presentation that describe one type of epilepsy (complex partial seizures) based on a case scenario.

1. Complex Partial seizures

2. introduction
A 25-year-old
woman has a
history of black-
outs.
She had these
black-outs since
she was a child.
She is now
pregnant and she
would like to stop
taking her
medication.
when she was 8
years old her teacher
noticed the seizures.
The patient doesn’t
remember them.
These attacks takes
only few seconds.
And were frequent.
The EEG she had
was abnormal with
generalized spikes
and waves.
When she was 14,
she had a different
kind of episodes
with tinnitus and
everything going
black.
She can feel the
attacks coming.
She feels tired
after the attack.
The EEG reveals
no abnormality.Absence
seizures ?

3. Based on the characteristics of the
attack she had:
• Aura “ I can feel it coming “
• Sometimes this attack occurs during sleep ( kick
her husband)
• The duration of the attack (5-10 min)
• The frequency of the attack ( 1 or 2/ year)
• She feel tired and confused after the attack
• Tinnitus or ringing during the attack

4. Learning Objectives:
• What’s Complex Partial seizure ?
• How the seizure happens?
• Etiology
• Clinical manifestation
• Diagnostic evaluation
• Treatment
• Prevention
• Case questions

5. Why is it important to study epilepsy ?
• There are around 40 different types of seizure
and a person may have more than one type.
• Epilepsy can affect anyone, at any age and
from any walk of life.
• Around 5 people in every 100 will have an
epileptic seizure at some time in their life.
Out of these five people, around four will go
on to develop epilepsy.
• Epilepsy affect nearly 50,000,000 people
worldwide.
• Epilepsy imposes an annual economic burden of
$15.5 billion.

6. Typesofepilepsy: epilepsy
partial
simple
Complex
Secondary
generalized
generalized
Absencec
Tonic
Tonic-
clonic
Atonic
Myoclonic

7. Complex Partial seizures
• is an epileptic seizure that is associated with
unilateral cerebral hemisphere involvement and
causes impairment of consciousness, it occurs in
all age groups.
• This type of seizures was previously know as
psychomotor epilepsy , or temporal lobe epilepsy.
It is due to a lesion or disturbance in the limbic
system usually in the temporal lobe, and sometimes
in the frontal lobe.

8. Complex Partial seizures cont…
• complex partial seizures are called "complex"
because they impair consciousness and "partial"
because they begin in a limited area of the brain
then spread to the whole brain hemisphere.

9. How the seizure happens?
• Normally brain neurons pass signals among
themselves using both electrical current and
chemicals.
• In a seizure, the brain's electricity is not
passed in an organized way from one neuron to the
next, but spreads over a cluster of cells or the
whole brain hemisphere all at once.

10. Etiology
• In the majority of cases,
complex partial seizures are of unknown etiology.
• Potential causes include the following:
 perinatal lesion (e.g. temporal sclerosis).
 congenital developmental anomalies, trauma,
and brain tumors.

11. Clinical manifestation
the episodes are often
preceded by
a seizure aura. The aura may
manifest itself as a feeling
of déjàvu , fear,
euphoria or depersonalization.
The seizure aura might also
occur as a visual disturbance,
such as tunnel vision or a
change in the size of objects
(macropsia or micropsia).
Aura

12. Clinical manifestation cont...
• Complex partial seizures have:
sensory, behavioral, psychomotor , and
autonomic manifestations.
• Which of theses manifestation will be
present in the patient depend on the prices
location of the epileptic focus.
• The manifestation could be very mild in
some patients, and very sever in others.

13. Sensory
disturbances
• dizziness
• Gustatory
sensations
• Unpleasant
olfactory
sensations.
Autonomic
disturbances
• Shortness of
breath
• Palpitations
• Nausea
• Salivation or
dry mouth
• Hunger
• Urge to
urinate
Behavioral and
psychomotor
disturbances
• Traumatic
experience
• Feeling of
unreality
• Anxiety
• Rage
• Hallucinations.

