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Classification of seizures
Def: paroxysmal episodes that resemble and often misdiagnosed as epileptic seizures
Psychological :ie, emotional, stress-related) in origin.
Organic Syncope, migraine, and transient ischemic attacks (TIAs)
Diagnosis and Ix
1. History (patient -details about auras, preservation of consciousness, and postictal states)and
witness account(the best are those who has witnessed several time)
Patient account
• Was any warning noted before the spell? If so, what kind of warning occurred? –taste,smell.de
javu.butterflies in stomach
• What did the patient do during the spell? Side tongue biting?Anything that bring it’s on?
(eg.flickering tv light/alcohol)
• Was the patient able to relate to the environment during the spell and/or does the patient have
recollection of the spell?
• How did the patient feel after the spell? How long did it take for the patient to get back to baseline
condition? Long recovery very suggestive.
• NB:On set of the spell (this help to diff partial & generalize)
• How long did the spell last?
• How frequent do the spells occur?
• Are any precipitants associated with the spells?
• Has the patient shown any response to therapy for the spells?
Witness Account
6. Admission if indicated for observation and investigatons.Counselling for first ever seizures.
DDx
Treatment
Drug indicated after firm dx.
Start with 1st line , dose increase until seizures controlled /tolerance achieved.
Aim at using only one drug-switch to 2nd most appropriate drug.
Use 2 drugs only if the 1st has been titrated to highest dose.
Partial Gen
lamotrigine –
rash,drowsiness,photosensitivities,diplop
ia,
vomiting,tremor,agitation
oxcarbazepine
Adjunct
Lamotrigine-rash,fever Levetiracetam
Levetriacetam-keppra Lamotrigine
Topiramate Topiramate
Tiagabin Clonazepam
Oxcarbazepine
Gabapentin ?-drowsiness,confusion
(Vigabatrin) –drowsiness, confusion
Surgical treatment
Pregnancy
• Preconception counseling-teratogenicity.
Withdrawal of AED