Epilepsy- a neurological disorder in which a person experiences recurring…
Epilepsy- a neurological disorder in which a person experiences recurring seizures
Described as a disease of the brain defined by any of the following conditions
Two unprovoked seizures more than 24 hours apart
One unprovoked seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years.
Diagnosis of an epilepsy syndrome
Risk Factors- vary per age group
Complicated febrile seizures.
A genetic condition that is known to be associated with epilepsy, such as tuberous sclerosis or neurofibromatosis.
Brain development malformations – usually associated with epilepsy developing before adulthood.
A family history of epilepsy or neurologic illness.
Head trauma, infections (for example meningitis, encephalitis), or tumours — can occur at any age.
Comorbid conditions such as cerebrovascular disease or stroke — more common in older people.
Dementia and neurodegenerative disorders (people with Alzheimer's disease are up to ten times more likely to develop epilepsy than the general population).
Assessment- determine risk factors, or any differential. Hx of seizure- before, during and after.
Physical Examination- Cardiac, neuro, mental state and developmental assessment. Evidence of trauma during or after seizure. Vital signs
Features of the seizure- Short-lived (less than 1 minute), abrupt, generalised muscle stiffening (may cause a fall) with rapid recovery — suggestive of tonic seizure. Generalised stiffening and subsequent rhythmic jerking of the limbs, urinary incontinence, tongue biting —suggestive of a generalised tonic-clonic seizure. Behavioural arrest — indicative of absence seizure. Sudden onset of loss of muscle tone — suggestive of atonic seizure. Brief, 'shock-like' involuntary single or multiple jerks —suggestive of myoclonic seizure.
Hx after the seizure, any witnesses
Baseline tests-Bloods such as full blood count, urea and electrolytes, liver function tests, glucose, and calcium.
A 12-lead electrocardiogram (ECG).
Focal seizures — originate in networks limited to one hemisphere, and may be localised or more widely distributed. Focal seizures are divided into those with retained awareness or impaired awareness
Generalised seizures — originate in bilaterally distributed networks, and can include cortical and subcortical structures. Divided into motor and non-motor (absence) seizures
transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain
Convulsive status epilepticus is a prolonged convulsive seizure lasting for 5 minutes or longer, or recurrent seizures one after the other without recovery in between
Structural — Underlying basis for a structural abnormality can be genetic or acquired e.g stroke, trauma, or malformation of cortical development.
Genetic — epilepsy resulting from a known or presumed genetic mutation (not necessarily inherited) in which seizures are a core symptom of the disorder, for example Dravet syndrome.
Infectious — epilepsy results from a known infection in which seizures are a core symptom of the disorder (rather than seizures due to acute infection such as meningitis) e.g TB, cerebral malaria, HIV, and congenital infection such as Zika virus.
Metabolic — epilepsy results from a known or presumed metabolic disorder in which seizures are a core symptom of the disorder (which may occur as a result of a genetic defect). e.g. porphyria, amino-acidopathies, or pyridoxine deficiency.
Immune — epilepsy that results directly from an immune disorder (where there is evidence of auto-immune mediated CNS inflammation) in which seizures are a core symptom of the disorder. Examples include anti-NMDA receptor encephalitis and anti-LG11 encephalitis.
Sudden unexpected death in epilepsy (SUDEP), in which a person with epilepsy dies suddenly without an identifiable cause. Most common cause of epilepsy-related death in young adults with uncontrolled epilepsy (rare in children). A significant risk factor is nocturnal seizures. The risk of SUDEP is reduced in people with optimized seizure control
Injuries — any seizure involving loss of awareness can cause trauma. Drowning, road accidents, and falls have all been associated with generalised tonic-clonic seizures. In pregnancy, abdominal trauma can cause ruptured fetal membranes and premature labour, although the risk is low
Depression and anxiety disorders are more common in adults and some children with epilepsy, particularly in people with poor seizure control,
Absence from school or work
Advice - avoid activities could be life threatening if a seizure occurred. DVLA should be informed and driving avoided.
Education patient and family on recognition and mx of seizures. ID bracelet
lifestyle advice e.g. sleep deprivation, drug and alcohol use
information and support available
seizure <5mins ensure safety- dentures, glasses, hazards, assess ABC, any injuries, recovery position post seizure
seizure > 5mins or have more than 3 seizures within an hour- buccal midazolam should be administered, or rectal diazepam, or IV lorazepam. Admit
Review- epilepsy SN, seizure control-diary, affect on life, adverse effect of medication, increase risk of osteoporosis
Alternative first line treatments can include a ketogenic diet, vagus and other nerve stimulation techniques or surgery
Medication- adverse effects, contraindications would require to be considered prior to prescribing
Seizures were prolonged or recurrent before treatment was given, particularly if seizures had developed into status epilepticus.
There is a high risk of recurrence, such as a history of repeated seizures or status epilepticus.
There are difficulties monitoring the person's condition.
This is their first seizure.
999 if the following:
specialist advice- poor control, cognitive impairment 2o to epilepsy, planning for pregnancy, seizure free over past 2 years and review of medication