Handwritten video lecture on Seizures and Epilepsy for USMLE Step1 and USMLE Step 2. Covering Classification, Signs and Symptoms, Diagnosis and Management.
Definition of seizure is the excessive discharge of neurons of the cortex.
PARTIAL SEIZURE
Partial seizure is focal lesion consisting of one side of hemisphere
Simple Partial Seizure patient remains concsious. Preictal phase of seizure consists of aura, similar to migraines and can be visual, auditory, smell or psychology. During the ictal phase of the seizure there is actual movement of the body part. Versive seizure is when the head turning, conjugate eye gaze. Post ictal phase of seizure doesn't exist.
Complex Partial Seizure patient is unconscious. Preictal phase of the seizure consists of loss of consciousness, aura, and automatism which are preprogrammed movements and this is common in this type of seizure. Ictal phase of seizure consists of automatism. It lasts longer the simple partial seizure and may lead to a generalized seizure.
GENERAL SEIZURE
Involves both sides of the hemisphere
Absence seizures consists of blank staring. Sudden cessation of motor activity, Flickering of the eyes and symptoms last less than 30 seconds. Characteristic EEG finding of this seizure is the 3Hz spike.
Tonic Clonic Seizure involves the whole body jerking. Preictal phase of the seizure consists of fever, aura, fever. Ictal phase of the seizure is the classic muscle contractions, incontinent, eyes roll back with loss of consciousness. Postictal phase of the seizure the patient is semi comatose and may want to sleep. Todd's paralysis consists of truncal ataxia, Decrease cognition.
Myoclonic seizures is associated with symmetric contractions of body with loss of body tone. Associated with Juvenile Myoclonic Epilepsy, MERRF, Lenox Gastaut.
Atonic Seizure is a sudden loss of muscle tone, very often confused with fainting, but they are actually having a seizure.
CAUSES OF SEIZURES
Any insult to the brain may cause seizures. Causes include Vascular, Infection, Trauma, Alzheimer, Metabolic disorders, Idiopathic, Neoplastic, Neurocutaneous disorders, Psychogenic.
In the younger age group there are other causes of seizures such as Febrile, MERFF, Lenox Geuset.
INVESTIGATION of SEIZURES
Diagnosis of epilepsy is 2 seizures with EEG.
Must do CT or MRI to rule our tumor
Also do electrolytes to rule out those causes of seizures
MANAGEMENT OF SEIZURES
If this is the first seizures rule out common causes such as febrile, acute. Educate the patient on how to deal when patient is having a seizure.
If seizure lasts less than five minutes than do nothing. But if last longer than 5 minutes than give rectal diazepam and go to ER.
If recurrence than refer to neurologist and EEG to diagnose possible epilepsy.