1. Epilepsy

2. 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.

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

4. 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.

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

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

7. 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.

8. 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.

9. 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.

10. 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.

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

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

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

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

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

16. 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.

17. 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.

18. Thank you