DEFINITION

Came from the Greek word epilepsia which

means to seize
Is a chronic neurologic disorder characterised
by seizures
The seizures are transient signs or symptoms
of abnormal, excessive but synchronous
neuronal activity in the brain
Should not be understood as a single disorder
but rather as a syndrome with vastly divergent
symptoms with all involving episodic abnormal
electrical activity in the brain

EPIDEMIOLOGY
About 50 million people world wide have

epilepsy
About 20,000,000 cases in US
About 3,000,000 in UK
It is placed at 14-57 per thousand population
for Africa and some South American countries
Generally it has been placed at 40-70per
100,000 population for developed countries
and 100-190 per 100,000 population for
developing countries.

CLASSIFICATION
Epilepsies are classified in five ways
By their first cause or aetiology
By the observable manifestations of the

seizures known as semiology

By the location in the brain where the seizures
originate
As a part of discrete identifiable medical
syndromes
By the event that triggers the seizure as in
primary reading epilepsy.

CLASSIFICATION
In 1981. the International League against

epilepsy (ILAE) proposed a classification

scheme for individual seizures that is still in
common use.
It is simple

Classification
Generalised means the source is distributed

around the brain and it involves loss of

consciousness
Tonic clonic
Tonic
Clonic
Absence
Atonic

Classification
Partial or focal when the source of the seizure

within the brain is localised

Simple: consciousness is unaffected
Complex: involving loss of consciousness
Simple with secondary generalisation
Complex with secondary generalisation
Simple becoming complex with secondary

generalisation

Classification
Unclassified these are seizure types that

could not fit into any particular category

Classification
Since 1997 the ILAE has been working on a

new scheme that have five axis

Ictal phenomenon ( pertaining to an epileptic

seizure )
Seizure type
Aetiology
Syndrome
Impairment

SIMPLE PARTIAL
SEIZURES
Can present with the following signs
Motor signs
Focal without a match
Focal with a match (Jacksonian )
Postural
Phonatory ( vocalisation, or arrest of speech )
With somatosensory or special sensory

symptoms e.g simple hallucinations like

tingling, light flashes, buzzing.

Somatosensory
Visual

SIMPLE PARTIAL
SEIZURES
Auditoy

Olfactory
Gastatory
Vertiginous

With autonomic symptoms or signs

Epigastric sensation
Pallor
Sweating
Flushing
Piloerection
Pupillary dilatation

SIMPLE PARTIAL
SEIZURES
With psychic symptoms ( disturbance of higher
centre functions ). These symptoms however,
rarely occurs without impairment of
consciousness and are therefore more
commonly experienced as complex partial
seizures
Dysphasic
Cognitive ( dreamy state, distortion of time )
Dysmesic e.g dejavu
Affective ( fear, anger etc )

CAUSES
The word epilepsy actually denotes idiopathic

nature of the problem

The diagnosis requires that the seizures
occurs spontaneously
Nevertheless, certain epileptic syndromes
require particular precipitants or triggers;
these are termed reflex epilepsy

Patients with primary reading epilepsy have

their seizures triggered by reading

Photosensitive epilepsy is limited to seizures
triggered by flashing lights.

CAUSES
Children with childhood absence seizures may

be susceptible to hyperventilation

Other precipitants can facilitate rather than

obligately trigger seizures in susceptible

individuals

Emotional stress
Sleep deprivation
Sleep itself
Heat stress
Alcohol
Fever as in febrile convulsions

CAUSES
The influence of various precipitants varies

with the epileptic syndrome

In different age groups some causes are
common
Neonatal age

HIE ( Hypoxic ischaemic encephalopathy )

CNS infections
Trauma
Congenital abnormalities
Metabolic disorders

CAUSES
Infancy and early childhood
Febrile convulsion
Childhood

Well defined epilepsy syndromes

Adolescents and adulthood

CNS lesions
Stress
Trauma
CNS infections
Brain tumours
Illicit drug use

PATHOPHYSIOLOGY
Seizures are paroxysmal manifestation of

electrical properties of the cerebral cortex

A seizure results when a sudden imbalance
occurs between the excitatory and inhibitory
forces within the network of cortical neurons in
favour of a sudden onset net excitation.
Depending on the affected cortical network the
manifestation will differ if it is the visual cortex,
the clinical manifestation are visual. Other areas
may give rise to sensory, gastatory or motor
manifestations.

