Question

Case 4 A 52-year-old male complained of episodic experiences (1/day) of brief (1 or 2 minute) loss of contact with his surroundings, during which time he had a glassy stare, uttered unintelligible sounds and did not understand what was being said around him. Each episode was preceded by a sinking feeling in his stomach. His blood work indicated normal electrolytes and normal serum glucose. His EEG showed interictal bilateral temporal and left frontal lobe spikes appearing at about 3/second. Skull X-rays and CT scan were normal. The cause of these episodes was diagnosed as idiopathic. Drug therapy was begun with carbamazepine (Tegretol) at low doses, increasing over the week to the standard therapeutic dosage of 200 mg four times each day. Blood levels of Sug/mL indicated that his effective therapeutic level had been reached, and the brief episodic experiences disappeared. 1. What is the disorder of this individual? 2. What are the major classifications of this disorder? 3. Define ictal/interictal. 4. Why were the skull X-ray and CT scan performed?

Answer 1

1.

All of the above sings and symptoms are suggesting as it is Epilepsy.

A 52 years old men is suffering from epilepsy.

Loss of memory for a few minutes, uttered unintelligible sounds and changes in EEG evidents that individual is suffering from epilepsy.

Epilepsy is a neurological disorder associated seizure activity, loss of memory with or without loss of consciousness

2.

There are various types of epilepsy. Briefly they are classified az below:-

1. FOCAL SEIZURES
2. GENERALIZED SEIZURES

FOCAL SEIZURES:- also called as partial seizures. Seizure activity occur in a part of one brain hemisphere.

Its again two types

• Focal seizures with retained awareness which means without loss of consciousness
• Focal seizures without awareness, in which patient will loss consciousness

GENERALIZED SEIZURES:- Generalized seizures occurs when there is seizures activity occurs in both right and left hemispheres of brain. There are many types of generalized seizures. They are

• Clonic seizures:jerky movements all over the body with loss of consciousness followed by confusion
• Tonic seizures: This type of seizures occurs without clonic jerky movements
• Myoclonic seizures: in this type sudden jerky movements occurs all over the body at a time.
• Absence seizures (Petit mal seizures): Epileptic activity occurs all over the brain. Person loss consciousness for a while without convulsions
• Tonic- clonic seizures( grand mal seizures) : combination of both clonic and tonic seizures
• Atonic seizures ( drop attack) : Without warning, person loss consciousness, fall down. Here no jerky movements

3.

Ictal phase is the middle of the seizure or convulsion. It is the physiological event of seizure activity.

Interictal phase is the period between seizure and convulsions.

4.

Skull X- ray and CT scan are useful tools to detect epilepsy.

X- ray helps to find any fractures in skull, or separated sutures, or erosions in the skull.

CT scan helps to view any tumors or hematomas in the brain which causes epileptic activity.