Epilepsy 2017 Text

Epilepsy
István FEKETE
2017.
Epilepsy
Epileptic seizures:
an abnormal and excessive discharge
of brain neurons involving
hypersynchrony accompanied by
some behavioral change.
Definition of epilepsy
• Epilepsy: – two or more seizures
– occur in attacks
– the behavioural changes
are usually stereotyped
– epileptiform abnormalities
on EEG
• Acute and recurrent seizures, status
epilepticus, occasional convulsion
Epidemiology of epilepsy
1. The prevalence within a particular

population: 0,3-0,6-1,0%. In children: >1%
2. Man/woman: 1,1-1,7
3. The incidence: 0,4-0,7-1,0‰ /year
4. The chances of having at least one
seizure during a lifetime: 8-10%
New classification of epilepsy (ILAE, 2017)
Epilepsia
8 MAR 2017 DOI: 10.1111/epi.13709
Classification of epileptic seizures
1. Partial (focal, local) seizures

1.1. Simple partial seizures
• with motor signs
• with somatosensory or special
sensory symptoms
• with autonomic symptoms
• with psychic symptoms
1.2. Complex partial seizures

• Simple partial onset followed by
impairment of consciousness
- only with impairment of
consciousness
- with automatism
• With impairment of consciousness at
onset
1.3. Partial seizures evolving to secondary

generalized seizures
• Simple partial seizures 
• Complex partial seizures 
• Simple partial seizures  Complex
partial seizures 
2. Generalized seizures
Absence seizures (typical and atypical)
Myoclonic seizures
Clonic seizures
Tonic seizures
Tonic-clonic seizures
Atonic (astatic) seizures
3. Unclassified epileptic seizures
Situation-related seizures
• Febrile convulsions
• Seizures occurring only with an acute
or toxic event, due to factors such as
alcohol, drugs, eclampsia, nonketotic
hyperglycaemia
Pathophysiology and
neurobiochemistry of epilepsy
 The role of ION channels: Na+, Ca2+, Cl- and

GABA receptor system and the glutamate
(NMDA) receptors:
some antiepileptics have effect on the closing

and the opening mechanism of the Na-
channel, prolonging the refractor time.
Pathophysiology and
 GABA : The most important inhibitor

neurotransmitter of the brain on the GABA
A-Benzodiazepine-Phenobarbital- receptor
complex, controlling the opening and closing
mechanism of the Chloride-channel.
 GABA B-receptor connects to the K+-ion
channels and influences the NMDA mediated
excitability.
Pathophysiology and
 GABA hypofunction causes seizure. The

GABA agonists can protect (valproate,
vigabatrin, tiagabine).
Developmental cortical
malformations with epilepsy
• Pachygyria, heterotopia (nodular),

lissencephaly
• polymicrogyria, shizencephaly, cortical
dysplasia (gliosis),microdysgenesis
Developmental cortical
malformations with epilepsy
2. Malformations due to abnormal neuronal

and glial proliferation:
microencephaly, non-neoplastic (tuberous
sclerosis), neoplastic (ganglioglioma)
3. Neurocutaneous disorders: Sturge-Weber
syndrome, neurofibromatosis
4. Others: subarachnoid cyst, porencephaly
Etiologies of epilepsy
genetic factors
• The concordance rate in monozygotic
twins: >70%, in dizygotic twins: 15%
• Occurrence of epilepsy in relatives

In idiopathic epilepsy: 1.3 - 8%
In symptomatic epilepsy: 0.5 - 5%
In normal population: 0.5%
Etiologies of epilepsy
genetic factors
• Known genes associated with epilepsy:
6p, 16p, 1q, 8q, 10q, 20q, 21q,
mitochondrial DNA disorder: MERRF
• Epilepsy may occur in 141 genetically

determined neurological diseases
Diagnosis of epilepsy
• Seizures are diagnosed primary by the

history (anamnesis, heteroanamnesis)
• Laboratory tests, ECG (Holter), Doppler
examination of supraaortic arteries,
examination of CSF, toxicology
EEG: routine, sleep

deprivation, photic
stimulation, HV, digital
analysis of power
spectrum, sphenoidal
recording, Holter EEG,
split screen EEG
(video+EEG)
LORETA (A low resolution electromagnetic tomography)
• Neuroimaging
MRI, (CT scan), SPECT, PET
• Genetic examination
• Psychological, psychiatric examination
Nonepileptic paroxysmal disorders
 Cardiovascular
Syncope
Breath-holding spells (cyanotic, noncyanotic)
Mitral valve prolapse
 Cerebrovascular (transient ischemic attack)
 Migraine
 Movement disorder
Tics, Tourette’s syndrome