14. Clinical manifestation cont...
• The seizure begins suddenly, Then the
patient loses awareness and stares blankly,
makes chewing and swallowing movements, or
perform other purposeless actions. These
movements are called "automatisms"
• The seizure usually last between 30 seconds
and 5 minutes. Afterward, the person may be
tired or confused for about 15 minutes and
may not be fully normal for hours.

15. Diagnostic evaluation
• Complex partial seizure activity can
generally be diagnosed from its typical
clinical picture.
• The EEG reveals temporal slow waves or
spikes.
But in the interictal period, however, it
is usually normal.

17. Treatment
• the treatment line for Complex
partial seizure is anti-epileptic
medications.

18. anti-epileptic drugs:
• Drugs which decrease the frequency and/or
the severity of the epilepsy.
• Treat the symptoms of the seizures not the
underlying condition.
• Their goal is to maximize the quality of
life by minimizing seizures.

19. anti-epileptic drugs cont…
• The drugs of choice in complex partial
seizures are:
Carbamazepine
ValporateLamotrigine

20. • Pregnancy category D
• Side effects :Drowsiness, loss of
coordination , Leukopenia,
hepatotoxicity, and increased risk
of teratoginicity.
Carbamazepine
• Pregnancy category D
• Side effects: Hepatoxicity, GI
irritation, weight gain, hair
loss.
• Highest risk of congenital
malformation.
Valporate
• Pregnancy category C
• Side effects: nausea, dry mouth,
constipation , skin rash
Lamotrigine

21. PreventionPreventepilepsy
Idiopathic
epilepsy is not
preventable.
Adequate perinatal
care can reduce
new cases of
epilepsy
Preventing head
injury to prevent
post-traumatic
epilepsy.
Preventseizures
Take the
prescribed
medications at
time without
missing doses.
Avoid crowded
places
Avoid standing
up quickly.

22. stop the medication, yes or No ?
• The answer is No.
• In pregnant women with epilepsy usually the
risk of harm to the mother and fetus from
convulsive seizure itself outweighs the risk
of continued therapy.
• The best way to manage the situation is to:
 continue with a low dose of the prescribed
drug (Lamotrigine) 25 mg/day, because it
the safest drug.
 and a high dose of folic acid 5mg/day

23. • New researches reveals a shared genetic
susceptibility to epilepsy and migraine.
• people with epilepsy are substantially more
likely than the general population to have
migraine headache
• The patients who have migraine should take
some medication to relive that migraine
attacks.
Migraine and epilepsy.

24. Is epilepsy hereditary?
• certain types of epilepsy do seem to run in
families.
• People who have a generalized epilepsy seem
somewhat more likely to have other family members
with seizures than those with a partial epilepsy.
• However most people with epilepsy do not have any
relatives with seizures, and the great majority of
parents with epilepsy do not have children with
epilepsy.
• But in our patient situation, since her nephew has
epilepsy from birth that is affecting his
development, there is a chance that her baby will
have also epilepsy.

25. the patient in our case has an attacks since she
was 14 with the special characteristics such as:
aura , tinnitus, attacks during sleep, these attacks
takes 5-10 min.
Based on these characteristics we diagnose the
patient with complex partial epilepsy.
Since the patient is pregnant, she is not advised to
stop the medication, the proper treatment for her is
low dose of Lamotrigine, with high dose of folic acid.

26. References:
Books:
• Mumenthaler M, & Mattle H.(2002) Fundamentals of Neurology, an illustrated
guide.
• Courtenay M. (2012) British National Formulary.
• Bromfield EB, Cavazos JE, Sirven JI. (2006) An Introduction to Epilepsy.
• Kaplan PW, Fisher RS. (2005) Imitators of Epilepsy, second edition.
Websites:
• http://www.who.int//
• http://www.epilepsyfoundation.org
• http://emedicine.medscape.com
• http://www.ncbi.nlm.nih.gov//