Epilepsy is a chronic disorder characterized by recurrent unprovoked seizures.
The epileptic seizure may be characterized by sensory Motor or autonomic phenomena which might be accompanied by loss of consciousness.
The patients with epilepsy have seizures but all those who have seizures do not necessarily have epilepsy.
Seizures can occur in the setting of an acute illness or medical condition like fever, hypoglycemia – acute symptomatic seizures.
What is syndromic diagnosis?
ILAE classification of epilepsies and epilepsy syndromes.
Classification is done based on: seizures type, age of onset and possible etiology.
Localization related epilepsies /generalized epilepsies.
Idiopathic / Symptomatic.
Epileptic seizures may present with various features and not all features need to be present in an individual person.
The seizure type(s) and epilepsy syndrome, etiology, and co-morbidities are identified.
Failure to classify the epilepsy syndrome correctly can lead to inappropriate treatment and persistence of seizures.
Algorithm for Investigations of a Patients
Presenting with Seizures
PWE and their family members should be informed about their seizure type(s), epilepsy syndrome, and the prognosis, choice of drugs, ADRs of the drug.
Confirmation of the details of seizures from an available witness, patient.
Perform EEG with procedure which increases the yield of EEG.
Plan for CT or MRI if necessary.
EEG abnormality helps identify seizure type or epilepsy syndrome CT or MRI scan helps in identification of the possible Etiology of seizures.
Treatment of Epilepsy
The aim of treatment is to control seizures with the most appropriate antiepileptic drug (AED) without causing any significant side effects.
Treatment of epilepsy with AEDs should be started after confirming the diagnosis of epilepsy.
Treatment of the first Unprovoked Seizure
Epilepsy should not be diagnosed after a single seizure.
The average risk of developing a second seizure following a single unprovoked seizure is about 35-40%.
Many individuals with a first seizure if left untreated may not have a second seizure. The risk of a third seizure following two unprovoked seizures is much higher.
Circumstances in which a single seizure may be treated
Prolonged focal seizure.
First seizure presenting as status epileptics.
Presence of neurological deficit, hemiparesis, mental retardation, cerebral palsy etc.
Family history of seizures among parents, siblings or children.
Abnormality on brain imaging (CT / MRI).
High risk jobs (professional or other activities that may endanger life during a seizure).
The individual and family do not accept the expected risk of recurrence.