Seizure Disorders Disease

DESCRIPTION

A sudden alteration of behavior, characterized by a sensory perception or motor activity without or with change in awareness or consciousness, due to aberrant cortical electrical activity

Classification of seizures
- I. Partial seizures (seizures begin locally) - (A) without impairment of consciousness, (B) with complex symptoms (with impairment of consciousness)
- II. Generalized seizures (bilaterally symmetrical and without local onset)
- III. Unclassified epileptic seizures
System(s) affected: Nervous
Genetics: Three times the prevalence of seizures in close relatives of seizure patients
Incidence/Prevalence in USA:
- 1.5 million for epilepsy
- Annual incidence is 1.2/1000 for all types of seizures and 0.54/1000 for recurrent seizures
- The age-adjusted prevalence is 0.625% or 6.25/1000; isolated seizures may occur in 10% of the general population
- 10–20% of all patients have intractable epilepsy
Predominant age: All ages
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

General
- Fever – indicative of infectious etiology
- Focal neurologic finding – may indicate tumor or localized injury to the brain
- Papilledema – suggestive of increased intracranial pressure
- Hemorrhagic eye grounds – suggests underlying hypertension
- Meningismus – may be present with meningitis
- Headache – sometimes associated with infectious or hemorrhagic causes of seizures
Generalized seizures
- Absence – loss of consciousness or posture
- Myoclonic – repetitive muscle contractions
- Tonic-clonic – sustained contraction followed by rhythmic contractions of all four extremities
Partial seizures
- Simple – Focal seizures without alteration of awareness/consciousness
- Complex – Focal seizures with alteration of awareness/consciousness
Febrile seizures (see separate chapter on febrile seizures)
- Occurs between three months and five years of age
- Fever without evidence of any other defined cause for seizures
- If febrile seizures occur in the first year, the recurrence rate is 51%
- If febrile seizures occur in the 2nd year, the recurrence rate is 25%
- 88% of all recurrences of febrile seizures occur in the first 2 years
- The earlier the age of onset, the more likely repetitive febrile seizures will occur
- Recurrent febrile seizures probably do not increase the risk of epilepsy
Status epilepticus (see separate chapter)
- Repetitive generalized seizures without return to consciousness between seizures
- Considered a neurological emergency

CAUSES

Brain tumor
Cerebral hypoxia (breath holding, carbon monoxide poisoning, anesthesia)
Cerebrovascular accident (infarct or hemorrhage)
Convulsive or toxic agents (lead, alcohol, picrotoxin, strychnine)
Eclampsia
Exogenous factors (sound, light, cutaneous stimulation)
Fever (see chapter on febrile seizures)
Head injury
Heat stroke
Infection
Metabolic disturbances
Withdrawal from, or hereditary intolerance of, alcohol

RISK FACTORS

Susceptibility to seizures determined by a complex interplay between genetic factors and acquired brain disorders
Children delivered breech have a prevalence rate of 3.8% compared with 2.2% in children delivered vertex

LABORATORY

Serum tests – glucose, sodium, potassium, calcium, phosphorus, magnesium, BUN, ammonia
Anticonvulsant levels – inadequate level of anticonvulsant medication is the most common cause of recurrent seizures in children, and many adults
Drug and toxic screens – include alcohol
Complete blood count – helpful in evaluating infection

Drugs that may alter lab results:

Anticonvulsant therapy may dramatically affect the EEG results
Levels of anticonvulsants may be altered by a variety of common medications such as erythromycin, sulfonamides, warfarin, and cimetidine, as well as alcohol

Disorders that may alter lab results: Pregnancy decreases serum concentration. Frequent monitoring and dosage adjustments are necessary.

PATHOLOGICAL FINDINGS

None

SPECIAL TESTS

Electroencephalogram (EEG) – A negative EEG does not rule out a seizure disorder. Sensitivity, specificity, and predictive value of the test depend on the underlying cause and anatomic location of the seizure focus.
24-hour ambulatory EEG – allows for continuous monitoring of cortical activity during regular activities
Video-monitoring – useful in conjunction with simultaneous EEG monitoring in separating true events from pseudoseizures

IMAGING

MRI of brain – superior in evaluation of the temporal lobes
CT scan of brain – indicated routinely in work-up of tonic-clonic seizures

DIAGNOSTIC PROCEDURES

None

APPROPRIATE HEALTH CARE

Outpatient therapy except for status epilepticus

GENERAL MEASURES

Protect the patient's airway

SURGICAL MEASURES

N/A

ACTIVITY

As tolerated

DIET

Regular

PATIENT EDUCATION

Stress the importance of compliance with anticonvulsant therapy
Printed patient information available from: Epilepsy Foundation of America, 4351 Garden City Drive, Landover, MD 20785-2267, (800) EFA-1000

PREVENTION/AVOIDANCE

Maintain adequate epileptic drug therapy. Patient education on compliance.

POSSIBLE COMPLICATIONS

Drug toxicity

EXPECTED COURSE AND PROGNOSIS

Depends on the pathophysiology of seizure within a particular patient
Seizure activity may become quiescent. If a patient has been seizure-free for two years, withdrawal of therapy may be considered. Relapse rate after three years of being off medications is 33%.

ASSOCIATED CONDITIONS

Infections
Tumors
Drug abuse
Metabolic disorders

AGE-RELATED FACTORS

Pediatric: Breastfeeding is not contraindicated in mothers receiving epileptic medication, although drug concentration in the infant may require monitoring if problems such as sedation occur
Geriatric: N/A
Others: N/A

PREGNANCY

Serum levels of anticonvulsants may decline, frequent monitoring recommended. There is a two-fold increased risk of congenital malformation in mothers taking anticonvulsant medication

OTHER NOTES

Jacksonian epilepsy - characterized by unilateral clonic movements that start in one group of muscles and spread systematically to adjacent groups, reflecting the march of epileptic activity through the motor cortex. Usual course - chronic; recurrent; intermittent.

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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