EPILEPSY

PRESENTED BY

SOORAJ .V. NAIR

BVM 08112 BATCH-D

EPILEPSY: Disorder of brain characterised by recurring seizures. SEIZURES: Manifestation of abnormal brain function. Paroxysmal stereotyped behaviour .

CONVULSION: Seizures with generalised motor component.

SYNCOPE: Transient loss of consiousness caused by ischemia of the brain. Common cause is cardiac arrhythmia.

EPILEPSY

 Altered behavior PRE ICTUS(AURA) Varying sensation Actual seizure Considerable variation(1 to 2 min) Return to normal Lethargic, restless, confused

ICTUS

POST ICTAL

SEIZURES

Seizure in dogs are more frequently seen

Aura and post-ictal are in no relationship to severity

Some of the behaviour changes :

Loss of memory Altrn. of muscle tone Altrn. Of sensation (V, A, O) Disturbances of autonomic CNS(S, U, D) Other psychic manifestations and abnormal moods.

2 categories
Originates in a circumscribed area of brain Those which involve 2 cerebral hemispheres bilaterally& synchronously . Seizure genesis : focal seizure +spread of abnormal activity to other areas of brain. Spread causes generalised cerebral dysrhythmia.

PATHOPHYSIOLOGY

CLASSIFICATION

Partial Based on seizures clinical Generalised signs: seizures

TWO TYPES

MECHANISM:
Reduction of dendrite or excitation potentiated by aspartate and glutamate Alteration of GABA inhibiton involved Gen. Seizures can be generated in ant individual by pharmacologic, metabolic, or electric changes.

1.tonic/clonic (grand mal, major motor) 2. Absence or petit mal seizures

GENERALISED SEIZURE

TONIC SEIZURES
Most frequent in animals. Preceded by an aura; animal actually falls and becomes unconsciousness, limbs extended rigidly, ophisthotonus, apnea. Running or paddling activity Chewing movement of mouth common VISCERAL ACTIVITY: S,U,D, pupillary dilatation Ictus : 1-2 min Post ictal phase: confusion, disorientation, blindness

Violent seizure- Just take a look >

DIAGNOSIS
Clinicians diagnose by 1. History 2. Any focal motor activity History: frequency of occurrence with chewing, forced turning of head, clonic jerk movements. Any focal motor activity focal seizures Thus generalises secondarily. Uncommon in animals Brief loss of contact but without motor activity.

PARTIAL SEIZURES
Activity of local seizure focus in an area producing motor activity.

Movements- restricted to one part of body face or limbs Focal component-seizure onset-key differential feature.

Show abnormal EEG abnormalities

Indicative contralateral cerebral hemispheres: (e.g rt. Cerebral cortex to left thoracic limb seizures)

DISEASES
1.IDIOPATHIC(GENETIC):
Primary genrn. epilepsy has no pathologic cause and may be inherited. Occurs in the form of clonic / tonic seizures E.g., breeds :Beagle, Daschund, GSD, Aberdeen angus cattle, Brown swiss cattle. Diagnosis done by excluding all other causes. Breed, age & history suggests diagnosis.

2. DEGENRATIVE:
Deficiencies in specific enzymes cause abnormal cellular metabolism with accumulation of metabolic products within the neurons . These storage diseases may produce seizures as one part of the clinical syndrome. Diagnosed by breed & biopsy tests.

3. DEVELOPMENTAL
May or may not be inherited. Distinguished from primary epilepsy by involving pathologic changes in the brain. Hydrocephalus is the most common condition.

4.INFECTIOUS
Any infectious has the potential to develop seizures when it invades the CNS. E.g., CD, Rabies, Toxoplasmosis, IBRT, Pseudo rabies & bacterial diseases of any type.

5.METABOLIC
Failure of endocrine glands or glucose or accumulation of toxic products.\ Hypoglycemia, Hypocalcemia, renal failure, ketosis(B) .

6.NEOPLASTIC:
Intracranial neoplasia, Activity is normal in neurons adjacent to neoplasms with insufficient blood supply . Brain tumors in old dogs common.

7.NUTRITIONAL:
B-complex vitamins are most frequently incriminated. Thiamine deficiency : (B)-Polioencepahalomalacia, cats-head ataxia,dilated puplis,coma. Treatment :50 to 100 mg i/v

8.TOXIC:
Lead poisoning, strychnine, organophosphate and insecticides

9.TRAUMATIC:
Seen immediately after head trauma. Post traumatic seizures occur after head injury depending on the brain lesion.

DIAGNOSIS AND MANAGEMENT

Data base useful for a diagnosis and management

Data base to include: History, patient details, frequency, time etc.

Informati on from the minimum data base

1. Definitive diagnosis 2. Possible cause requiring further tests 3. No suggestion of cause

Syncope is caused by loss of blood supply to brain or hypoglycemia Cardiac arrthymia common

TREATMENT
DOGS: Phenobarbital is the initial drug of choice for dogs and cats. Dose:2.55mg/kg b.wt.
If seizures not controlled in 2 weeks. Use of potassium bromide at a dosage of 40mg/kg once in a day addition to phenobarbital. Clonazepam may be used when KBR reaches therapeutic levels.

CATS: phenobarbital and diazepam :0.5-1mg/kg single or combined .

 A condition of rapidly recurring convulsions without complete recovery between seizures. A serious emergency which result in death of the patient.

Protocol for treatment:

1.Stop seizure .Administer diazepam 10-50mg in 10mg boluses. Then phenobarbital or clonazepam given. 2. Ensure ventilation. RL given. 3.Thiamine in 0.5-1g doses several times for ruminants and cats. 4.If hypocalcemia ,calcium i/V given and monitor heart rate. 5.Cool the body temperature.Thus controlled

STATUS EPILEPTICUS: