Epilepsy

Definition:

• Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. These seizures are the result of sudden, excessive electrical discharges in a group of brain cells (neurons).

Epidemiology:

• Affects people of all ages.
• Incidence is higher in children and older adults.

Classification of Seizures:

1. Focal Seizures:
   • Originating in one area of the brain.
   • Can be with or without loss of consciousness.
   • May progress to bilateral tonic-clonic seizures.
2. Generalized Seizures:
   • Affect both sides of the brain.
   • Include tonic-clonic, absence, myoclonic, atonic, and tonic seizures.

Etiology:

• Can be idiopathic (no identifiable cause) or secondary to various conditions like brain injury, stroke, brain tumors, infections, and genetic disorders.

Pathophysiology:

• Involves abnormal neuronal activity, which can be due to a variety of factors including ion channel dysfunction, neurotransmitter imbalances, or structural brain changes.

Clinical Features:

• Depend on the type of seizure.
• Focal seizures may involve involuntary movements, altered emotions, sensory distortions.
• Generalized tonic-clonic seizures involve muscle rigidity, convulsions, and loss of consciousness.
• Absence seizures are characterized by brief lapses in awareness.

Diagnosis:

• Based on clinical history and characteristic EEG findings.
• Neuroimaging (MRI or CT) to identify structural causes.
• Blood tests to rule out metabolic causes.

Management:

• Pharmacological treatment with antiepileptic drugs (AEDs) is the mainstay.
• Choice of AED based on seizure type, patient age, side effect profile, and comorbid conditions.
• Surgical treatment for drug-resistant epilepsy.
• Lifestyle advice and supportive care, especially regarding safety during seizures.