Epilepsy resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: , Fahimeh Shojaei, M.D., Moises Romo, M.D.
Synonyms and keywords: Epilepsy management, Epilepsy workup, Epilepsy approach, approach to Epilepsy, Epilepsy treatment
Overview
Epilepsy is a common chronic neurological disorder that is characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain. Epilepsy can be diagnosed based on history, symptoms and physical examination of a patient with seizure complain. Among the patients who present with clinical signs of seizures, the EEG is the most efficient test for diagnosis. Anti-seizure medications for epilepsy include drugs that affect voltage-dependent Na+ channels, drugs that affect Ca currents, drugs that affect GABA activity, drugs that affect glutamate receptor, and drugs with multiple mechanisms of action.
Causes
Life-threatening Causes
Life-threatening causes of epilepsy include:[1][2][3][4][5][6]
Common Causes
Common causes of epilepsy may include:[7][8][9][10][11][12]
- Cerebral palsy
- Electrolyte disturbances
- Epileptic encephalopathy - Lennox-Gastaut type
- Febrile seizures
- Huntington's disease
- Intoxication
- Uremia
Diagnosis
Shown below is an algorithm summarizing the diagnosis of Epilepsy according the the ESC guidelines:
| Clinical presentation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Loss of conscoiusness | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| No | Yes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| • Transient? • Rapid onset? • Short duration? • Spontaneous recovery? | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Falls | Altered consciousnes | Yes | No | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Coma | Aborted SCD | Others | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
| T-LOC | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Non-Traumatic | Traumatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Syncope | Epileptic seizure | Psychogenic | Rare causes | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
| • Reflex syncope • Orthostatic hypotension • Cardiac syncope | • Tonic • Clonic • Tonic-clonic • Atonic | • Pseudo-epileptic • Pseudo-syncopal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- Adults with an unprovoked first seizure should be informed that their risk of recurrence is higher within the first 2 years.[13]
- Treat with immediate antiepileptic therapy from the first unprovoked seizure, since it has been seen that it reduces recurrences, as compared with the delay of treatment pending a second seizure. This may not improve quality of life.[14]
Don'ts
- The content in this section is in bullet points.
References
- ↑ Annegers JF, Coan SP (October 2000). "The risks of epilepsy after traumatic brain injury". Seizure. 9 (7): 453–7. doi:10.1053/seiz.2000.0458. PMID 11034867.
- ↑ Englot DJ, Chang EF, Vecht CJ (2016). "Epilepsy and brain tumors". Handb Clin Neurol. 134: 267–85. doi:10.1016/B978-0-12-802997-8.00016-5. PMC 4803433. PMID 26948360.
- ↑ Faught E, Peters D, Bartolucci A, Moore L, Miller PC (August 1989). "Seizures after primary intracerebral hemorrhage". Neurology. 39 (8): 1089–93. PMID 2761703.
- ↑ Misra UK, Tan CT, Kalita J (August 2008). "Viral encephalitis and epilepsy". Epilepsia. 49 Suppl 6: 13–8. doi:10.1111/j.1528-1167.2008.01751.x. PMID 18754956.
- ↑ Sloper JJ, Johnson P, Powell TP (September 1980). "Selective degeneration of interneurons in the motor cortex of infant monkeys following controlled hypoxia: a possible cause of epilepsy". Brain Res. 198 (1): 204–9. PMID 7407585.
- ↑ Chung JM (May 2014). "Seizures in the acute stroke setting". Neurol. Res. 36 (5): 403–6. doi:10.1179/1743132814Y.0000000352. PMID 24641717.
- ↑ Diaconu G, Burlea M, Grigore I, Frasin M (2003). "[Epilepsy in different types of cerebral palsy]". Rev Med Chir Soc Med Nat Iasi (in Romanian). 107 (1): 136–9. PMID 14755984.
- ↑ Riggs JE (February 2002). "Neurologic manifestations of electrolyte disturbances". Neurol Clin. 20 (1): 227–39, vii. PMID 11754308.
- ↑ Markand ON (2003). "Lennox-Gastaut syndrome (childhood epileptic encephalopathy)". J Clin Neurophysiol. 20 (6): 426–41. PMID 14734932.
- ↑ Shinnar S, Glauser TA (January 2002). "Febrile seizures". J. Child Neurol. 17 Suppl 1: S44–52. doi:10.1177/08830738020170010601. PMID 11918463.
- ↑ Cendes F, Andermann F, Carpenter S, Zatorre RJ, Cashman NR (January 1995). "Temporal lobe epilepsy caused by domoic acid intoxication: evidence for glutamate receptor-mediated excitotoxicity in humans". Ann. Neurol. 37 (1): 123–6. doi:10.1002/ana.410370125. PMID 7818246.
- ↑ D'Hooge R, Pei YQ, Marescau B, De Deyn PP (October 1992). "Convulsive action and toxicity of uremic guanidino compounds: behavioral assessment and relation to brain concentration in adult mice". J. Neurol. Sci. 112 (1–2): 96–105. PMID 1469446.
- ↑ Krumholz, A.; Wiebe, S.; Gronseth, G. S.; Gloss, D. S.; Sanchez, A. M.; Kabir, A. A.; Liferidge, A. T.; Martello, J. P.; Kanner, A. M.; Shinnar, S.; Hopp, J. L.; French, J. A. (2015). "Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 84 (16): 1705–1713. doi:10.1212/WNL.0000000000001487. ISSN 0028-3878.
- ↑ Krumholz, A.; Wiebe, S.; Gronseth, G. S.; Gloss, D. S.; Sanchez, A. M.; Kabir, A. A.; Liferidge, A. T.; Martello, J. P.; Kanner, A. M.; Shinnar, S.; Hopp, J. L.; French, J. A. (2015). "Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society". Neurology. 84 (16): 1705–1713. doi:10.1212/WNL.0000000000001487. ISSN 0028-3878.