Por lo general, se puede tratar con medicamentos. Las mujeres que tienen epilepsia corren un mayor riesgo de sufrir complicaciones durante el embarazo. Sin embargo, no debe dejar de tomar este medicamento por su cuenta. Puede ayudar a prevenir ciertos tipos de defectos de nacimiento. El embarazo afecta a cada mujer que tiene epilepsia de manera diferente.
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A seizure is the clinical manifestation of abnormal electrical activity in the brain. Epilepsy refers to multiple seizures occurring over a long period of time. Although there is no universal agreement on the minimum number of seizures or period of time, a useful clinical definition is two or more seizures over a month or more. Not all seizures are associated with epilepsy.
For example, a seizure can be the reaction of a normal brain to a transient insult, such as intoxication or meta- bolic disorder. This is called a provoked seizure or reactive seizure.
On the other hand, if a patient has several seizures over a period of a month or more, and there is no detectable short-term illness responsible for the seizures, then we would say the patient has the condition called epilepsy. Because there are many causes of chronic recurrent seizures, epilepsy is not a specific disease but rather a diverse category of disorders. Epilepsy is broadly divided into idiopathic and symptomatic disorders.
Symptomatic epilepsy, also called secondary epilepsy, is when the seizures are caused by an identifiable structural lesion of the brain, such as a tumor. Instead, it refers to recognized clinical syndromes with typical clinical features, such as age of onset and lack of other neuro- logical abnormalities. Several other terms are commonly used. The ictus is the seizure itself. Postictal signs are transient clinical abnormalities in brain function that are caused by the ictus and appear when the ictus has ended.
Postictal signs typically last a few minutes to hours and can include confusion, blindness, ataxia, and deep sleep. All rights reserved. Some patients with seizures experience a prodrome, which is long-lasting abnormality occurring hours to days before a before a seizure, such as restlessness or anxiety. Human patients describe various sensations during their auras, including dizziness, tingling, and anxiety.
Applying these schemes to veterinary patients is problematic because not all seizure types in human patients are recognized in animals and EEG data are usually not avail- able for our patients.
Therefore, the following descriptive list is offered not as a formal classification but to facilitate communication among clinicians. Generalized-onset Seizures Generalized-onset seizures are those in which the first clinical signs indicate initial involvement of both cerebral hemispheres. Consciousness may be impaired and motor manifestations are bilateral. The most common type of generalized seizure is a generalized tonic-clonic seizure formerly called grand mal seizures.
The first part of the seizure is the tonic phase, during which there is sustained contraction of all muscles. The animal typically loses consciousness and falls to its side in opisthotonus with the limbs extended. Respirations are often irregular or absent and cyanosis is common. Autonomic signs such as salivation, urination, and defecation are common. The tonic phase lasts for a minute or so and then gives way to the clonic phase, during which there is rhythmic contraction of muscles, manifested as paddling or jerking of the limbs and chewing movements.
Some animals suffer milder generalized tonic- clonic seizures in which consciousness is maintained. Focal-onset Seizures Focal-onset seizures are those in which the initial clinical signs indicate abnormal activity in one region of a cerebral hemisphere. Focal motor seizures consist of abnormal movements of a body part, such as turning the head to one side, rhythmic contractions of a limb or facial muscles, or chewing movement.
An aura that does not evolve into loss of consciousness is a focal sensory seizure. Affected patients may not respond to their owner and often engage in automa- tisms, which are coordinated, repetitive motor activities such as head pressing, vocalizing, or aimless walking or running. The secondary spread can occur so rapidly that the initial focal component is missed and the seizure is misclassified as a generalized-onset seizure.
But with close obser- vation, including videotape review of the seizures, it is apparent that secondarily generalized seizures are common in dogs and cats.
Based on pedi- gree analysis, a genetic basis for idiopathic epilepsy is suspected in a number of breeds, including the beagle, Belgian tervuren, Keeshond, dachshund, British Alsa- tion, Labrador retriever, golden retriever, Shetland sheepdog, Irish wolfhound, Vizsla, Bernese mountain dog, and English springer spaniel.
In the past, generalized tonic-clonic seizures were considered the most common type of seizure in dogs with idiopathic epilepsy, and some authors even claimed focal-onset seizures were inconstant with a diagnosis of idiopathic epilepsy. However, more recent observations reveal this is clearly not the case and dogs with idiopathic epilepsy can have a variety of focal-onset seizures, including secondarily generalized seizures, and some individuals have more than one type of seizure.
In human patients, sleep deprivation, emotional stress, menstruation, missed medication, and concurrent illness are recognized. Reflex seizures are seizures that can be provoked by specific stimuli or events.
Other triggers include immersion in hot water, reading, certain sounds, and eating. With reflex seizures, the trigger is specific and the latency between the trigger and seizure is short seconds to minutes. Idiopathic epilepsy is much less common in cats, compared to dogs, so we have less data for feline epilepsy.
A genetic basis for seizures has not been documented in cats and feline epilepsy is more likely to be symptomatic than idiopathic, compared to dogs.
