Epilepsy

Definition

Epilepsy is a chronic neurological disorder characterised by recurrent, unprovoked seizures. Seizures are episodes of abnormal electrical activity in the brain that can cause a variety of symptoms, depending on the region of the brain affected.

Aetiology

Epilepsy can be caused by various factors, including:

Genetic factors
Structural abnormalities in the brain (e.g., brain tumours, congenital malformations)
Infections (e.g., meningitis, encephalitis)
Head trauma
Metabolic disorders
Stroke

Pathophysiology

Seizures result from abnormal, excessive, or synchronous neuronal activity in the brain. The specific pathophysiology varies depending on the type of epilepsy but generally involves disruptions in the normal balance of excitatory and inhibitory neurotransmission.

Risk Factors

Family history of epilepsy
Previous brain infections or injuries
Developmental disorders (e.g., autism, neurofibromatosis)
Stroke or cardiovascular disease
Alcohol or drug abuse

Signs and Symptoms

Recurrent seizures
Temporary confusion
Staring spells
Uncontrollable jerking movements of the arms and legs
Loss of consciousness or awareness
Cognitive or emotional disturbances

Investigations

Clinical assessment and detailed history
Electroencephalogram (EEG) to detect abnormal brain activity
Neuroimaging (MRI or CT scan) to identify structural abnormalities
Blood tests to rule out metabolic causes

Management

Primary Care Management

Initial assessment and referral to a neurologist for diagnosis and treatment plan
Education and support for patients and caregivers
Monitoring and management of coexisting conditions

Specialist Management

Antiepileptic drugs (AEDs) such as carbamazepine, valproate, and lamotrigine
Regular follow-up to monitor treatment effectiveness and side effects
Surgical intervention in refractory cases
Vagus nerve stimulation or ketogenic diet for specific cases
Psychological support and cognitive behavioural therapy (CBT) for associated mental health issues

Example Management for Epilepsy

A patient diagnosed with focal epilepsy may be started on carbamazepine. The initial dose is typically 100-200 mg twice daily, gradually increased based on response and tolerability. The patient should be educated about the importance of medication adherence and regular follow-up appointments. If seizures are not controlled with medication, further evaluation and potential surgical options may be considered. Lifestyle advice includes avoiding known seizure triggers, ensuring adequate sleep, and avoiding alcohol.

References

NICE. (2024). Epilepsies: Diagnosis and Management. Retrieved from NICE
NHS. (2023). Epilepsy. Retrieved from NHS
Shorvon, S. D. (2016). Handbook of Epilepsy Treatment. Wiley-Blackwell.
Engel, J. Jr., Pedley, T. A. (2008). Epilepsy: A Comprehensive Textbook. Lippincott Williams & Wilkins.
National Institute of Neurological Disorders and Stroke. (2023). Epilepsy Information Page. Retrieved from NINDS