EPILEPSY

PRIYADHARSHINI S
ROLL NO 20
FINAL BHMS 2018 BATCH
EPILEPSY
A seizure can be defined as the occurrence of signs
and/or symptoms due to abnormal, excessive or
synchronous neuronal activity in the brain.
Epilepsy is the tendency to have unprovoked seizures.
All patients who have seizures may not be suffering
from epilepsy but everyone who has epilepsy has
seizures.
CLINICAL APPROACH
1. Consider epilepsy in every patient who presents with
sudden, transient and recurrent attacks of symptoms
suggestive of CNS dysfunction.
2. Obtain a detailed history from the patient and at least
from one eye witness to these episodes.
3. Inquire into the following:
• Age of onset of symptoms.
• Accurate and full description of one attackif the attacks
are stereotyped. Otherwise description of each type of
attack separately.
• Particularly inquire about aura, focal onset of a
convulsion, loss of consciousness, tongue bite,
frothing from the mouth, bladder or bowel
incontinence, sustained injuries, postictal phenomena,
interictal symptoms and frequency of the attacks.
• Epileptic attacks are precipitated by several stimuli. In
many cases attacks are precipitated by avoidance of
the drug, failure, travel, insomnia, photic stimulation
by cinema or television, late dinner and others.
• Past history of trauma, CNS infections, febrile
convulsions or any other neurological disorder should
be elicited.
• Medication history, with details of antiepileptic drugs
and their dosage. If drug has been discontinued, reason
for doing so.
• After taking the history, perform full general
examination and detailed neurological examination.
INDICATION FOR BRAIN
IMAGING
Epilepsy starting after the age of 16 years
Seizures having focal features clinically
Electroencephalogram showing a focal seizure source
 Control of seizures difficult or deteriorating
While CT excludes a major structural cause of
epilepsy, MRI is required to demonstrate subtle
changes such as hippocampal sclerosis, which may
direct or inform surgical intervention
DIFFERENTIAL DIAGNOSIS
SYNCOPE
HYPOGLYCEMIA
PANIC ATTACKS
PAROXYSMAL MOVEMENT DISORDERS LIKE
ACUTE DYSTONIC REACTIONS, HEMIFACIAL
SPASMS, NON EPILEPTIC MYCLONUS
SLEEP DISORDERS LIKE PARASOMNIA,
CATAPLEXY,HYPNIC JERKS ETC
TRANSIENT ISCHEMIC ATTACKS
MANAGEMENT – FIRST AID
 Move the person away from danger (fire, water, machinery,
furniture)
 After convulsions cease, turn the person into the 'recovery'
position (semi-prone)
 Ensure the airway is clear but do NOT insert anything in the
mouth (tongue-biting occurs at seizure onset and cannot be
prevented by observers)
 If convulsions continue for more than 5 mins or recur
without the person regaining consciousness, summon urgent
medical attention
 Do not leave the person alone until fully recovered
(drowsiness and delirium can persist for up to 1 hr)
LIFESTYLE ADVICE
Patients should be advised to avoid activities where
they might place themselves or others at risk if they
have a seizure. This applies at work, at home and at
leisure.
At home, only shallow baths (or showers) should be
taken.
 Prolonged cycle journeys should be discouraged until
reasonable freedom from seizures has been achieved.
Activities involving prolonged proximity to water
(swimming, fishing or boating) should always be
carried out in the company of someone who is aware
of the risks and the potential need for rescue measures.
HOMOEOPATHIC
MANAGEMENT
CICUTA – in spasms with rigidity, fixed staring eyes,
blue face and frothing at the mouth, great difficulty in
breathing, opisthotonus and loss of consciousness,
spasms followed by profound exhaustion
ARGENTUM NITRICUM - Epilepsy from fright or
coming on during menses, pupils are dilated for days,
or hours, before attack, after attack restlessness and
trembling of hands
BUFO RANA-The aura starts from the epigastrium
and from the genital organs. There is often preceding
the attack great irritability of mind.
NUXVOMICA- The characterizing feature of epilepsy is
‘Convulsions with conciusness’.Spasms with titanic
Rigidity of nearly all muscles of the body, with
interruptions of few minutes, during which the muscles
becomes relaxed,pulse becomes soft and patient regain
consciousness and speech, the spasm gets again renewed
by slightest touch.

CUPRUM MET -Convulsion here is caused by a blow on

head or from getting wet. Aura begins in lower extremities
and proceeds upwards. (from above down wards is
cicuta ) In epilepsy calling for Cuprum we have
contractions and jerking of the knees, fingers and toes.
AGARICUS- Seizure caused due to bad effects of sexual
excess, alcohol, debauch or suppressed excess. Twitching
and trembling, jerking of the whole body with chore.
Delirium with constant raving. Involuntary movements
while awake, ceases during sleep. Chorea of single muscle
with dancing of whole body. Great mental excitement with
incoherent talks. Stumbles over objects.

HELLABORUS - During convulsion there is automatic

motion of one arm and one leg. There is extreme coldness
of the body, except in head or occiput which may be hot.
The patient greedily swallows cold water; he bites the
spoon, still remaining unconscious.
THANK YOU