(A&E)

Overview

• Common neurological condition characterised by recurrent seizures. Need to have had >2 seizures (>24 hrs apart) for a diagnosis of epilepsy.
• Seizure → excessive activity of cortical neurons resulting in transient neurological symtpoms
• Aetiology → idiopathic, primary epilepsy. Secondary causes include tumour, meningitis, vasculitis, alcohol withdrawal, haemorrhage, metabolic.

Types of Seizure:

• Focal Seizure → seizure localised to specific cortical regions. May be complex (consciousness affected) or non-complex (consciousness not affected).
• Generalised Seizure → affects the whole brain and consciousness (lost immediately). Types include tonic-clonic, absence, myoclonic, atonic, tonic.
• Status Epilepticus → seizure lasting longer than 5 mintues or ≥2 seizures within a 5-minute period without the person returning to normal between them. Tx with IV lorazepam or PR diazepam.
  • Rule out hypoxia and hypoglycaemia (measuring blood glucose is key part in management of status epilepticus)

Making Diagnosis

Clinical Features:

• Focal Seizures:
  • Frontal Lobe → motor convulsions, may show post-ictal flaccid weakness, jacksonian march (clonic movements starting in one extremity and moving proximally through the body)
  • Temporal Lobe (most common type of partial seizure) → aura (weird smells, involuntary movements, deja vu, abdominal pain), lip smacking/plucking/grabbing (automatisms), post-ictal dysphasia and hallucinations
  • Occipital Lobe → visual disturbances (flashers and floaters)
  • Parietal Lobe → sensory issues (paraesthesia - tingling, numbness)
  • Frontal Lobe Complex → loss of consciousness, involuntary actions, rapid recovery
  • Localising of Focal Seizures
• Generalised Seizures:
  • Tonic-Clonic → vague symptoms before attack (eg. irritability), tonic phase (generalised muscle spasm - goes stiff and falls to floor), clonic phase (repetetive synchronous jerks - jerking limbs or loss of bladder control), urinary incontenence, tongue biting. Post-Ictal phase = impaired consciousness, lethargy, confusion.
  • Absence → onset in childhood, loss of consciousness but maintained posture (don’t fall down). No post-ictal phase. Often begin abruptly without warning and end abruptly, with patients having no recollection of the episode. (Stare blankly into space). Tx with Ethosuximide.
  • Myoclonic → convulsions without the muscle tensing (tonic phase). Sudden jerking of limb, trunk or face with preserved consciousness.
  • Atonic → sudden muscle relaxation causing patients to fall to the ground and then may motionless. Can also result in incontinence.
  • Tonic → muscle tensing without convulsions (clonic phase)

Investigations:

Clinical Diagnosis → 2 or more unprovoked seizures 24 hrs apart