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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.

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