Академический Документы
Профессиональный Документы
Культура Документы
Ivan Nugroho
LO 1
Menjelaskan kejang secara umum
Definisi, etiologi, patofisiologi, klasifikasi
Definition
instantaneous loss of consciousness, alteration of
perception or impairment of psychic function, convulsive
movements, disturbance of sensation, or some
combination thereof
Convulsion
an intense paroxysm of involuntary repetitive muscular
contractions, is inappropriate for a disorder that may consist only
of an alteration of sensation or consciousness
Seizure
preferable as a generic term, since it embraces a diversity of
paroxysmal events and also because it lends itself to qualification
Classification
Seizures
Etiology
Idiopathic (primary)
Symptomatic (secondary)
Site of origin
Clinical form
Generalized
Focal
Frequency
Isolated
Cyclic
Repetitive
Electrophysiologic
correlates
Partial / focal Generalized seizures
seizures Convulsive seizures
Tonic-clonic (grand mal)
Simple seizures
consciousness is Less common
undisturbed Purely tonic, purely
clonic, generalized
Complex clonic-tonic-clonic
consciousness is Non-convulsive seizures
altered brief lapse of
consciousness or absence
(petit mal)
minor motor phenomena
(brief myoclonic, atonic,
or tonic seizures)
Etiology (seizures)
Pathophysiology
Mechanisms of Seizure Initiation and Propagation
Initiation phase
high-frequency bursts of action potentials
relatively long-lasting depolarization of the neuronal membrane due
to influx of extracellular calcium opening of voltage-dependent
sodium (Na+) channels influx of Na+ repetitive action potentials
Hypersynchronization
Followed by hyperpolarizing afterpotential mediated by G-
aminobutyric acid (GABA) receptors or potassium (K +) channels, but
it is not functioning well synchronized bursts from a sufficient
number of neurons spike discharge on the EEG
EEG pattern
generalized three-per-second spike and wave
pattern
Other type of seizure that simulate petit mal
Atypical petit mal
long runs of slow spike-and-wave activity, usually with
no apparent loss of consciousness
External stimuli (asking the patient to answer a
question) interrupt the run of abnormal EEG activity
West syndrome
infantile spasms
EEG picture (3-Hz hypsarrhythmia)
arrest in mental development
Myoclonic seizure
brusque, brief, muscular contraction
some myoclonic jerks are so small as to involve only
one muscle or part of a muscle
may occur intermittently and unpredictably or
present as a single jerk or a brief salvo
Signs
outbreak of several small, rhythmic myoclonic jerks may
appear with varying frequency as part of absence seizures
as isolated events in patients with generalized clonic-tonic-
clonic or tonic-clonic seizures
Quite benign & respond well to medication
Disseminated myoclonus (polymyoclonus)
Childhood
acute viral encephalitis
the myoclonus-opsoclonus-ataxia syndrome of Kinsbourne
Lithium or other drug toxicity
If lasting for few weeks subacute sclerosing panencephalitis
Chronic progressive polymyoclonus + dementia
group of juvenile lipidosis, Lafora type familial myoclonic epilepsy
progressive dementia, myoclonus, and episode of generalized seizure
certain mitochondrial disorders
other chronic familial degenerative diseases of undefined type (paramyoclonus
multiplex of Friedreich, dyssynergia cerebellaris myoclonica of Ramsay Hunt)
middle and late adult years, disseminated myoclonus +
dementia Creutzfeldt-Jakob disease; alzheimer disease
(rare)
Juvenile Myoclonic Epilepsy
most common form of idiopathic generalized epilepsy
in older children and young adults
begins in adolescence (15 yo)
Clinical signs
generalized seizure often upon awakening
myoclonic jerks in the morning that involve the entire body
occasional myoclonic jerks of the arm and upper trunk that
become prominent with fatigue, during early stages of sleep,
or after alcohol ingestion
EEG pattern
bursts of 4- to 6-Hz irregular polyspike activity
Th/ valproic acid
Partial seizure
Frontal lobe partial seizure (focal &
jacksonian)
Somatosensory, Visual, and Other
Types of Sensory Seizures
Complex Partial Seizures
(Psychomotor Seizures, Temporal
Lobe Seizures)
Partial / focal seizure
Partial / focal seizure
often the product of a
demonstrable focal lesion or
EEG abnormality Generalized seizure
in some part of the cerebral clinical and EEG
cortex
manifestations
Simple
indicate bilateral
Consciousness retained and diffuse cerebral
arise from foci in the cortical
sensorimotor cortex
Complex involvement from
focus in the temporal lobe on the onset
one side or the other, but a
frontal localization is also well
known
Frontal Lobe Partial Seizures
(Focal Motor and Jacksonian Seizures)
Focal motor seizure
e/ discharging lesion of the opposite frontal lobe
Most common type originating in the supplementary
motor area
movement of the head and eyes to the side opposite the irritative
focus often associated with a tonic contraction of the trunk and
limbs on that side
entire seizure / generalized clonic movements, before or with
loss of unconsciousness
Clinical sign
forceful, sustained deviation of the head and eyes, and sometimes
