Epilepsy

Dr. Tarek Elsaid MD

Objectives
• Definition
• Types
• Causes
• Triggers
• Diagnosis
• Management
• Home care
Definition
• Group of disorders in which fits or deizers occur as a resultof
spontaneous abnormal electrical discharge in any part of the brain
• Prevalence 5-10/1000
• Usually starts in childhood or over 60
Classification
• Partial : limited to one area of the brain, simple if no impairment of
consciousness and complex if consciousness is impaired
• Generalized : whole brain is involved; consciousness is usually
impaired. Six subtypes (tonic-clonic {grand mal}; absence {petit-mal};
myoclonic, tonic, clonic and atonic.
• Combined partial and generalized
• Unclassified
Causes (60 %)
• Cerebrovascular disease
• Cerebral tumors
• Genetic
• Post infective
• Drugs, alcohol and other toxins
• Head trauma
• Others
Triggers
• Lack of sleep
• Alcohol
• Flashing lights
• Tiredness
• Others
Assessment
• A good history from the patient and a witness is important:
1. What happened
2. When and where (during sleep, immediately after awakening?)
3. Were there any precipitating events?
4. Were there any warning signs?(aura, feeling going to faint?...)does
the patient remember the whole event?
Assessment (cont.)
1. Did the patient lose consciousness?
2. Did the patient jerk the limbs?, was it generalized?
3. What did the patient look like during the attack?
Assessment (cont.)
1. How long did it last?
2. Did anything else happen during the attach?(tongue biting,
incontinence)
3. What happened after the attack? (disorientation, drowsiness or
headache?)
Check
• General medical history (cardiac, CVA, other neurological symbtoms)
• Psychiatric history (depression, anexiety or panic attachs)
• Past medical history (trauma. Post-febrile convulsions, meningitis or
encephalitis?)
• Family history (epilepsy)
• Substance abuse (alcohol or drugs)
Clinical examination
• General
• Neurological
• Skin changes (café au lait for neurofibromatosis) and others
• Cardiovascular anomalies
• Focal neurological deficits
Investigations (first fit)
• EEG
• CT
• Blood for U&E
• Cr. E_GFR, LFTs,Ca, FBC, ESR,CRP
• Genetic testing?
• Anti-body testing?
Diagnosis

• By neurology ( type , triggers, causes, othe neurological and

psychiatric illnesses, co-morbidities)
• Effect on driving, work and social functions
• Plan of care (multi-discplinary care)
• Long term management
What to do if someone has a seizure (fit)

• If you see someone having a seizure or fit, there are some simple
things you can do to help.
• It might be scary to witness, but do not panic.
• If you're with someone having a seizure:
• only move them if they're in danger, such as near a busy road or hot cooker
• cushion their head if they're on the ground
• loosen any tight clothing around their neck, such as a collar or tie, to aid
breathing
• turn them on to their side after their convulsions stop – read more about
the recovery position
Cont.,
• stay with them and talk to them calmly until they recover
• note the time the seizure starts and finishes
• If the person is in a wheelchair, put the brakes on and leave any seatbelt or
harness on. Support them gently and cushion their head, but do not try to
move them.
• Do not put anything in their mouth, including your fingers. They should not
have any food or drink until they have fully recovered.
When to call an ambulance

• Call 999 and ask for an ambulance if:

• it's the first time someone has had a seizure
• the seizure lasts longer than is usual for them
• the seizure lasts more than 5 minutes, if you do not know how long
their seizures usually last
• the person does not regain full consciousness, or has several seizures
without regaining consciousness
• the person is seriously injured during the seizure
• People with epilepsy do not always need an ambulance or to go to
hospital every time they have a seizure.
Long term management
• Provide tailored information and support to people with epilepsy, and their
families or carers if appropriate, according to their individual needs and
circumstances.
• Include children and young people in discussions about their information
and support needs, and provide information appropriate to their
developmental age.
• Take into account the information and support needs of people with
epilepsy who are older, have a learning disability or have other complex
needs, for example: • give longer appointments to allow more time for
discussion • provide information in different formats, such as easy read,
large print or audio versions • involve family members or carers or an
advocate if the person wishes
Activities of daily living
• • Safety issues, including activities that should be adapted or avoided, for
example, showering rather than having baths, cooking safely, caring for
babies and young children safely, and avoiding working at heights.
• • Safety issues for children and young people, including supervised
swimming and water sports, not climbing above their height without
supervision. •
• Potential impact on lifestyle and social life and any experiences of social
exclusion. •
• Driving, including Driver and Vehicle Licensing Agency (DVLA) regulations.
• • Employment and education, including concerns and rights related to
employment and education.
Home care
• Safety issues at home
• Cooking
• Fire safety
• Gardening
• Bathing
• Swimming
• Going out
Important questions

• Taking patients off medication

• Back to driving
• Marriage
• Pregnancy
• Others ?