Seizures clincal presentation

Clinical Features of Seizures

Dr. Avdhesh Agrawal

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

Atonic

Drop Attack Sudden loss of consciousness and

falls down

Clonic Type Tonic Type

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

Aura of Migraine v/s seizures

Time duration

Treatment of Seizures

Approach Choice of Drugs MOA Side Effects

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

Comparative as per Ghai

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

Duration/ Discontinuation of Theraphy