Epilepsy

Chronic neurological condition characterised by recurrent unprovoked seizures due to abnormal electrical brain activity.

Risk Factors

Family history of epilepsy
Perinatal insult (e.g. hypoxic injury)
CNS infections (e.g. meningitis, encephalitis)
Traumatic brain injury
Neurodevelopmental disorders (e.g. autism, cerebral palsy)

Aetiology

Idiopathic (genetic) – most common in children
Structural – cortical malformations, trauma, tumours, strokes
Metabolic – electrolyte disturbances, inborn errors of metabolism
Infectious – neurocysticercosis, HSV
Autoimmune, vascular, or degenerative causes

Pathophysiology

Hyperexcitable neurons → paroxysmal discharges
Focal: begins in one region of cortex
Generalised: widespread from onset
Can secondarily generalise

Diagnosis

Types

Focal (aware/impaired)
Generalised (tonic-clonic, absence, myoclonic, atonic)
Unknown onset
Epilepsy syndromes: childhood absence epilepsy, juvenile myoclonic epilepsy, Lennox-Gastaut

Clinical diagnosis

At least two unprovoked seizures >24 hrs apart
Clinical history (witnessed events, postictal state)

Differential Diagnosis

Syncope
Febrile seizures
PNES (psychogenic)
Tics, migraines
Sleep disorders (e.g. night terrors)

Investigations

EEG – abnormal discharges, helps classify type
MRI brain – for structural lesions
Bloods – rule out reversible causes (e.g. glucose, Na, Ca, Mg)

Management

Antiepileptic drugs (AEDs) – based on seizure type
– Generalised: valproate, levetiracetam
– Focal: carbamazepine, lamotrigine
Ketogenic diet – for refractory epilepsy in children
Epilepsy surgery – for focal epilepsy non-responsive to medication
Vagal nerve stimulation
Education: avoid triggers (sleep deprivation, flashing lights), seizure first aid

Complications & Prognosis

Injury during seizures
Status epilepticus
Psychosocial impacts – stigma, driving restrictions
Sudden unexpected death in epilepsy (SUDEP)
Many children achieve seizure freedom with appropriate treatment

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