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

ABSCESS

ABSCESS

THE DEFINITION;

• Collection of pyogen material that is wrapped by a capsule, which is located in the parenchim the brain

• Abscesses occur when pyogen cerebri bacteria reach the CNS as a direct invasion of otitis media, mastoiditis, the nasal sinusitis. An abscess is a rare complication cerebri of pyogen meningitis.

THE ETIOLOGY

The evolution of the abscess cerebri;

1. Cerebritis, is an infection that revolve around the white matter oedema.

2. core cerebritis became enlarged and necrosis, capsul fibroblasts begin to form.

3. the capsule being formed perfect, with the proliferation of fibroblast proliferation, surrounded astrocyt and edema.

4. abscess becomes ripe, thick capsule around the cavum central containing debris and PMN.

The time it takes 14 days

CLINICAL OVERVIEW

• More common are at the frontoparietal and temporal, about 13% with abscesses that multiple.

• The most common Symptoms are fever, headache, coma and focal neurological deficit marks, but may also be without signs of infection but with signs of the presence of a tumor.

• may also be occurring seizures, SIADH, fontanella convex and enlarged head circumference in children

COMPLICATIONS

-Herniation

-Seizures

-rupture of an abscess on the sub arachnoid space and ventricle → Meningitis.

DIFFERENTIAL DIAGNOSES

• intra cranial tumors

• meningitis

• Chronic SDH

• sub dural empiyema

• infarction cerebri

• Tuberkuloma

• Sub acute Stroke

• Radiation Necrosis ok

• Encephalomalacia

• Disseminated encephalomyelitis

• Herpes encephalitis

DIAGNOSTIC PROCEDURES

• Signs of infection

• LP to be avoided

• MRI:

Hipointense areas surrounded by hiperintense on T2 or FLAIR

-Informs the contras enhancement

• CT Scanà ring hipodense area with contrast enhancement

• Culture bacteri feature of abscess

PICTURE OF AN ABSCESS ON MRI

(ROOS, 2010)

THERAPY

• Antibiotics administered for 4-6 weeks

• Evaluation of imaging to look at the size of abscess

• Surgery may be either biopsy or excision abscess

• Corticosteroids may inhibit the absorption of antibiotics and formation of capsule

• The mortality rate 40%

Therapy

Infection Source	Causative Organism	Antibiotic
Ear, mastoid, Sinus	Anaerobes,b Pseudomonas aeruginosa, Streptococcal Sp, enterobacteriaceae	Metronidazole 7.5 mg/kg iv every 6 hours Plus Cefepime 2 g iv every 6 hours or meropenem 2 g iv every 8 hours
Lungs	S Pneumonia	Same as above
Teeth, mouth	Streptokokkus anaerob, Eikenella dan Prevotella	Metronidazole 7.5 mg/kg every 12 hours Plus Pennicillin G 4 million units iv every 4 hours or ceftrizoxime 3 g iv every 6 hours
Postoperative, decubitus, atau furuncel	Staphylococcus aureus S epidermidis,	Cefepime 2 g every 8 hours or oxacilline nafcillin or 2 g every 4 hours
	MRSA	Linezolid 600 mg iv every 12 hours