Epilepsy

Question 1

What is Epilepsy?

Answer 1

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. A seizure is a sudden, abnormal electrical discharge in the brain that leads to a variety of symptoms, including loss of consciousness, uncontrolled movements, or sensory disturbances.

Question 2

What are seizures?

Answer 2

Sudden, transient recurrentepisodes ofsensorydisturbance, loss ofconsciousness, orconvulsions, associated with abnormalelectrical activity in the brain

Question 3

Define Status Epilepticus.

Answer 3

Status epilepticus is a medical emergency characterized by prolonged seizure activity or recurrent seizures without full recovery of consciousness in between. It typically lasts for 5 minutes or more and requires urgent treatment to prevent brain damage and other complications.

Question 4

How is Epilepsy classified?

Question 5

What are the risk factors?

Answer 5

Cerebrovascular disease
Head trauma
Family history
Congenital malformations
Genetic conditions associated with epilepsy

Epilepsy most commonly occurs in isolation, although certain conditions havean association with epilepsy:
Cerebral palsy
Tuberous sclerosis
Mitochondrial diseases

Question 6

What is the underlying pathophysiology of seizures?

Answer 6

Seizures occur due to abnormal electrical activity in the brain, caused by an imbalance between excitatory neurotransmitters (e.g., glutamate) and inhibitory neurotransmitters (e.g., GABA). This leads to excessive and synchronized neuronal firing.

Focal seizures involve a specific brain region, while generalized seizures affect both hemispheres.
Structural brain changes, genetic mutations, or hyperexcitable neurons can increase seizure susceptibility.
Seizures can be triggered by factors like sleep deprivation, stress, or metabolic disturbances.

Question 7

What are the symptoms and clinical features of Epilepsy?

Answer 7

Clinical features are dependent on location

Temporal lobe(mnemonic HEAD)​:
Hallucinations (auditory/gustatory/olfactory)​
Epigastric rising/Emotional​
Automatisms (lip smacking/grabbing)​
Deja vu/Dysphasia (post-ictal)​

Frontal lobe (motor)​:
Head/leg movements​
Posturing​
Post-ictal weakness​

Parietal lobe (sensory)​:
Paraesthesia​

Occipital lobe (visual)​:
Floaters/flashes​

Question 8

What are the different seizure types?

Answer 8

Area of onset
Focal – localised to a network of neurones in one hemisphere of the brain
Generalised – affecting both hemispheres and their associated neuronal networks

Awareness
Aware – fully aware of themself and surrounding throughout the seizure
Impaired awareness – any impairment of awareness during the course of a seizure

Motor
Tonic (generalised muscle stiffening)
Clonic (rhythmic muscle jerking)
Myoclonic (brief, shock like involunatary jerks)
Atonic (loss of muscle tone)
Spasms (sudden flexion/extension movements)

Non-motor
Sensory, cognitive, emotional, autonomic or behavioural changes