epilepsy Different from a convulsion which is involuntary muscle movement

Size: px

Start display at page:

Download "epilepsy Different from a convulsion which is involuntary muscle movement"

Theodora Clark
5 years ago
Views:

1 Philip Kozan

2 It comes from a Greek word meaning to hold or seize Seizures are what happens to people with epilepsy Different from a convulsion which is involuntary muscle movement It is a disorder of the brain May cause uncontrollable Shaking or Jerking In some cases only results in a loss of consciousness Two types-generalized and localized

3 Epilepsy is not a mental illness and it is not a sign of low intelligence It is not contagious Between seizures, a person with epilepsy is no different from anyone else

4 Everyone s brain has the ability to produce a seizure under the right conditions Epilepsy may start at any age It is most often diagnosed before the age of 20 and after the age of 60 There are over 40 different types of seizures Hippocrates was first to recognize that epilepsy starts in the brain Epilepsy is as common as breast cancer and takes just as many lives -CURE

5 In some cases, sometimes seizures are triggered by certain factors Some but not all seizure inducing triggers are Lack of Sleep Stress Infection/illness Diet Severe changes in temperature photosensitivity

7 Generalized tonicclonic seizures(grand Mal) Absence Seizure(petit mal) Myoclonic Seizure Atonic Tonic Seizure Clonic Seizure Primary Generalized seizures Simple partial seizure Complex partial seizure Partial seizure

8 Grand Mal-involves uncontrollable shaking and stiffening Usually affects primary motor cortex Most visual seizure and usually lasts 1-3 minutes Status epilepticus This is what most people think of when they hear the word seizure

9 Absence seizure/petit mal Most common in children Subtle visual cues involved- unresponsiveness, blank staring Often mis-diagnosed as ignorance/ behavioral problem Children often out grow these seizures

11 Myoclonic seizure Very brief jerks, sometimes many can occur in brief period of time Rapid jerking/twitching of muscles Normal people can experience myoclonus randomly Juvenile myoclonic, Lennox-Gastaut syndrome, progressive myoclonic

12 Tonic- stiffening in arms/legs Last for very short times Clonic- rhythmic jerking of arms and legs Very rarely does it occur by itself Atonic Seizure-drop attack Consciousness?

ringing, hallucinations Autonomic-sweating, goose bumps,

13 Different for every person Person remains alert Divided into different categories Motor-muscle activity Sensory-hearing, taste, ringing, hallucinations Autonomic-sweating, goose bumps, butterflies Psychic- ex. déjà vu, depression, understanding/speaking Simple partial

14 A simple partial that spreads No recollection of seizure Starts with warning Spreads to different parts of brain No clear diagnosis and hard to treat

15 Warning sign associated with partial seizures aura Depends on where the seizure starts Partial seizure itself also depends on area of brain Temporal Lobe- familiarity/unfamiliarity, mixture of different feelings, emotions,sensations, experiences 1 st most common Frontal Lobe-incredible variety of auras and seizures. Ex. Uncontrollable laughing, random movements, strange thoughts and actions 2 nd most common

16 Occipital lobe- associated with hallucinations, flashing lights, rapid blinking, blindness, decreased vision, image repetition Similar to temporal lobes seizures but not as common Parietal lobe-somatosensory seizures, somatic illusions, vertigo, visual distortions Rarest form of epilepsy Numbness, tingling, heat, pain Sensations move in predictable paths down arm or leg

18 disruption in the normal balance between excitation and inhibition in part or all of the brain Seizure occurs when excitation increases, inhibition decreases or both hyperexcitability can occur at different levels of brain function Networks of neurons, neuronal membrane, neurotransmitters/receptors, etc. Important neurotransmitters involved are glutamate and GABA EPSP excitatory post synaptic potential IPSP inhibitory post synaptic potential

