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Epilepsy Dr payam Sasannejad
Assistant Professor of MUMS
What Is the Difference Between Epilepsy & Seizures? A seizure is a brief, temporary disturbance in the electrical activity of the brain
Epilepsy is a disorder characterized by recurring seizures (also known as “seizure disorder”) A seizure is a symptom of epilepsy
To understand epilepsy, it is important to review the difference between epilepsy and seizures. Epilepsy is a generic term used to define a variety of disorders characterized by recurring seizures. A diagnosis of epilepsy means that a person has an underlying condition, such as a brain injury, that affects the delicate systems which govern how electrical energy behaves in the brain, making it susceptible to recurring seizures.
A seizure is a brief, temporary disturbance in the electrical activity of the brain. Seizures are a symptom of epilepsy. However, having a seizure does not necessarily mean that a person has epilepsy. There are other causes of seizures, including high fever, kidney failure, or lack of oxygen.
Epilepsy is not contagious. You cannot catch epilepsy from someone else and nobody can catch it from you. Many misconceptions surround epilepsy, and sometimes people inadvertently add to the negative image of the disorder by choice of language. Like all individuals with a disability, persons with epilepsy dislike labels, such as “he’s an epileptic.” Epilepsy is a condition that a person has, not what they are. The preferred terminology is “person with epilepsy.” In addition, epilepsy should be referred to as a “disorder,” since it is not a disease by definition. It is a disorder characterized by a recurring disturbance in the electrical activity of the brain.
Differential diagnosis of seizures Syncope
Drop attacks
Narcolepsy-Cataplexy
Pseudoseizures
Panic attacks
Hypoglycemia
Migraine
Classifying Epilepsy and Seizures Classifying epilepsy involves more than just
seizure type
Seizure types:
Partial Generalized
Simple Complex Absence Convulsive
Consciousness
is maintained Consciousness
is lost or impaired Altered awareness Characterized by
muscle contractions
with or without loss
of consciousness
Epilepsy is classified by the seizure type as well as additional important information, including typical brain-wave recordings, clinical features such as behavior during the seizure, the expected course of the disorder, precipitating factors, expected response to treatment, and genetic features.
In addition, it is possible for a person with epilepsy to have more than one kind of seizure. The type of seizure depends on which part and how much of the brain is affected by the sudden electrical discharge. Partial seizures are the most common type of seizure experienced by people with epilepsy.
Seizures that begin early in life may change into different seizure types as the child grows older. If a family member or caretaker notes that a person with epilepsy is having new seizure patterns, they should alert the treating physician; this may help determine the most effective medication and provide a more accurate picture of how the condition will progress.
Seizure Types Syncope
Migraine
Psychogenic
Toxic
Cerebrovascular
Metabolic Single Nonepileptic Recurrent Epileptic Generalized Partial Simple Complex Secondarily
Generalized Absence
Tonic-clonic
Tonic
Clonic
Myoclonic
Atonic Adapted from International League Against Epilepsy. Epilepsia. 1981:22:489-501.
Epilepsy is a symptom of numerous disorders, but in the majority of
sufferers the cause remains unclear despite careful history
taking,examination and investigation!
An approach to Seizures
Epilepsy – Investigation The concern of the clinician is that epilepsy may be symptomatic of a treatable cerebral lesion.
Routine investigation: Haematology, biochemistry (electrolytes, urea and calcium), chest X-ray, electroencephalogram (EEG).
Neuroimaging (CT/MRI) should be performed in all persons aged 25 or more presenting with first seizure and in those pts. with focal epilepsy irrespective of age.
Specialised neurophysiological investigations: Sleep deprived EEG, video-EEG monitoring.
Advanced investigations (in pts. with intractable focal epilepsy where surgery is considered): Neuropsychology, Semiinvasive or invasive EEG recordings, MR Spectroscopy, Positron emission tomography (PET) and ictal Single photon emission computed tomography (SPECT)
Diagnosis of epilepsy Clinical picture
Clinical history
Description of Sz
Symptomatology
Physical/Neurologic examination
Therapy EEG
Background activity
Epileptiform activity
Interictal
Ictal
Postictal
Laboratory tests
Neuroimaging
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