INVESTIGATIONS

FBC
MPS
LP
Blood culture
EEG may tell seizure type
Neuroimaging; these may provide evidence
about structural abnormalities that could be
the cause for the seizures
CT scan
MRI

TREATMENT
Indications for starting treatment include
A patient with more than one seizure episode
The older indication was 2 episodes in 6 months
or 3 episodes in a year
This is taken in conjunction with abnormal
results like abnormal EEG, MRI or CT scan
Indications also reflect seizure type as complex
seizures require treatment

DRUGS
Blockers of repetitive activation of sodium

channels
Phenytoin
Carbamazepine
Oxcarbamazepine
Lamotrigine
Topiramate

Enhancer of slow activation of sodium

channels

DRUGS
Lacosamide
Rufinamide

GABA A receptor enhancers

Phenobarbital
Benzodiazepines
Glutamate modulators
Topiramate
Lamotrigine
Felbamate

DRUGS
T. Calcium Channel blockers
Ethusuximide
Valproate
N- and L- Calcium channel blockers
Lamotrigine
Topiramate
Zonisamide
Valproate

DRUGS
H. Current modulators
Gabapntin
Lamotrigine
Blockers of unique binding sites
Gabapentin
Lenetiracetin
Carbonic anhydrase inhibitors
Topiramate
Zonisamide

Indication for discontinuing

treatment

Seizure free for 2 5 years

Over 30% of patients with epilepsy do not
have seizure control even with the best
medications

Other treatment
modalities
Surgery
Palliative: Anterior callostomy which is rarely

done now. Used for intractable atonic seizures

Curative
Lobectomy
Lesionectomy

Diet
Ketogenic diet has been effective in improving

seizure control in selected patients

Other treatment
modalities
Electrical stimulation; one approved method is
the vagus nerve stimulation ( VNS )
Stem cell transplantation

PROGNOSIS
The patient prognosis for disability and for

recurrence of epileptic seizures depends on

the type of seizure and the epileptic syndrome
in question.
Prognosis is worse with partial seizures
Prognosis is worse with frequent seizures
before presentation

FEBRILE CONVULSIONS
Definition: Convulsion with fever in children

aged 6 months to 5 years whose cause is of

an extra cranial origin. Usually lasts
15minutes or less.
About 4% of people will have one seizure
episode in their life time

CLASSIFICATION
Simple
Complex

CAUSES
Any condition that causes a rapid increase in

temperature
AOM
Malaria
Measles
Bronchopneumonia
Post immunisation

DIFFERENTIAL
DIAGNOSIS
Meningitis
Encephalitis
Cerebral malaria
Metabolic problems
Hypoglycemia
Hypocalcaemia

INVVESTIGATIONS
FBC
MP
Blood culture
Viral serology
LP
RBS
Serum calcium

TREATMENT
Control seizure
Treat cause
Long term seizure control

STATUS EPILEPTICUS
A life threatening condition in which the brain

is in a state of persistent seizures

Defined as one continuous seizure lasting
more than 30minutes or recurring seizures
lasting more than 30 minutes without
regaining consciousness in between.
Mortality is in the upward of 20% if not
treated early

STATUS EPILEPTICUS
With optimal neurologic care a good prognosis

is expected

TREATMENT
Make sure patient is breathing
Clear airway by suctioning if need be
Drugs
Diazepam given intravenously its effect lasts 5

15 minutes may need to be repeated ( though

its half life is 30 hours )
Lorazepam when available lasts longer.

TREATMENT
Phenytoin or fosphenytoin: takes 15 30

minutes to act so could be administered

together with diazepam
Sodium valproate may also be used
intravenously
Phenobarbitone or barbiturates

TREATMENT
Practice here
Diazepam
Phenobarbitone
Largactil
When all fail
Anaesthesia with patient paralysis and

ventilation