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Epilepsy (Causes (Anoxia (low oxigen), neoplasms (tumor), 75% not found,…
Epilepsy
Causes
75% not found
Drugs/alcohol
Anoxia
low oxigen
neoplasms
tumor
Congestional disorders
Head trauma
Vascular disease
CNS Infection
Age of onset important
Genetics
Seizure
Consequence of paroxysmal uncontrolled discharge of neurons
From major motor convulsion to brief lack of awareness
Phases
Prodome
changes before attack
Aura
symptom immetiately before seizure
Itcus
Attack
Postictal period
confusion/disorentation/automatic behavior
Focal seizure
Glutamate
depolarization
5% will have 1
0,5% recurrent
70% controlled by drugs
Types
Focal
Partial
Simple
Motor
Sensory
Autonomic
Complex
Impaired consciousness
temporal lobe
Can evolve Tonic/clonic convulsions
Site of onset
Lobes
Generalized
Abscences
Mostly in children
Other
Clonic
Tonic
Atonic
Myoclonic
brief sudden muscle contractions
Tonic/clonic
Tonic phase
Unconsciousness
Contraction
Clonic phase
Jerking
Bilateral
Unclassified
New system
Focal
aware
non aware
Generalized
Location determines symptoms
Treatment
Drug therapy
Anticonvulsants
Monotherapy
Polytherapy
Not preferred
Interactions
Inhibiting exitation
Inhibition
Withdrawal after 3 years of no attacks
Common drugs
Carbamazepine
Sodium valproate
Phenytion
Phenobarbitone
Lamotrigine
Gabapentin
Topiramate
Tiagabine
Zonisamide
Oxcabrazepine
Levetiracetam
Side effects
Surgery
Vagal nerve stimulation
Treating cause
Deep brain stimulation
Lifestyle
Prevention
Diagnoses
Recognition of types
EEG
Not always conclusive
Different types
Abscent or tonic clonic
Focal vs generalized
After 25 MRI
More than 1 seizure
Look for underlying cause
Consequences
Social
Stigmatization
Unemployment
Dependence on support
Psychological
Neuropathologies
Low self worth
Icatal fear and anxiety
Psychological disorder
Neuropsychological
disruptive neuronal discharge
Learning problems
sustained attention
Early epilepsy
Lower mental abilities
More drugs
cummulative effect
Transitory cognitive impairment
results in inercital cognitive/behavioral changes
Drug side effects
cognitive consequences
Polytherapy negative
Monotherapy positive
Influencial factors
Etiology
Age of onset
earlier = worse
type
Generalized worse
duration
severity
hereditary/psychosocial factors
Fequency
Seidenberg
Cognitive decline
Progressive decline in cognition
Lack of practice effect
Biassed groups (unresponsive to treatment)
Duration of epilepsy best predictor
Piccinelli
Longdituninal study of newly diagnosed children
Mild educational problems (11%)
Attentional disorders
12 months later most unchanged or improved
behavioral disturbance/psychological context correlate to cognitive difficulties
Epilepsy subtypes
Idiopathic
abscence of other diseases
Genetic
Childhood abscent
Absent seizures
Juvenile
Myoclonic
10-20%
Symptomatic
Tumor, infection
30-40%
Cryptogenic
Unknown cause
50%
More than 1 seizure