However, idiopathic epilepsy does occur in cats. In one study, most cats with idiopathic epilepsy had their first seizure between about 1 and 5 years of age. Ask about any focal signs at the start of the seizure, such as turning the head to one side or jerking of one limb.
Any abnormalities before and after the seizure should be characterized. It is also important to determine if the events occur at a certain time of day or in association with situations such as feeding or exer- cise.
In some cases it helps if the client videotapes the episodes. Ask about familial history of seizures, significant injuries or illnesses, vaccination status, diet, and potential exposure to toxins. Ask about any prescription or nonpre- scription medications.
Any interictal abnormalities are noted, such as changes in behavior, gait, appetite, weight, or sleep habits. The client is often the best person to identify subtle changes in personality or behaviors that are not readily apparent to the clinician in the examination room.
A thorough physical examination is important to detect signs of systemic illness that might suggest an underlying cause for the seizures. Perform a complete neurological examination to detect any persistent neurological deficits. Cerebral lesions often cause focal, relatively subtle deficits such as delayed proprioceptive positioning on one side or blindness in one visual field.
Be careful when interpreting the examination shortly after a seizure because any generalized deficits, such as ataxia, depression, or blindness may be a result of postictal disturbances and not necessarily indicate under- lying brain disease. Repeating the examination in 24 to 48 hours may be necessary to determine if any deficits persist.
A complete blood count and serum chemistry profile are indicated in any animal with one or more seizures. Blood lead determination is performed in patients with possible exposure to lead, patients from areas with a high incidence of lead poisoning, and in animals younger than 1 year of age.
Serum bile acids are helpful in young animals to identify or rule out a porto-systemic shunt. The diagnostic evaluation is designed to answer two questions: 1 is the patient having seizures, and 2 if so, what is the cause of the seizures. Seizures are recog- nized by their spontaneous onset, stereotypic signs, self-limiting time course, and postictal signs.
Disorders that can be mistaken for seizures are listed in Table 1. Idiopathic epilepsy is a clinical diagnosis based on the typical age of onset, lack of interictal abnormalities, and exclusion of other causes.
Symptomatic epilepsy should be suspected when 1 seizures start before 1 or after 5 years of age, 2 the patient suffers focal seizures, 3 there is a sudden onset of multiple seizures, or 4 there are interictal abnormalities detected on history, examination, or laboratory tests.
If CSF is abnormal, titers for infectious causes of encepha- litis are in order. But total freedom from seizures and side effects remains elusive for many patients so a more realistic goal is to reduce the frequency and severity of the seizures to a level that does not substantially compromise the quality of life for the pet and family while avoiding serious side effects.
Achieving this goal requires the clinician to make decisions regarding when to initiate therapy, how to promote compliance, choose appropriate drugs and doses, monitor treatment, and terminate therapy. When to Start Treatment Patients with a single seizure, provoked seizures, or isolated seizures separated by long periods of time generally do not require daily maintenance therapy.
Treatment is indicated for patients with frequent seizures, a trend toward increasing frequency or severity of seizures, any episode of unprovoked status epilepticus or clusters, or an underlying, progressive disorder responsible for the seizures. Whether early treat- ment of idiopathic epilepsy alters the prognosis is unknown; however, one study suggests that dogs treated early in the course of epilepsy have better long-term control of their seizures compared to dogs that are allowed to have a lot of seizures before treatment is started.
If the client is not fully committed to the prescribed treatment, a good outcome is unlikely. The client and veterinarian should thoroughly discuss these factors and decide together when and if treatment should be initiated, weighing the risks and benefits of treatment versus no treatment.
Client Education The key to successful treatment of epilepsy is client compliance. And the best way to promote compliance is good client education. Clients should be fully informed about the nature of the disease and its treatment. They should understand the goals of therapy and potential side effects.
Mild side effects are common when first starting treatment with antiseizure drugs. These will often resolve or diminish after a few weeks of treatment. If clients understand this, they are less likely to become alarmed and prematurely stop treatment if they notice side effects. Clients must appreciate the need for regular administration of medication. They need to know what to do if a dose is missed in general, the missed dose is given as soon as the mistake is recognized, then the next dose is given on schedule.
Main- taining an adequate supply of medication is important and clients should know how to obtain refills if medication is lost or runs out during travel. Suddenly stopping antisei- zure medication may precipitate seizures and should be avoided at all costs. Having clients keep a log of the date and characteristics of each seizure and any side effects is very helpful in assessing therapy.
Finally, clients must not alter treatment without the advice of the veterinarian. Some clients are tempted to alter the dose based on a short-term assessment of seizure control or side effects, but frequent dose changes are detrimental and make interpretation of therapeutic monitoring difficult. Idiopathic Epilepsy in Dogs and Cats Choice of Drug The choice of treatment depends on efficacy, safety, and price.
Based on clinical experience and pharmacokinetic information, phenobarbital or bromide is the initial drug of choice for dogs with idiopathic epilepsy.
¿Qué es epilepsia?
Epilepsia y embarazo