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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.
  • Epilepsy Treatment in Hyderabad

    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.
  • EEG abnormality.
  • 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.

  • Treatment of Newly Diagnosed Epilepsy

    AED Treatment may Occasionally be deferred under the Following Circumstances

  • Infrequent seizures with extremely long intervals.
  • Occurrence of brief (and infrequent partial sensory or myoclonic) seizures without underlying structural lesion.
  • Benign epilepsy with Centro-temporal spikes (Rolandic epilepsy in children).

  • Principles of AED Treatment

  • The decision to start AED treatment should be made after discussion of the risks and benefits of treatment and taking into account the person’s -seizure type, prognosis, lifestyle and socioeconomic circumstances.
  • Treatment should be started with a single conventional antiepileptic drug (AED monotherapy).
  • Start with a low dose and gradually increase the dose until seizures are controlled or side-effects occur.
  • If the initial treatment is ineffective or poorly tolerated, then monotherapy using another AED can be considered.

  • The dose of the second drug is slowly increased until adequate or maximum tolerated dose is reached. The first drug is then tapered off slowly.

  • If the second drug is also unhelpful, the drug with lesser efficacy or tolerability should be taken off.
  • Combination therapy (polytherapy or adjunctive or ‘add-on’ therapy) can be considered when two attempts at monotherapy with AEDs have not resulted in curing of seizure.
  • The formulation or brand of AED should preferably not be changed (variations in bioavailability or different pharmacokinetic profiles may increase the potential for reduced effect or excessive side effects).
  • Modified release formulations offer ease of administration due to less frequent dosing and better compliance.
  • These are expensive compared to regular formulations.
  • Daily administration of AEDs should be used with caution during pregnancy.