19 GABA main inhibitory neurotransmitter GABA is synthesized from Glutamate When GABA is released into the synapse, receptors bind and chloride goes into postsynaptic terminal hyperpolarizing neuron This is an inhibitory post synaptic potential which makes it harder to reach threshold for depolarization Also a neuromodulator Glutamate main excitatory neurotransmitter Normal binding of glutamate to receptors allows influx of sodium and calcium ions into postsynaptic terminal depolarizing it

21 Hyperexcitability-abnormal responsiveness of a neuron to excitatory input Hypersynchrony-large numbers of neighboring neurons in an abnormal firing pattern Ultimately, epilepsy is a network phenomenon requiring participation of many neurons firing synchronously

22 MRI Magnetic Resonance Imaging CT scan- computerized tomography EEG electroencephalogram

25 As more neurons are recruited into synchronized firing, loss of inhibitory control occurs Depolarization shift occurs-giant Action Potential It is believed that hyperpolarization is diminished because of potentiation(strengthening) of EPSPs, decreasing IPSPs Continues to propagate to nearby neurons in a continuous loop

26 Still no clear explanation Possible reasons include Restoration of ionic gradients Neuromodulators? Restoration of excitatory and inhibitory synaptic transmission Fatigue?

27 Seizure Increases: Cerebral blood flow Oxygen consumption Glucose uptake/metabolism Decreases in brain: Glucose level ATP

28 Biggest question Do seizures cause brain damage Many factors involved: Age Underlying brain disorder Duration, frequency and severity Brain damage interpreted in different ways Structural damage; i.e. metabolic stress, Oxygen depletion, longevity Cognitive deficits Neurological disabilities Psychosocial challenges

When I arrived at Johns Hopkins just before Thanksgiving in 1993 I was 20 months old. I weighed about 19 pounds and was taking Dilantin, Felbatol, Tegratol, and transene several times every day.

31 When I arrived at Johns Hopkins just before Thanksgiving in 1993 I was 20 months old. I weighed about 19 pounds and was taking Dilantin, Felbatol, Tegratol, and transene several times every day. I still had a bandage on the back of my head from when they operated on my brain. I had been having dozens, sometimes as many as a hundred seizures a day for a year. Then Dr. Freeman and Diana Pillas and Mrs. Kelly changed what I ate. My seizures were gone in two days. I was off all those drugs in a month. I m not sure what would have become of me if my family hadn t found the ketogenic diet, but I doubt that today I would be an A student in high school with lots of friends; I doubt I would have been playing piano for the last eight years; and I doubt I could hit an eight iron 160 yards. -The Charlie Foundation

32 Form of fasting high protein/fat diet with low carbohydrates Glucose starvation: inhibition of glycolysis Entire mechanisms behind the diet remains unknown Possible reasons include: Ketones released in blood stream become main source of energy for brain Beta-hydroxybutarate Lowered calories intake Changes in fatty acids KD may affect amino acid metabolism structurally changing GABA Hormonal changes

33 Most effective treatment for most types of epilepsy Most patients come off it after two years without need of AEDs Brain plasticity? Most difficult to maintain Strict diet schedule; maintain correct levels of ketones Could fall into shock if consume sugar Possibility of ketoacidosis if not strictly followed

34 Intractable Epilepsy Effective in over 50% of cases Most patients come off the diet within 2 years Alzheimer's Disease (AD) Reductions in Amyloid beta plaque 42 Improvements in cognitive functioning 5 million currently diagnosed and predicted to increase to 16 million people by 2050 High carb (HC) diets suggested to be cause of increase in AD HC inhibit lipases causing high levels of lipoproteins; associated with AD and heart disease Parkinson Disease (PD) Clinical studies show improvements in PD symptoms Ketone bodies protected against mitochondrial respiratory chain defects