of the entire body (versive / adversive) opposite side
(contraversive); same side (ipsiversive)
seizures of temporal lobe origin head turning ipsilaterally
followed by forceful contraversive head (and body) turning
Jacksonian motor seizure
tonic contraction of the fingers of one hand, the face on one
side, or the muscles of one foot clonic movements
Localized movement / spread movement (march from the
part first affected to other muscles on the same side of the
body)
Classic jacksonian form
seizure spreads from the hand, up the arm, to the face, and down the leg;
if the first movement is in the foot, the seizure marches up the leg, down the
arm, and to the face (uncommon)
one-sided seizure activity turning of the head and eyes to
the convulsing side generalized seizure with loss of
consciousness
Consciousness is not lost if the sensorimotor symptoms remain
confined to one side
may be a transient paralysis of the affected limbs persists for
minutes or at times for hours after seizure (Todds paralysis)
If there are continued focal paralysis presence of a focal brain
lesion
focus of excitation is usually in or near the rolandic (motor)
cortex onset of focal motor epilepsy in the hand
high medial frontal lesions (area 8 and supplementary motor
complex)
Tonic elevation and extension of the contralateral arm (fencers
posture) and choreoathetotic and dystonic postures have been
complex, bizarre, and flailing movements of a contralateral limb
(hysterical seizure)
Seizure discharges arising from the cortical language areas
brief aphasic disturbance (ictal aphasia) and ejaculation of a
word, or, more frequently, a vocal arrest
Somatosensory, Visual, and
Other Types of Sensory Seizures
Somatosensory seizures
e/ a focus in or near the postrolandic
convolution of the opposite cerebral
hemisphere
numbness, tingling, or a pins-and-
needles feeling and occasionally as a
sensation of crawling, electricity, or
movement of the part
in the lips, fingers, or toes, and the spread to
adjacent parts of the body follows a pattern
determined by sensory arrangements in the
postcentral convolution of the parietal lobe
Visual seizures
e/ Lesions in or near the striate cortex of the occipital
lobe
elemental visual sensations of darkness or sparks and flashes of
light, which may be stationary or moving and colorless / colored
Seizure arising in one occipital lobe momentary
blindness in both fields
temporal half of a homonymous field defect
lesions on the lateral surface of the occipital lobe
sensation of twinkling or pulsating lights
focus in the posterior part of the temporal lobe near its
junction with occipital lobe visual hallucinations &
auditory hallucinations
Auditory hallucinations
Infrequent
e/ focus in one superior temporal convolution
buzzing or roaring in the ears
Human voice sometimes repeating unrecognizable words / the
sounds of music
Vertiginous sensations
e/ lesion in the superoposterior temporal region (junction
between parietal and temporal lobes)
sensation of vertigo
With a temporal focus vertigo is followed by an auditory
sensation
Giddiness, or light-headedness, is a frequent prelude of
seizure
Olfactory hallucinations
e/ disease of the inferior and medial
parts of the temporal lobe
perceived odor is exteriorized
(disagreeable or foul, unidentifiable)
Gustatory hallucinations
e/ lesions of the insula and parietal
operculum
salivation and a sensation of thirst may
be associated
Complex Partial Seizures
(Psychomotor Seizures, Temporal Lobe Seizures)
Signs
the aura
focal seizure of simple type / hallucination (visual and
auditory) / perceptual illusion indicating temporal lobe origin
Objects or persons in the environment may shrink / enlarge in
the distance (micropsia/macropsia); perseverate as the head is
moved (palinopsia)
dyscognitive state (dj vu & jamais vu)
certain old memories or scenes may insert / abrupt interruption
of memory
Emotional experiences (sadness, loneliness, anger, happiness)
Postictal behavior
global and nonfluent aphasia (left sided origin)
Prolonged disorientation for time and place (right sided
origin)
Postictal nose wiping is carried out by the hand
ipsilateral to the seizure focus
Other manifestation
Amnesic seizure
Rarely, brief, recurrent attacks of transient amnesia
(manifestations of temporal lobe epilepsy)
Behavioural & psychiatric seizure
Post ictal state protracted paranoid-delusional or
amnesic psychosis lasting for days or weeks
Epileptic personality disorder
exhibit a number of abnormalities of behavior and
personality during the interictal period (slow and rigid in
their thinking, verbose, circumstantial and tedious in
conversation, inclined to mysticism, preoccupied with
rather naive religious and philosophical ideas)
Special epileptic syndromes
Benign childhood epilepsy with centrotemporal spikes &
epilepsy with occipital spikes
5-9 years of age; autosomal dominant trait
nocturnal tonic-clonic seizure with focal onset; one side of the face
(centrotemporal spikes)
visual hallucinations, sensations of movements of the eyes, tinnitus,
or vertigo (occipital spikes)