Seizures Tutor Professor V Wong Presentation by Daniel
Seizures Tutor: Professor V. Wong Presentation by: Daniel Tsang, Dragon Man, Michele Yuen
Outline of Presentation 1. Some basic terminologies 2. Brief overview of seizures 3. Video demonstrations
Part 1: Basic Terminologies
Some stuff you probably know already… § Epilepsy: § group of syndromes § characterized by paroxysmal transient disturbances of the brain function § Seizure: a single episode of epilepsy
Consciousness § Consciousness: awareness or responsiveness to external stimuli § Awareness: contact with events during the period in question § Responsiveness: ability to carry out simple commands or willed movement
Drowsiness or somnolence § Drowsiness or somnolence: sleep state from which the patient can be aroused to make appropriate motor and verbal responses § Stupor: state from which the patient can be aroused by painful or other vigorously applied stimuli to make avoidance movements
Aura § component of seizure which occurs before consciousness is lost and for which memory is retained afterwards § In seizures that occur without lost of consciousness, the aura is the whole seizure
Automatisms § Involuntary motor activity occurring during the state of clouding of consciousness either in the course of, or after an epileptic seizure § Continuation of an activity that was going on when the seizure occurred vs. new activity developed in associated with the ictal impairment of consciousness § Related to discharge in the limbic system
Types of Automatisms 1. Eating automatisms → Absence seizures 2. Automatisms of mimicry Complex partial + 3. Gestural automatisms absence seizures 4. Ambulatory automatisms 5. Verbal automatisms
Part 2: Brief overview of seizures
Classification of seizures Seizure Partial Simple 1. 2. 3. 4. 5. Motor Somatosensory Special sensory Autonomic Psychic Complex Generalized Secondarily Generalized 1. Simple partial at 1. Simple to generalized onset 2. Complex to 2. Impairment of generalized 3. consciousness at 3. Simple to complex to onset generalized 1. 2. 3. 4. 5. 6. Absence Myoclonic Clonic Tonic-clonic Atonic
Partial seizures Consciousness Hemispheric involvement Simple partial seizure Intact Unilateral; Bilateral involvement rare Complex partial seizure Impaired Primarily unilateral; often bilateral in course of seizure
Simple partial seizure Several types: 1. With motor signs 2. With somatosensory or special sensory symptoms 3. Seizures with autonomic symptoms 4. With psychic symptoms
Simple partial seizures with motor signs § Strictly focal § Spread to contiguous cortical area → sequential involvement of body parts § “Epileptic march” / Jacksonian seizure § Presentations: § Head turns to one side (usually contralateral to discharge) § Speech arrest / vocalization § Epileptic palilalia § Todd’s paralysis § Epilepsia partialis continua
Simple partial seizure with somatosensory or special sensory symptoms § Somatosensory § “pins-and-needles / numbness § Proprioception or spatial perception disorders § Special sensory § Visual: flashing lights, structured visual halluncinations § Auditory: crude auditory sensations, highly integrated functions (e. g. music) § Olfactory: unpleasant odours § Gustatory: crude (salty, sour, sweet, bitter), sophisticated (‘metallic’) § Vertiginous: falling in space, floating, totatory vertigo
Simple partial seizures with autonomic symptoms § Vomiting § Pallor § Flushing § Sweating § Piloerection § Pupil dilatation § Borborygmi § Incontinence
Simple partial seizure with psychic symptoms § Dysphasia: motor, sensory, global aphasia § Dysmnesic: distortion of time sense, deja-vu, § § jamais-vu, deja-entendu, jamais-entendu, panoramic vision Cognitive disturbances: dreamy state, distortion of time sense, unreality, depersonalization Affective: extreme pleasure or displeasure, fear, anger, rage Illusions: objects appear deformed Structured hallucination
Complex partial seizure § Gradual impairment of consciousness (c. f. abrupt impairment in absence seizures) § Presentations: § Limited to impairment of consciousness § With additional psychic, motor and autonomic symptoms
Complex partial seizure - Types Complex partial seizure Temporal Extratemporal Start with an empty stare + Clouding of consciousness ↓ Automatism (oral, mimic, gestural, verbal) Frontal type: Fronto-cingular epilepsy
Generalized seizures
Absence seizures § Sudden in onset, interruption of ongoing activities, blank stare § Non-responsive § Vanish in second § Atypical § Can associate with other components § Tonus, clonus, automatism
Myoclonic seizures § Sudden, brief § Generalized to individual muscle group § Ddx § Spinal cord, brainstem and cortices lesions
Clonic seizure § Generalized seizure sine tonic component § Postictal phase is usually short § May progress to tonic phase, clonic-tonicclonic seizure
Tonic seizures § Rigid, violent muscular contraction fixing the limbs in some strained position § Deviated eyes, head towards one side, alteration in posture § Pale, flushed and ultimately livid
