epilepsia curs 5
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DefinitieDefinitie
• Reprezinta o boala cronica sau un grup de boli cronice caracterizate prin aparitia de crize recurente, neprevazute si de obicei neprovocate.
• O criza de epilepsie este generata de o descarcare electrica sincrona a creierului.
EtiologieEtiologie
• Idiopatica – conditionata genetic
• Secundara:– Traumatisme– Tumori– A.V.C.– Infectii– Boli degenerative
Canale ioniceCanale ionice
• Canalele ionice sunt constituite din proteine care
formeaza pori la nivelul membranei celulare si
permit trecerea selectiva a anumitor ioni (Na, Ca, K,
Cl) contribuind astfel la mentinerea diferentei de
potential intra- extracelular si formarea curentilor
electrici transmembranari.
• Canalele ionice au deasemenea rol in semnalizarea
intercelulara, transportul transmembranar, reglarea
ph-ului si a volumului celular.
Canalul de CalciuCanalul de Calciu
Canalul de SodiuCanalul de Sodiu
Na channel
Canalul de PotasiuCanalul de Potasiu
ClasificareClasificarePartiale (focale)• Simple
– Motorii– Senzitive– Vegetative– Psihice
• Complexe
• Secundar generalizate
Generalizate• Tonice• Atonice• Clonice• Tonico-clonice• Mioclonice• Absente
Neclasificabile
International Classification of Seizures International Classification of Seizures (ILAE, Epilepsia 1981)(ILAE, Epilepsia 1981)
Copyright 2002 The Cleveland Clinic Foundation
Return to Epilepsy Article
Epilepsy Primary Generalized Epilepsy Focal or Partial
Seizure Features
Auras Not present Present
Prodrome Occasionally present Occasionally present
Starting with LOC Present Present
Starting with automatisms Not usually present Present
Prolonged postical confusion without generalization
Not usually present Present
Generalized tonic-clonic seizure Present Present
True versive head movements Not present Present
Focal motor clonic or tonic seizures
Not usually present Present
Risk Factors for Epilepsy
Family history of seizures May be present Not usually present
History of CNS infections, head truama, febrile seizures, CNS tumors, vascular malformation
Not usually present May be present
Examination Findings
Neurologic examination Usually normal May be abnormal
Neuroimaging Findings
Brain MRI Usually normal May be abnormal
EEG Findings
Generalized epileptiform activity Present Not present
Focal epileptiform activity Not present Present
• Epileptogeneza
• Descarcarea anormala are ca punct de plecare o zona bine delimitata – focar epileptic.
InvestigatiiInvestigatii• Electroencefalografia – analiza spectrala
• Computer Tomografia cerebrala (CT)
• Imageria prin rezonanta magnetica (IRM)
• Tehnici de imagerie functionala:– PET– fMRI– SPECT
• Magnetoencefalografia
• Monitorizarea video - EEG
EEG - normal
Complexe virf-unda
fMRIfMRI
PETPET
Magneto-Magneto-encefalografencefalograf
Crize generalizateCrize generalizate
• Crizele Grand Mal
• Crizele de absenta
• Crize tonice
• Crize atone
• Crize mioclonice
Epilepsia Grand MalEpilepsia Grand Mal
Crizele de absentaCrizele de absenta
Crize partiale motorii
(clonii pe jumatate de corp)
• Crize Jacksoniene motorii
• Crize oculocefalogire
• Crize adversive
• Crize de arie motorie suplimentara (vocalizari si contractiile membrelor)
Crize partiale senzitive si Crize partiale senzitive si senzorialesenzoriale
• Crize Jacksoniene senzitive
• Crize vizuale
• Crize auditive
• Crize vestibulare
• Crize olfactive si gustative
• Crize vegetative(transpiratii,raceala pe jumatate de corp)
Crize partiale complexeCrize partiale complexe
Afectarea ariilor de asociatie:
• Alterarea partiala a starii de constienta
• Starea de vis,
• Déjà vu,
• Jamais vu
• Crize de furie, frica, bucurie…
Crize partiale motorii si senzitiveCrize partiale motorii si senzitive
Crize partiale complexeCrize partiale complexe
• Medicamentos
• Dieta cetogena
• Chirurgical
• Stimulare vagala
Principii de tratamentPrincipii de tratament
• Monoterapie
• Politerapie
• Titrare
• Oprirea medicatiei
Medicamente eficiente in crizele de Medicamente eficiente in crizele de absentaabsenta
• Etosuximida
• Oxazolidindiona
Medicamente eficiente in toate Medicamente eficiente in toate crizele cu exceptia absentelorcrizele cu exceptia absentelor
• Fenobarbital
• Fenitoin
• Carbamazepin
• Primidon
Medicamente eficiente in toate Medicamente eficiente in toate tipurile de crizetipurile de crize
• Valproat de sodiu
• Clonazepam
Status epilepticStatus epileptic
• Crize subintrante
• Tratament injectabil cu :
–Clonazepam
–Diazepam
–Fenitoin
Antiepileptice: Antiepileptice: spectru de spectru de activitateactivitate
Antiepileptice: Antiepileptice: spectru de spectru de activitateactivitate
Spectru larg Spectru ingust
* Based on preliminary evidence* Based on preliminary evidence
• Sodium valproate
• Levetiracetam
• Phenobarbital
• Benzodiazepine
• Topiramate
• Lamotrigine
• Phenytoin
• Carbamazepine
• Ethosuximide
• Gabapentin
• Oxcarbazepine
Pregabalin
Antiepileptice moderneAntiepileptice moderne
• Topiramat
• Vigabatrin
• Oxcarbazepina
• Lamotrigina
• Clobazam
• Gabapentin
• Pregabalin
• Tiagabin
• Levetiracetam
• Zonisamid
Efecte secundare ale Efecte secundare ale tratamentuluitratamentului antiepilepticantiepileptic
• Hipertrofie gingivala
• Hirsutism
• Ovar polichistic
• Carente de folat
• Boala Dupuytren
• Modificari ale metabolismului osos
Tratament chirurgicalTratament chirurgical
• Rezectia focarului epileptic
• Lobectomie
• Hemisferectomie
• Calosotomie
Stimularea vagalaStimularea vagala
• Electrozii de stimulare sunt atasati pe nervul vag
• Stimularea se face intermitent
• Indicat in forme de epilepsie refractara
ParticularitatiParticularitati
• Conducerea autovehiculelor
• Sporturi cu risc
• Anumite profesii
• Sarcina si alaptarea
Lord Byron
““People with epilepsy have People with epilepsy have excelled in every area.”excelled in every area.”
Kardinal Richelieu
Wladimir Iljitsch Lenin
Margaux Hemingway
Vincent van Gogh
Gustave Flaubert
Jeanne d'Arc
Hermann von Helmholtz
Alfred Nobel
Sokrates
G. Julius Caesar
Napoleon Bonaparte
F.M. Dostojewskij
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