37 Cancer Animals fed KC had elevated levels of b-hydroxybutyrate (p = ) and an increased median survival of approximately 5 days relative to animals maintained on SD. KC plus radiation treatment were more than additive, and in 9 of 11 irradiated animals maintained on KC the bioluminescent signal from the tumor cells diminished below the level of detection (p,0.0001). Animals were switched to SD 101 days after implantation and no signs of tumor recurrence were seen for over 200 days. KC significantly enhances the anti-tumor effect of radiation. Decreased Brain tumor rates Seyfried et al. (2011) Beneficial in stroke Pre-treatment with the KD resulted in decreased functional damage from the stroke Tai et al. (2008) Positive results in Brain trauma reduced contusion volume Mitochondrial disorders, autism, Depression, Migraines, Multiple Sclerosis, Reversal of neuronal aging

38 Improved Mitochondrial function Metabolizing ketone bodies may cause decreases in reactive oxygen species Reduction of apoptotic cell death Improved metabolism in brain cells New astrocytes found in the hippocampus act as extracellular buffers Increased antioxidant activity in hippocampus Increased brain derived neurotrophic factor Partially due to decreased caloric intake

39 Medications act upon gates/mechanisms described Inhibition of glutamate receptors, hydrolysis of glutamate, amplification of GABA etc. Similar to how medications such as antihistamine work-block receptors Phenobarbital, Topamax, Kepra Not the best solutions Most AEDs cause drowsiness, low energy, mood changes Carbamazepine and phenobarbital cause osteoporosis over long period of time

Can be the best option if seizure localized Traditional brain surgery- scalpel Always chance of stroke Gamma knife-localized radiation burns away tissue Non invasive Used more often for tumor rather

41 Can be the best option if seizure localized Traditional brain surgery- scalpel Always chance of stroke Gamma knife-localized radiation burns away tissue Non invasive Used more often for tumor rather than epilepsy Causes inflammation of surrounding tissue Laser Ablation Therapy(newest) Real time MRI guided thermal imaging targeting lesions in brain Smaller risk of affecting surrounding tissue Guided laser probe

42 Wait to help person after seizure has occurred Lay person down on side with head support Incapable of swallowing their tongue If it continues for more than 5 minutes call 911 This means that seizure will continue on for at least 20minutes causing massive damage potentially leading to stroke

The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders Stafstrom, C. ; Rho, J. Epilepsy and the Ketogenic Diet-Carl E. Stafstrom MD PHD, Jong M.

43 The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders Stafstrom, C. ; Rho, J. Epilepsy and the Ketogenic Diet-Carl E. Stafstrom MD PHD, Jong M. Rho MD Abdelwahab MG, Fenton KE, Preul MC, Rho JM, Lynch A, et al. (2012) The Ketogenic Diet Is an Effective Adjuvant to Radiation Therapy for the Treatment of Malignant Glioma. PLoS ONE 7(5): e Alzheimer s disease facts and figures Alzheimer s Association Duan W, Lee J, Guo Z, Mattson MP. Dietary restriction stimulates BDNF production in the brain and thereby protects neurons against excitotoxic injury. J Mol Neurosci. 2001;16:1 12 Noh HS, Kim DW, Kang SS, Cho GJ, Choi WS Ketogenic diet prevents clusterin accumulation induced by kainic acid in the hippocampus of male ICR mice. Brain Res. 1042(1): Bellido T, Huening M, Raval-Pandya M, Manolagas SC, Christakos S Calbindin- D28k is expressed in osteoblastic cellsand suppresses their apoptosis by inhibiting caspase-3 activity.j. Biol. Chem. 275, Prins ML, Fujima LS, Hovda DA Age-dependent reduction of cortical contusion volume by ketones after traumatic brain injury. J Neuroscience Research 82(3): High carbohydrate diets and Alzheimer s disease - Samuel T. Henderson* Center for Agricultural and Rural Development

There are several types of epilepsy. Each of them have different causes, symptoms and treatment.

There are several types of epilepsy. Each of them have different causes, symptoms and treatment. 1 EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic