Epilepsy

Epilepsy is a chronic disease of the brain.

The basic signs include recurrent spontaneous unprovoked paroxysmal attacks with motor,
sensory or psychic phenomena which are the result of hypersynchronous discharges in the
neurons of the cortex.

1. Idiopathic epilepsy is a type of epilepsy where no underlying cause for seizures can be
identified, despite thorough testing and evaluation. It is believed to be caused by a
genetic predisposition and may run in families.
 Idiopathic epilepsy typically presents in childhood or adolescence and can be well-
controlled with medications in many cases.

2. Symptomatic epilepsy is a type of epilepsy where seizures are caused by a specific

underlying condition or injury, such as a brain tumor, traumatic brain injury, stroke, or
infection.
 This type of epilepsy may be more difficult to control with medications, as the
underlying condition must be addressed in addition to managing seizures.

3. Cryptogenic epilepsy is a type of epilepsy where no specific underlying cause for

seizures can be identified, but there is suspicion that there may be an underlying cause
that has not yet been discovered.
 This type of epilepsy may be more difficult to diagnose and treat than idiopathic
epilepsy, as further testing and evaluation may be necessary to identify a potential
underlying cause.

Symptoms of epilepsy:
1. Uncontrollable movements: Some seizures can cause jerking or twitching movements in
the arms, legs, or other parts of the body.
2. Loss of consciousness: Some seizures can cause a person to lose consciousness and
become unresponsive.
3. Sensory changes: Some seizures can cause changes in the senses, such as hearing,
vision, taste, or touch.
4. Emotional changes: Some seizures can cause changes in mood or emotions, such as fear,
anxiety, or euphoria.
5. Convulsions: Some seizures can cause convulsions, which are violent shaking of the
body.
6. Aura: Some people with epilepsy may experience an "aura" before a seizure, which can
be a warning sign of an impending seizure. Auras can vary widely, but may include
changes in vision, hearing, or sensation.
Diagnosis
Diagnosing epilepsy typically involves a combination of medical history, physical examination,
and diagnostic tests. Here are some of the common steps involved in making a diagnosis for
epilepsy:
1. Medical history: The doctor will ask you questions about your symptoms, including when
they started, how often they occur, and what they feel like. They may also ask about any
family history of epilepsy or other neurological disorders.
2. Physical examination: The doctor will perform a neurological examination to check for
any signs of abnormal brain activity, such as seizures or abnormal reflexes:
I. Observation of physical symptoms: The healthcare provider will observe any
physical symptoms that the patient may be experiencing, such as seizures,
tremors, or jerking movements.
II. Assessment of motor function: The provider may assess the patient's motor
function, including coordination, strength, and reflexes, to check for any
abnormalities that may suggest epilepsy or other neurological conditions.
III. Sensory testing: The provider may also perform sensory testing to evaluate the
patient's sense of touch, vibration, temperature, and other sensations. This can
help identify any sensory abnormalities that may be related to epilepsy.
IV. Cranial nerve testing: The provider may test the function of the patient's cranial
nerves, which control sensory and motor function in the head and neck. This can
help identify any abnormalities that may be related to epilepsy or other
neurological conditions.
V. Mental status testing: The provider may also evaluate the patient's mental
status, including their memory, language, and cognitive function. This can help
identify any cognitive or behavioral abnormalities that may be related to
epilepsy.

The specific physical examination techniques used will depend on the individual patient
and their symptoms.
3. Diagnostic tests: There are several diagnostic tests that can help confirm or rule out a
diagnosis of epilepsy. These tests may include:
I. Electroencephalogram (EEG): This test records the electrical activity of the brain
and can detect abnormal brain waves that are often associated with seizures.
II. Magnetic resonance imaging (MRI): This test uses a powerful magnet and radio
waves to create detailed images of the brain. It can help identify structural
abnormalities or other conditions that may be causing seizures.
III. Blood tests: These tests can help rule out other medical conditions that may be
causing seizures. (Electrolyte imbalances, Infections, Metabolic disorders,
Genetic disorders, or Drug or alcohol abuse.)
IV. Video-EEG monitoring: In some cases, doctors may recommend video-EEG
monitoring, which involves recording both brain activity and video of a person's
behavior during a seizure. This can help confirm a diagnosis of epilepsy and
determine the type of seizure.
It's important to remember that diagnosing epilepsy can be a complex process and may require
several tests and evaluations. If you are experiencing symptoms that may be related to epilepsy,
it's important to seek medical attention from a qualified healthcare provider.

 Epilepsy is a condition involving recurrent seizures, due to a chronic underlying process.

  A seizure is a paroxysmal event due to abnormally discharging central nervous system
(CNS) neurons.

Seizure
The causes of seizure can be remembered from the acronym “VITAMINS”:
- Vascular (stroke, bleed, arteriovenous malformation).
- Infection (meningitis, abscess, encephalitis).
- Trauma (especially penetrating).
- Autoimmune (CNS vasculitis).
- Metabolic (hyponatremia, hypocalcemia, hypomagnesemia, hypoglycemia, hypoxia,
drug overdose/withdrawal).
- Idiopathic.
- Neoplasm.
- pSychiatric.

Partial seizure:
 Can present with motor (head turning), sensory (paresthesias), or autonomic (sweating)
symptoms.

 Localization: cortical region, motor (irritation of pre-central gyrus), sensory (irritation of

post-central gyrus)

 If consciousness is maintained for the duration of the seizure

 simple partial seizure.

 If there is a change in consciousness for the duration of the seizure

 complex partial seizure.

 1 hemisphere

Symptoms of partial seizures:

1. Motor symptoms: These can include jerking or twitching movements of a specific body
part, such as the arm or leg. These movements may be repetitive and can last for several
seconds to a few minutes.
2. Sensory symptoms: These can include tingling or numbness in a specific body part, a
feeling of warmth or coldness, or changes in vision, hearing, or taste.
3. Autonomic symptoms: These can include changes in heart rate, breathing, or sweating.
4. Cognitive symptoms: These can include confusion, memory loss, or changes in mood or
behavior.
5. Psychic symptoms: These can include feelings of déjà vu, hallucinations, or intense
emotions.

There are several types of generalized seizures, including:

  Absence seizures (formerly known as petit mal seizures): These seizures are
characterized by brief episodes of staring and impaired consciousness. They
typically last only a few seconds and are most common in children.
 Tonic-clonic seizures (formerly known as grand mal seizures): These seizures
involve loss of consciousness, stiffening of the body (tonic phase), and rhythmic
jerking of the limbs (clonic phase). They can last several minutes and can cause
injury.
 Myoclonic seizures: These seizures involve brief, involuntary muscle contractions.
They can affect a single muscle or a group of muscles and can occur in clusters.
 Clonic seizures: These seizures involve rhythmic, repetitive muscle contractions
and relaxations.
 Tonic seizures: These seizures involve sustained muscle contractions and can
cause the body to become rigid.
 Atonic seizures (also called drop attacks): These seizures involve a sudden loss of
muscle tone, causing the person to fall to the ground.

It is important to note that some individuals may experience a combination of different

types of seizures, and some seizures may be difficult to classify.
 1. Absence seizures: Anticonvulsant medication such as ethosuximide,
valproic acid, and lamotrigine may be prescribed.
2. Tonic-clonic seizures: Anticonvulsant medication such as carbamazepine,
valproic acid, and phenytoin may be prescribed. In some cases, surgery
may be recommended.
3. Myoclonic seizures: Anticonvulsant medication such as valproic acid,
levetiracetam, and clonazepam may be prescribed.
4. Clonic seizures: Anticonvulsant medication such as benzodiazepines,
phenobarbital, and valproic acid may be prescribed.
5. Tonic seizures: Anticonvulsant medication such as valproic acid,
carbamazepine, and phenytoin may be prescribed.
6. Atonic seizures: Anticonvulsant medication such as lamotrigine,
topiramate, and valproic acid may be prescribed. In some cases, a vagus
nerve stimulator may be recommended.

First-line drugs
1. Absence seizures: Ethosuximide or valproic acid.
2. Tonic-clonic seizures: Carbamazepine, valproic acid, or phenytoin.
3. Myoclonic seizures: Valproic acid, levetiracetam, or clonazepam.
4. Clonic seizures: Benzodiazepines, phenobarbital, or valproic acid.
5. Tonic seizures: Valproic acid, carbamazepine, or phenytoin.
6. Atonic seizures: Lamotrigine, topiramate, or valproic acid.