Epilepsy-FacultyofMedicine,MasarykUniversity.pptVIP

Epilepsy ?Once sacred disease“ Milan Brázdil 1st Department of Neurology Medical Faculty and St. Anne Hospital Definition A chronic neurologic disorder manifesting by repeated epileptic seizures (attacks or fits) which result from paroxysmal uncontrolled discharges of neurons within the central nervous system (grey matter disease). The clinical manifestations range from a major motor convulsion to a brief period of lack of awareness. The stereotyped and uncontrollable nature of the attacks is characteristic of epilepsy. Pathogenesis The 19th century neurologist Hughlings Jackson suggested “a sudden excessive disorderly discharge of cerebral neurons“ as the causation of epileptic seizures. Recent studies in animal models of focal epilepsy suggest a central role for the excitatory neurotransmiter glutamate (increased in epi) and inhibitory gamma amino butyric acid (GABA) (decreased) Epidemiology and course Epilepsy usually presents in childhood or adolescence but may occur for the first time at any age. Newborns Early school age Adolescents Seniors Epidemiology and course 5% of the population suffer a single sz at some time 0.5-1% of the population have recurrent sz = EPILEPSY 70% = well controlled with drugs (prolonged remissions) 30% epilepsy at least partially resistant to drug treatments = INTRACTABLE (FARMACORESISTANT) EPILEPSY. Epilepsy versus epileptic syndromes Epilepsy is not a nosological entity – not one disease! Not unique aetiology... Might be a symptom of numerous disorders – symptomatic epilepsy (TBI, tumours, inflammation, stroke, neurodegeneration, ...) Sometimes the cause remains unclear despite careful history taking,examination and investigation! Epilepsy - Classification The modern classification of the epilepsies is based upon the nature of the seizures rather than the presence or absence of an underlying cause. Seizures which begin focally from a single location within one hemisphere are thus distinguished from those of a genera