CLINICAL ASPECT OF PARTIAL EPILEPSY

CLINICAL ASPECT OF PARTIAL EPILEPSY

Depend on the involving brain area :

•   Convulsion

•   Conciousness disturbance

•   Behaviour

•   Visual, smell disturbance

Seizure type

Origin and spread of seizure

DIAGNOSIS of  EPILEPSY

·    Mainly → Ax  + witness

·    Physical EX

-    unrevealing.

-    to elicit

-    any cortical abnormality or dysfunction,

·    EEG

·    Neuro imaging

·    Dx epilepsy → sosial & economical impact

Generalized Tonic Clonic Seizure

 

 

Partial Seizure
Pathophysiology

·    Mostly -- a localized brain abnormality,

·    Idiopathic epilepsies

-    no apparent structural cause,

-    with seizures as

* the only manifestation

Causes of Seizure
Partial Seizure

Partial Seizure
Characterized by

·    seizures arising from a localized region of the brain.

·    cause is found  →  symptomatic.

·    imaging studies are normal, →  the cause remains elusive →  

   cryptogenic.

·    depends on → diagnostic and imaging techniques ..!

Partial Seizure
EEG

·    Interictal EEG shows → focal spikes or sharp waves, and

·    ictal EEG shows → a focal or regional discharge at onset.

·    Due to differences in

-    electroclinical semiology and

-    management,

·    localization-related epilepsies usually are divided into

-    mesiotemporal and

-    neocortical

Partial Seizure
The most common localization-related epilepsy

·    in adults is → mesiotemporal lobe epilepsy,

·    neonates & young children, → neocortical epilepsy.

Partial Seizure
Conciousness

·    Simple Partial Seizure →  intact

·    Complex Partial Seizure →  Impaired !!

Simple Partial Seizure

Complex Partial Seizure

·    an impairment of consciousness.

·    Automatism.

-    involuntary

-    coordinated motor activity,

-    purposeless and

-    repetitive

·    Common automatisms

-    lip smacking,

-    chewing,

-    fidgeting, and

-    walking.

Automatisme

Complex partial Seizure

Secondary  Generalized Seizure.

·    Prior generalization

-    SPS only,

-    CPS only,

-    SPS evolving into CPS.

·    Pt forgot  partial phase  !

-    Look like  general convulsion

-    Actualy

         * secondarily generalized tonic-clonic seizure

Partial Seizure
Mesial TLE

·    The common cause of TLE  epilepsy surgery in adults

-    hippocampal sclerosis,

·    while in children, etiologies are dominated by

-    cortical dysplasias and

-    low-grade neoplasms.

Mesial TLE
Sign & symptom

·    Seizures typically are

-    complex partial with automatisms,

-    often preceded by a simple partial phase with sensory 

   symptoms

-    ie, aura.

Mesial TLE
Auras commonly observed in

·    epigastric (abdominal) 

·    psychic auras, including déjà-vu or jamais-vu and fear.

Seizure Imitators