Epilepsy

Epilepsy *It is not a disease but it is a symptom of disease. *A seizure is a transient disturbance of cerebral function caused by abnormal neuronal discharge. *Epilepsy is the tendency to have recurrent seizure due to chronic underlying cause.

Epidemiology *Epilepsy is a common cause of disturbed level of consciousness. *Incidence of epilepsy is 45/100000. *Prevalence of epilepsy is 0,5%. *The life time probability of a seizure is approximately 3%.

Classification *Essential for diagnostic approach,selection therapy,providing information about prognosis. *It is based on clinical features and EEG findings. *Partial seizures subdivided into;simple,complex,with secondary generalization.

Classification *Primary generalized epilepsy subdivided into;tonic-clonic,tonic,absence,atonic and myoclonic seizures. *Unclassified include;neonatal seizures,infantile seizures and epilepsy syndromes.

Seizure Dx *The circumstances of the attack. *Whether injury or incontinence has occurred. *The occurrence of aura +/- post –ictal todd’s paresis.

Clinical Dx History *Details of events from a witness. *Birth details and historyof febrile convulsion. *Previous trauma or intracranial infections. *Family history of epilepsy or neurological disorders.

Clinical Dx Examination *History of alcohol ingestion or drug abuse. *Skin;signs of neurofibromatosis or tuberous sclerosis. *Blood pressure ;if any postural drop. *Pulse;if irregular consider emboli or arrythemia.

Clinical Dx *heart murmer ;emboli,valve disease,or atrial myxoma. *Liver & spleen;alcohol,and lymphoma. *Limb asymmetry;in cerebral palsy. *cranial bruits;in AVM and in atheroma. *Anosmia; in subfrontal meningioma.

Clinical Dx *Optic disc; papilloedema in mass lesion. *Visual field abnormality;in mass lesion. *Limb asymmetry;in mass lesion. *Planter asymmetry;in mass lesion. *Reflex asymmetry;in mass lesion.

Etiology Primary neurological disease *febrile convulsion. *idiopathic epilepsy. *head injury. *stroke or AVM. *mass lesion.

Etiology Systemic diseases *meningitis or encephalitis. *HIV encephalopathy. Systemic diseases *hypoglycemia. *hyponatremia. *hyperosmolar states.

Etiology *hypocalcemia. *uremia. *hepatic encephalopathy. *drug overdose or withdrawal. *hypertensive encephalopathy or eclampsia. *global cerebral ischemia or hyperthermia.

Clinical presentation Generalized seizures *generalized tonic-clonic;tonic,clonic phase and recovery. *absence seizures;typical and atypical. *tonic or clonic. *atonic and myoclonic.

Clinical presentation Partial seizures *simple partial; motor ,sensory and autonomic. *complex partial seizures ; with or without automatism.

Diagnosis *History. *General physical examination. *Complete neurological examination. *Blood tests;Hb,ESR,WBC count,RFTs,LFTs,s.electrolytes and screening for syphilis or HIV. *EEG &MRI.

Drug therapy *Establish the diagnosis before starting therapy. *Choose the right drug for seizure type. *Treat the seizure rather than serum drug level. *Evaluate one drug at a time.

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