Epilepsy

• Epilepsy is a condition characterised by seizures.
• Seizures are transient episodes of abnormal electrical activity in the brain.
• The types of seizure generally seen in adults include: Generalised tonic-clonic seizures, Partial seizures (or focal seizures), Myoclonic seizures, Tonic seizures, Atonic seizures.
• The types of seizure more common in children include: Absence seizures, Infantile spasms, Febrile convulsions.
• Generalised tonic-clonic seizures involve tonic (muscle tensing) and clonic (muscle jerking) movements associated with a complete loss of consciousness.
• Typically, the tonic phase comes before the clonic phase.
• Generalised tonic-clonic seizures are also called grand mal seizures.
• Before the seizure, patients might experience aura, an abnormal sensation that gives a warning that a seizure will occur.
• During a seizure, patients might experience tongue biting, incontinence, groaning and irregular breathing.
• After the seizure, there is a prolonged post-ictal period, where the person is confused, tired, and irritable or low.
• Partial seizures (or focal seizures) occur in an isolated brain area, often in the temporal lobes.
• Partial seizures affect hearing, speech, memory and emotions.
• During partial seizures, patients remain awake.
• Lamotrigine or Levetiracetam
• Tonic and atonic
• Treatment for epilepsy depends on the type of seizure and is guided by a specialist.
• Seizure Type
• Women who cannot have children
• Partial (or focal)
• Women able to have children
• The aim of treatment is to be seizure-free on the minimum anti-epileptic medications, ideally monotherapy with a single drug.
• First-line therapies for epilepsy depend on the type of seizure, based on the NICE guidelines (2022):
• Safety precautions for epilepsy include having a driving licence removed until specific criteria are met, showering rather than bathing due to the risk of drowning, and taking extra caution with swimming, heights, traffic and dangerous equipment.
• Generalised tonic-clonic
• Sodium valproate
• Absence seizures are usually seen in children, where the patient becomes blank, stares into space, and then abruptly returns to normal, during the episode, they are unaware of their surroundings and do not respond, these typically last 10 to 20 seconds, and most patients stop having absence seizures as they get older.
• During simple partial seizures, individuals remain aware, but lose awareness during complex partial seizures.
• Febrile convulsions are tonic-clonic seizures that occur in children during a high fever, they are not caused by epilepsy or other pathology, and occur in children aged between 6 months and 5 years, they do not usually cause any lasting damage, and one in three will have another febrile convulsion, they slightly increase the risk of developing epilepsy.
• Infantile spasms, also known as West syndrome, is a rare (1 in 4,000) disorder starting at around six months of age, presenting with clusters of full-body spasms, and is associated with hypsarrhythmia, which is a characteristic EEG finding, and has a poor prognosis, treatment is with ACTH and vigabatrin.
• Differential diagnosis is essential to differentiate seizures from other conditions with a similar presentation, such as vasovagal syncope, pseudoseizures, cardiac syncope, hypoglycaemia, and hemiplegic migraine.
• Various symptoms are associated with partial seizures, depending on the location of the abnormal electrical activity, including déjà vu, strange smells, tastes, sight or sound sensations, unusual emotions, abnormal behaviours, myoclonic seizures, tonic seizures, atonic seizures, absence seizures, infantile spasms, and hypsarrhythmia.
• Patients and families presenting with seizures are advised about safety precautions and recognising, managing and reporting further seizures.
• An electroencephalogram (EEG) shows typical patterns in different forms of epilepsy and supports the diagnosis, MRI brain is used to diagnose structural pathology, and additional investigations can be considered to exclude associated pathology.
• Tonic seizures involve a sudden onset of increased muscle tone, where the entire body stiffens, resulting in a fall if the patient is standing, usually backwards, and last only a few seconds or at most a few minutes.
• Atonic seizures (causing “drop attacks”) involve a sudden loss of muscle tone, often resulting in a fall, and last only briefly, with patients usually aware during the episodes.
• Myoclonic seizures present with sudden, brief muscle contractions, like an abrupt jump or jolt, and can occur as part of juvenile myoclonic epilepsy in children.