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 motoriiCrize partiale motorii• Crize somatice motorii (clonii pe jumatate

de corp)

• Crize Jacksoniene motorii

• Crize oculocefalogire

• Crize adversive

• Crize de arie motorie suplimentara (vocalizari si contractiile membrelor)

• Crize tonice

• Crize miotonice

Crize partiale senzitiveCrize partiale senzitive

• Crize Jacksoniene senzitive

• Crize vizuale

• Crize auditive

• Crize vestibulare

• Crize olfactive si gustative

• Crize vegetative

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

• Carbamaxepin

• 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: Spectru de Antiepileptice: Spectru de activitateactivitate

Antiepileptice: Spectru de Antiepileptice: Spectru de activitateactivitate

Spectru larg Spectru ingust

* Based on preliminary evidence* Based on preliminary evidence

• Sodium valproate

• Levetiracetam

• Phenobarbital

• Benzodiazepines

• Topiramate

• Lamotrigine

• Zonisamide*

• Phenytoin

• Carbamazepine

• Ethosuximide

• Gabapentin

• Oxcarbazepine

• Tiagabine

• Pregabalin

Antiepileptice moderneAntiepileptice moderne

• Topiramat

• Vigabatrin

• Oxcarbazepina

• Lamotrigina

• Clobazam

• Gabapentin

• Pregabalin

• Tiagabin

• Levetiracetam

• Zonisamid

Efecte secundare ale tratamentului Efecte secundare ale tratamentului 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