What is Epilepsy?
Introduction
Epilepsy is the tendency to have unprovoked seizures
Definition of Seizure
Seizure can be defined as the occurrence of signs and symptoms due to abnormal, excessive or synchronous neuronal activity in the brain
Triggering Factors of Seizures
- Sleep deprivation
- Missed dose of anti-epileptic drugs
- Alcohol withdrawal syndromes
- Recreational drug misuse
- Physical and mental exhaustion
- Flickering lights (TV and Computer screens)
- Intercurrent infections and metabolic disturbance
- Loud music, noise, hot baths
Classification of Seizures
- Generalized Seizure
- Tonic-Clonic Seizure
- Absence Seizures - Typical / Atypical / Absence with special features
- Myoclonic - Myoclonic / Myoclonic atonic / Myoclonic tonic
- Clonic
- Tonic
- Atonic
- Myeloid Absence Seizures
- Eyelid Myoclonia
- Focal Seizures
- Without impairment of consciousness or awareness
- With impairment of consciousness or awareness
- Evolving to a bilateral, convulsive seizure - Tonic / Clonic / Tonic-Clonic
- Unknown Seizure
- Epileptic spasm
Causes of Focal Seizures
A) Idiopathic
- Benign Rolandic Epilepsy of childhood
- Benign Occipital Epilepsy of childhood
B) Focal Structural Lesions
- Genetic
- Tuberous Sclerosis
- Autosomal dominant frontal lobe epilepsy
- Autosomal dominant partial epilepsy with auditory features
- Von Hippel-Lindau disease
- Neurofibromatosis
- Cerebral migration abnormalities
- Infantile Hemiplegia
- Dysembryonic
- Cortical dysgenesis
- Sturge-Weber Syndrome
- Mesial Temporal sclerosis
- Cerebrovascular disease
- Intracerebral haemorrhage
- Cerebral infarction
- Arteriovenous Malformation
- Cavernous Haemangioma
- Tumours (Primary and Secondary)
- Trauma
- Infective
- Cerebral abscess
- Toxoplasmosis
- Cysticercosis
- Tuberculoma
- Subdural empyema
- Encephalitis
- HIV
- Inflammatory
- Sarcoidosis
- Vasculitis
Causes of Generalized Tonic-Clonic Seizures
- Generalisation from Focal Seizure
- Genetic
- Inborn errors of metabolism
- Storage diseases
- Phakomatosis
- Cerebral birth injury
- Hydrocephalus
- Cerebral anoxia
- Drugs
- Antibiotics: Penicillin, Isoniazid, Metronidazole
- Antimalarials: Chloroquine, Mefloquine
- Ciclosporin
- Cardiac Anti-arrhythmics: Lidocaine, Disopyramide
- Psychotropic agents: Phenothiazines, Tricyclic anti-depressants, Lithium
- Amphetamines withdrawal
- Alcohol
- Toxins
- Organophosphate
- Heavy metals (lead, tin)
- Metabolic disease
- Hypocalcaemia
- Hypoglycaemia
- Hypomagnesaemia
- Liver failure
- Renal failure
- Infective
- Post-infectious encephalopathy
- Meningitis
- Inflammatory
- Multiple sclerosis
- SLE
- Diffuse degenerative disease
- Alzheimer's Disease
- Creutzfeldt-Jakob disease
Investigations of Epilepsy
- ECG
- Standard ECG
- Sleep ECG
- ECG with special electrodes
- CT
- MRI
- For Metabolic disorder
- Urea and electrocytes
- Blood Glucose
- Serum calcium, Magnesium
- For Inflammatory or Infective disorder
- Full Blood count
- Erythrocyte Sedimentation Rate
- C-reactive protein
- Chest X-ray
- Serology for syphilis, HIV, Collagen disease
- CSF Examination
- Ambulatory ECG
- Videotelemetry
Management of Epilepsy
- First aid Management for Seizure
- Move person away from danger (fire, water, machinery, furniture)
- After convulsion ceases turn person into recovery position (semi-prone)
- Ensure airway is clear or insert anything in mouth
- If convulsions continue for more than 5 mins or recur without person regaining consciousness, summons urgent medical attention
- Do not leave the person alone until fully recovered
- Immediate Care
- Lifestyle Advice
- Avoid triggering factors
- Only shallow bath
- Prolong cyclone journey is avoided
- Activities requiring prolonged proximity to water (swimming, fishing, boating) should be carried out in company with someone
- Anticonvulsant / Anti-epileptic Therapy
- Monitoring Therapy
- Epilepsy Thearpy
- Withdrawal of Anticolvusant Therapy
