Seizures
Seizures
YACOUB BAHOU MD
Professor in neurology at
the University of Jordan
1. Introduction
2.Classification:focal seizures, generalized seizures
3. Epidemiology and etiologies
4. Clinical manifestations
5. Diagnostic evaluation
6. Treatment
7. Status epilepticus
8. Special topics
1. Introduction
Seizures are among the most common problems in neurology
Seizures can arise from one specific focus within the brain( focal) or
involve both cerebral hemispheres at the onset ( generalized)
Those that arise from one portion of the brain can evolve and spread to
involve the whole brain( secondarily generalized)
Among focal seizures, those in which awareness is impaired are
termed “ with impaired awareness” ( previously complex partial
seizures) , whereas those in which awareness is preserved are termed
“ aware” ( previously simple partial seizures) ( table)
* FOCAL SEIZURES
By definition, focal seizures( previously termed “ partial”) begin in a
focal area of the brain and do not impair awareness, at least at the
onset( figure)
The classic Jacksonian march occurs when the electrical activity spread
along the motor strip, leading to rhythmic jerking that spreads along
body parts following the organization of the motor homunculus
Focal nonmotor seizures from other regions of the brain can cause
sensory phenomena( sometimes parietal), visual phenomena( usually
occipital), or gustatory, olfactory, and psychic phenomena( frequently
temporal)
Toward the end of the clonic phase, the frequency of the jerking may
decrease and stop as the body becomes flaccid
The patient may bite the tongue and become incontinent of urine
during a generalized motor seizure
- and it may establish whether a patient who has had a seizure and is
not regaining alertness promptly is postictal or is having ongoing
continuous nonconvulsive seizures
The diagnosis of whether a particular paroxysmal event was a seizure
or not, however, rests primarily on clinical grounds
Most neurologists would not start an ASD after a single seizure for
which no underlying cause is found
ASD treatment is usually begun after 2 seizures that are not provoked
The primary goals of ASD treatment are to eliminate seizures and avoid
side effects, ideally with monotherapy- i.e., using a single drug
Most neurologists increase the dose of a single drug until either seizure
control is achieved or adverse effects become intolerable
If the latter occurs, the dose is lowered and a 2nd drug may be added
It produces urine and plasma ketones, which are used for monitoring
therapy
It can be difficult for patients to tolerate and is not known to be safe for
other medical comorbidities, including lipid disorders
C) Vagus nerve stimulation
The vagus nerve stimulator is a device shown to be effective in the
treatment of partial and generalized seizures
For seizures of medial temporal lobe origin( the most common target of
epilepsy surgery), the rate of complete seizure freedom following
resective surgery can be over 60%