blindness with ictal vomitings Automatism
Syncope
Sudden loss of consciousness More common than epilepsy Potential Trigger – Heat , Fatigue, Fear, Pain,
Sudden Upright position from supine, bending , stretching, prolonged standing, working in stuffy environment , micturation against obstruction and paroxysmal cough, CCB
Light headedness, darkening in front of eyes, gradually sinking to the ground
No postical stupor, prostration/ sleep Transient Throbbing headache is common
Choice of Drug
Type of Seizure
PECS America 2005
Europe 2007
DACH Brand 2nd Line
GTC VPA Epilex 200mg/5ml
Absence ESM VPA VPA
Myoclonic
VPA, LTG
VPA VPA
Atonic
Simple Partial
CBZ, OXC
CBZ, OXC
Tab Zen 200
Complex Partial
CBZ, OXC
CBZ, OXC
Side Effects
Phenobarbitone- Aggresive Outburst, Insomnia, Hyperactivity, Mood Flactuations
Carbamazepine- Rash ( Steven Johnson Syndrome), Agranulocytosis, Aplastic Anaemia, Liver toxicity
VPA- wt Gain, Hepatic & Pancreatic Toxicity, Menstural Irregularities, Hair Loss
LTG- Rash ( Steven Johnson Syndrome), Less than other AET ( Headache, tremor, Ataxia). Rarely Liver Toxic
Phenytoin- Gingival Hyperplasia, Hirsutism, Nystagmus, Ataxia, Coarseness of Facies , Rash ( Steven Johnson Syndrome), Liver toxicity
Levetiracetam-, Abnormal Behaviour and CNS Adverse effects- But less than other AED, Depressive Mood- More in children