Tonic-clonic seizures § Vague ill-described warning § Tonic phase: § Sudden, sharp, tonic contraction of muscles (+ stridor), cyanosis § Fall on ground, tongue bitten, urine incontinence § Clonic phase: § Grunting § drooling § Deep respiration, all muscle relax, remain unconscious for variable time, § Awake with soreness and drowsiness, deep sleep
Atonic seizures § Sudden reduction in muscle tone § Head drop, slacking of jaw, dropping of limb or slumping to the ground § Drop attack § Ddx: brainstem ischaemia, narcolepsy
Part 3: Video Demonstrations
CS 2 § D: HMR_ROM 1AVICS 2. AVI
CS 2: Simple partial seizure with motor signs and march § No loss of consciousness § Rhythmic twitching of the fingers of the left hand, spreading through arm to shoulder § He held his affected hand § Simple partial seizure with motor signs § Focal
CS 12 § D: HMR_ROM 1AVICS 12. AVI
CS 12: Simple partial seizure with psychic symptoms and dysphasia § With dysphasic symptoms § Clicking of tongue, mumbling incomprehensible words and smiles § Fully understand commands but unable to speak properly
CS 15 § D: HMR_ROM 1AVICS 15. AVI
CS 15: Complex partial seizure, simple partial onset, impairment of consciousness § Slight loss of postural tone § Preserved orientation reflex § Impaired consciousness
CS 17 § Patient was asked to hyperventilate in the beginning § D: HMR_ROM 1AVICS 17. AVI
CS 17: Complex partial seizure vs generalized absence § Patient suddenly stopped hyperventilating § Motionless and blank facial expression § Regain consciousness with told nurse her had vague stomach sensation § EEG: localized right frontal activity pre and postictally favours a partial seizure
CS 19 § Patient with right frontal ganglioma § D: HMR_ROM 1AVICS 19. AVI
CS 19: Complex partial seizure, impairment of consciousness at onset § Sudden sat up and started to roll about § Lying on his belly § Manipulated his genitals (frontal automatism)
CS 20 § D: HMR_ROM 1AVICS 20. AVI
CS 20: Simple partial seizure with secondary generalization § Left arm started jerking § Still responsive § Coarse jerking of arms, stretching of back, tonic contraction of face, open mouth § Loss of consciousness § Twitching of all limbs and head § Relaxation and postictal sleep
CS 23 § D: HMR_ROM 1AVICS 23. AVI
CS 23: Typical absence seizure § Slight loss of tone in neck muscle when stop hyperventilation § Seizure started § Mild eyelid clonus § Regain responsiveness later
CS 29 § D: HMR_ROM 1AVICS 29. AVI
CS 29: Generalized atypical absence seizure § Head drop gradually § Not responsive § Later responded to staff and gradually regain upright position
CS 30 § D: HMR_ROM 1AVICS 30. AVI
CS 30: Generalized myoclonic seizure § Brief repetitive movements of the limbs
CS 32 § D: HMR_ROM 1AVICS 32. AVI
CS 32: Generalized clonic seizure § Opening of eyes and massive myoclonic jerks § Continuous clonic movement of limbs § Repetitive vocalization with clonic movement of the chest
CS 33 § D: HMR_ROM 1AVICS 33. AVI
CS 33: Tonic seizure § Gradual elevation of both hands and stopped walking § Took 2 steps and then passed urine § Bent body strongly forward but kept standing § Dropped handkerchief
CS 34 § D: HMR_ROM 1AVICS 34. AVI
CS 34: Tonic clonic seizure § Suddenly bent forward with extended arm and legs § Twitching in face and body § Tonic stretching of arms and legs
CS 35 § D: HMR_ROM 1AVICS 35. AVI
CS 35: Atonic seizures § Sudden relaxation of muscles § Head drop, floppy limbs and slumping to the ground
Some more videos if we have time Otherwise, THE END.
CS 27 § D: HMR_ROM 1AVICS 27. AVI
CS 27: Absence seizure § With automatism § Not necessarily specific for complex partial seizures
§ D: HMR_ROM 1AVICS 24. AVI
Absence with mild clonic component
§ D: HMR_ROM 1AVICS 26. AVI
Absence with tonic component § Head mainly affected
CS 3 § D: HMR_ROM 1AVICS 3. AVI
CS 3: Partial seizure with motor signs and march § Complex partial seizure → partial motor seizure with secondary generalization § Not a Jacksonian seizure: consciousness was impaired before the march starts
CS 4 § D: HMR_ROM 1AVICS 4. AVI
CS 4: Simple partial seizure with motor signs and versive movements § Sudden start of seizure from sleep § Version of trunk towards the right § Left arm bent at the elbow, fingers forcefully stretched § Right arm beats on arm of chair to warn nurse § Tonic contraction of face and eyes § EEG: not interpretable due to artifacts (pseudospike waves)
CS 13 § D: HMR_ROM 1AVICS 13. AVI
CS 13: Simple partial seizure with psychic, dysmnesic and affective symptoms and hallucinations § Happily talking § Deja-vu § Spontaneous hyperventilation § Facial expression of suffering with weeping and crying § No loss of contact; can give age, date and name of objects § Cries and yells; feels very bad and asks for help; weeps – affective sympoms
THE END Questions?
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