Myoclonus
Chorea and paroxysmal choreoathetosis
 Sleep disorders
Narcolepsy
Sleep terrors and somnambulism
Rapid eye movement (REM) sleep disorder
Benign sleep jerks
Periodic leg movements (nocturnal
myoclonus)
 Metabolic-toxic (e.g., pheochromocytoma, drug
ingestion)
 Gastrointestinal (vomitus, diarrhoea: disturbance of

ion levels
 Psychiatric
Psychogenic seizures
Somatization and dissociative disorders
Panic disorder
Intermittent explosive disorder
Malingering
Therapy of epilepsy
Sixty-seventy percent of patients are seizure
free on AE therapy and another 25 percent’s
are decreased
Phytoterápia
Status epilepticus
 After 5 min, after 10 min, should be stopped in an

hour
 Life threatening event
 Medication:
-first choice BDZ: lorazepam, diazepam, clonazepam
-IV. valproate, levetiracetam, lacosamide
-IV. phenytoin
-IV. propofol, midazolam
Surgical treatment of epilepsy
Ten percent to 15% of patients with refractory

seizures may be surgical candidates.
The aim of surgery is
 to remove the focus of origin of the seizures
 or to prevent spread of the seizure discharge
 DBS (deep brain stimulation)
VNS
Presurgical evaluation
 Patient selection
 Clinical evaluation
 EEG (interictal recordings, ictal recordings to
document seizure onset, EEG/video telemetry
monitoring is required, intracranial EEG recording:
epidural electrodes subdural strip electrodes, IC
electrodes)
 Neuroimiging (MRI, SPECT, PET, functional MRI)
 Neuropsychological Psychiatric Assessment
Subdural records
Surgical procedures
 Lesionectomy (dysplasia, ganglioma, low grade

gliomas, vascular anomalies, neuronal
migration, in presence of mesial-temporal
sclerosis)
 Selective amygdalohippocampectomy (focal

mesio-temporal sclerosis)
Surgical procedures
 Anterior temporal lobectomy (amygdala,

anterior hippocampus, anterior temporal
neocortex)
 Hemispherectomy (Sturge-Weber syndrome,
Lennox-Gastaut Syndrome)
 Corpus callosotomy (anterior two-thirds or
complete; atonic seizures, Lennox-Gastaut
syndromre)
 Multiple subpial transection
Temporal lobectomy

Epilepsy 2017 Text

Uploaded by

Copyright:

Available Formats

Epilepsy 2017 Text

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Epilepsy 2017 Text

Uploaded by

Copyright:

Available Formats

Epilepsy

1. The prevalence within a particular

1. Partial (focal, local) seizures

1.2. Complex partial seizures

1.3. Partial seizures evolving to secondary

 The role of ION channels: Na+, Ca2+, Cl- and

some antiepileptics have effect on the closing

 GABA : The most important inhibitor

 GABA hypofunction causes seizure. The

• Pachygyria, heterotopia (nodular),

2. Malformations due to abnormal neuronal

• Occurrence of epilepsy in relatives

• Epilepsy may occur in 141 genetically

• Seizures are diagnosed primary by the

EEG: routine, sleep

 Cerebrovascular (transient ischemic attack)

Tics, Tourette’s syndrome

 Gastrointestinal (vomitus, diarrhoea: disturbance of

 After 5 min, after 10 min, should be stopped in an

Ten percent to 15% of patients with refractory

 Lesionectomy (dysplasia, ganglioma, low grade

 Selective amygdalohippocampectomy (focal

 Anterior temporal lobectomy (amygdala,

You might also like