Pathology: Transient seizures due to abnormal excessive or synchronous neuronal activity in the brain
Partial Seizures: Focal in onset and originate in one hemisphere.
Simple partial: consciousness preserved
Complex partial: Consciousness impaired
Generalized Seizures: Begin in both hemispheres simultaneously
Aetiology: Structural: Trauma, space occupying lesion, vascular malformation, stroke
Metabolic: alcohol withdrawal, high/low glucose, high/low sodium, low oxygen
Infection: HIV, encephalitis, syphilis
Idiopathic
Neurodegenerative: Alzheimer’s/vascular dementia
Genetic diseases
Symptoms: Dependent on seizure type
Signs: Dependent on seizure type
Investigations: Bloods: FBC,U&E, LFTs, Glucose – to exclude infection or electrolyte imbalance
Imaging: MRI Brain: To exclude structural pathology
ECG: To assess for structural or valvular abnormalities
EEG: Assess for seizure activity
Treatment: Partial focal seizures: 1st line lamotrigine, carbamazepine
Generalized and unclassified seizures: 1st line sodium valproate
Refractory epilepsy: Vagal nerve stimulation, epilepsy surgery
Status epilepticus: 1st line IV benzodiazepines, IV phenytoin/valproate, consider
ICU admission for sedation for resistant episodes
Complications: Injury, refractory seizures, sudden unexplained death in epilepsy, drug side effects
Prognosis: 50% will be seizure free after using first anti-epileptic medication
15% mortality rate in status epilepticus
