Epilepsy

Epilepsy is a group of disorders resulting from spontaneous electical discharge in the brain.

Many different types of fit. But they will usually be the same type in a given patient.

5-10 per 1,000 have epilepsy.

 

All patients with suspected seizure should be referred for urgern assesssment by neurology – for medication and advice on work/driving.

 

Seizure Type

Focal Seizure

  • (Previously called “partial” seizure)
  • Happens only in one part/hemisphere of the brain
    • Simple – no impairment of consciousness
    • Complex – impairment of consciousness
  • Partial seizures can go on to become generalised

Generalised Seizure

  • Whole brain is involved
  • Consciousness usually impaired

 

6 Types of Generalised Seizures

  1. Tonic Clinic (= grand mal) – patient goes tense and then shakes
  2. Absence Seizure  (=petit mal) = patient appears spaced out
  3. Myocloinic – short muscles twitch
  4. Tonic – stiff flexed muscles – patient may fall (backward)
  5. Clonic – convulsions
  6. Atonic – relaxed muscles – patient may fall (forward)
  • and then some people have seizures which can’t be classified

 

Todd’s Palsy

  • This is focal CNS sign – for example hemiplegia
  • Which follow and epileptic fit
  • Patient may seem to have had a CVA
  • But then recovers in 24hours

Causes in Adults

  • Two thirds of adults will have a cause found for the epilepsy
  • Which could be:
    • Cerebrovascular disease
    • Cerebral Tumours
    • Genetic / Herediatry conditions
    • Post Infective
    • Drugs / Alcohol related
    • Head Trauma / surgery

 

Epilepsy Treatment

Options:

  1. Medication
  2. Surgery
  3. Nerve Stimulation (vagus nere – affects neuro transmitters)
  4. Ketogentic diet (body burns fat and produces ketones which are used by brain as energy – but the mechanism by which it works is unclear)

 

Medication is usually started after the second seizure

Medication may be started after the first seizure if:

  • Patient has neurolgocial deficit
  • There is a structural abnormality on imaging
  • The EEG shos unequivocal epileptic activity
  • Patient or carers consider risk of further seizure unacceptable