Chapter 2: Epilepsy

• Disorder characterized by recurrent seizures
• Repetitive abnormal electrical discharges within the brain

• Altered consciousness
• Altered motor activity (convulsion) = involuntary contraction of muscles; tonic activity (stiffening and rigidity of muscles; clonic activity (rhythmic jerking of extremities) 
• Sensory phenomena = pt experiences somatosensory, visual, auditory, olfactory, gustatory, and vertiginous sensations
• Autonomic phenomena = associated with sudden attack of anxiety, tachycardia, sweating, piloerection, abnormal sensation rising up in upper abdomen and chest 
• Cognitive phenomena = sudden failure of comprehension, inability to communicate, intrusion of thought, illusions, hallucinations, affective disturbances (intense feelings of anger, fear, and hate)

• Acquired brain disease or trauma = tumor, stroke
• Degenerative brain disease = Alzheimers, dementia, amyloidosis
• Developmental brain defects
• Drug overdose (cocaine, antihistamines, cholinesterase inhibitors, methylxanthines, tricyclic antidepressants)
• Drug withdrawal (alcohol, benzodiazepines)
• Electrolyte disorders = hyponatremia, hyernatreamia, hypoglycemia, hypomagnesemia
• Hyperthermia
• Infections 
• Brain abscess, meningitis, neurocysticercosis 
• Pregnancy compilcations (eclampsia)

• Generalized
• Partial
• Secondarily generalized seizures
• Status epilepticus

• Tonic-clonic (grand mal)
• Absence seizures (petite mal)

• Dramatic loss of consciousness with a cry, fall, and tonic-clonic convulsions of all extremities
• Often with dengue biting and arrested breathing, urinary, and fecal incontinence
• After 2-5 min, contractions subside and consciousness is gradually regained
• Pt confused, drowsy and amnesiac about event
• Full recovery may take several hours
• Some attacks preceded by a brief aura

• Brief, almost imperceptible lapse of consciousness followed by immediate and full return to consciousness
• Posture is maintained, with no convulsive muscle contractions
• May occur as often as 100x/day

• Simple partial seizures
• Focal motor
• Focal motor with march (Jacksonian)
• Temporal lobe seizure
• Complex partial seizures

• Focal, begin locally
• Limited to a portion of the body
• Consciousness preserved
• Usually has an identifiable structural cause

Clonic activity involving a specific area of the body

An orderly spread or march of clonic movements from initial muscles to involved adjacent muscles with spread to entire side

• Episodic changes in behavior 
• Complex hallucinations
• Automatisms (lip smacking, chewing, pulling on clothing)
• Altered cognitive and emotional function (sexual arousal, depression, violent behaviors)
• Preceded by an aura

Simple partial seizures followed by impairment of consciousness

Simple or complex partial seizures followed by impairment of consciousness

• Prolonged seizure or series of seizures (lasting > 30 min) 
• Very little recovery between attacks
• May be life threatening
• Medical emergency (generalized status epilepticus)

• Antiepileptic Meds (drugs may have significant ADRs) 
• Surgical intervention (drug resection, hemispherectomy)