EPILEPSY _Part 2_ Diagnosis شرج بالعربي :تشخيص الصرع

EPILEPSY Part 2 Diagnosis شرج بالعربي :تشخيص الصرع ============================================== Link to this lecture as pdf file: https://www.mediafire.com/file/ya0rkg... ========================================================================== Lecture outline 1-Clinical features 2-Diagnosis Clinical features Generalised seizures(Grand Mal ) Tonic–clonic seizures 1-An initial ‘aura’ may be experienced by the patient, depending on the cortical area from which the seizure originates 2-The patient then becomes rigid (tonic) and unconscious, falling heavily if standing (‘like a log’) and risking facial injury. During this phase, breathing stops and central cyanosis may occur. 3-Jerking (clonic) movements emerge for 2 minutes at most. 4- Afterwards, there is a flaccid state of deep coma, which can persist for some minutes. 5-On regaining awareness the patient may be confused, disorientated and/or amnesic(post ictal state). During the attack, urinary incontinence and tongue-biting may occur. A severely bitten, bleeding tongue after an attack of loss of consciousness is pathognomonic of a generalised seizure Typical absence seizures (Petit Mal ) This generalized epilepsy almost invariably begins in childhood. There is loss of awareness and a vacant expression for less than 10 seconds before returning abruptly to normal and continuing as though nothing had happened. Apart from slight fluttering of the eyelids , there are no motor manifesttions. Each attack is accompanied by 3Hz spike-and-wave EEG . Typical absence seizures (Petit Mal ) Patients often do not realize they have had an attack but may have many per day. Typical absence attacks are never due to acquired lesions such as tumours; they are a manifestation of primary generalized epilepsy. Children with absence seizures may go on to develop generalized convulsive seizures. Absence seizures are often confused with temporal lobe seizures causing transient alteration of awareness. Myoclonic, tonic and atonic seizures Myoclonic seizures or ‘jerks’ take the form of momentary brief contractions of a muscle or muscle groups: for example, causing a sudden involuntary twitch of a finger or hand. They are common in primary generalized epilepsies. Tonic seizures consist of stiffening of the body, not followed by jerking. Atonic seizures involve a sudden collapse with loss of muscle tone and consciousness. Focal seizures A focal seizure is caused by electrical discharge restricted toa limited part of the cortex of one cerebral hemisphere. Focal seizures are further characterized according to whether or not there is: • Aura, e.g. smell or auditory hallucination, déjà vu, fear, visual distortion, sensory symptoms such as tingling, abdominal rising sensation• Motor features, e.g. one limb jerking (a Jacksonian seizure)• Loss of awareness or responsiveness, e.g. in many temporallobe seizures. Focal seizures may spread after a few seconds, due to failure of inhibitory mechanisms, to involve the whole of both hemispheres, causing bilateral tonic–clonic seizure