Epilepsy

last authored:
last reviewed:

 

 

Introduction

Epilepsy is a cluster of symptoms characterized by recurrent, spontaneous, unprovoked seizures. It affects 0.5-1.0% of the population.

Generalized epilepsy tends to begin in children and adults, though 10-20% of cases begin after age 20.

People can have a number of different seizures as a part of their epilepsy, though tend to have either partial or generalized.

Epilepsy syndromes show the presence of some seizures, along with other findings, but do not meet the criteria for epilepsy.

 

 

 

The Case of...

a simple case introducing clincial presentation and calling for a differential diagnosis. To get students thinking.

return to top

 

 

 

Causes and Risk Factors

return to top

 

 

 

Pathophysiology

seizure is a "sudden excessive discharge of gray matter"

return to top

 

 

 

Signs and Symptoms

  • history
  • physical exam

History

neurologic history is very important from both patient and witness

Todd's paresis: if during the postictal phase they can't speak, it suggests the language centre is the area of focus

 

EEG can be used to localize seizure foci. Interictal (non-clinical) waves can sometimes be seen

 

neuroimaging for aetiology

Physical Exam

 

return to top

 

 

 

Investigations

  • lab investigations
  • diagnostic imaging

Lab Investigations

Diagnostic Imaging

return to top

 

 

 

Differential Diagnosis

distingush from:

 

Benign Rolandic epilepsy

onset from ages 4-10

focal seizure, related to sleep

appears to be inherited in an AD fasion, with very incomplete penetrance

EEG has characteristic findings

always outgrown

return to top

 

 

 

Treatments

Treatments are first to prevent injury and preserve life.

They also have a substantial psychosocial role: people want to know their seizures are being managed.

ketogenic diet - high fat, low sugar = no fun

 

First Aid for a Seizure

 

Stopping a Seizure

 

Prophylactic Medications

 

Surgery

cortical resection of focus, corpus callostomy (for atonic seizures), hemisperectomy (but only really for kids who have serious seizures

 

vagal nerve stimulation

return to top

 

 

 

Consequences and Course

return to top

 

 

 

Resources and References

return to top

 

 

 

Topic Development

authors:

reviewers:

 

return to top