EPILEPSY

Terms
Seizures

Convulsion or transient event caused by a paroxysmal discharge of

cerebral neurons

Epilepsy

Continuing tendency to have seizures

Aura

Stereotyped perception before partial seizures

A: Generalised seizures
B: Partial seizures
C: Partial seizures with secondary generalisation

EPILEPSY
Type
Generalised seizure typesBilateral abnormal electrical
activity, bilateral motor
manifestation and impaired
consciousness

Subtype
Absent seizures (petit mal)

Generalised tonic-clonic
seizures (grand mal)
Myoclonic seizures
Tonic seizures
Akinetic seizures

Partial seizure typesabnormal electrical activity

localised to one part of the
brain
a. simple-without loss of
awareness
b. complex-with loss of
awareness

Simple Jacksonian seizures

Complex Partial seizures (eg
Temporal lobe which can
either be simple or
complex)

Partial seizures evolving to

tonic-clonic
Apparent generalised tonicclonic seizures

Features
Begins in childhood
(tendency to develop
generalised tonic-clonic
seizures in adulthoodPrimary generalised
epilepsy)
Typical (with 3Hz spike and
wave EEG activity) or
atypical

Isolated muscle jerking

Cessation of movement,
falling and loss of
consciousness
Impaired awareness
Can have features of:
Motor
Sensory
Autonomic
Psychiatric

EEG but not clinical

evidence of focal onset

Unclassified seizures
Causes
1. Idiopathic
2. Cerebrovascular disease (cerebral infarction, cerebral haemorrhage or venous
thrombosis
3. Head injury (more likely if associate with > 30 min LOC, > 30 min post-traumatic
amnesia
4. Following cranial surgery
5. CNS infection (meningitis or encephalitis)
6. Neurodegenerative disease (Alzheimers or multi-infarct dementia)
7. Autoimmune disease
8. Tumour
9. Genetic disease
10. Drugs (phenothiazines, isoniazid, TCA, alcohol binging or withdrawal,
benzodiazepine withdrawal
11. Metabolic disease (uraemia, alcohol related hypoglycaemia, hypoglycaemia,
hyponatraemia, hypernatraemia, hypercalcaemia and hypicalcaemia)
Status epilepticus
Continuous prolonged seizures without recovery of consciousness
Mortality 10-15%
50% without history of epilepsy
Mx

EPILEPSY
10 -20 mg of i.v. diazepam at 5mg/min
Repeat once
Give rectal diazepam if no i.v. access
Check blood glucose, alcohol, drugs screen, magnesium, drug screen and anticonvulsant level
Thiamine 250 mg i.v. if evidence nutrition poor or suspected alcohol abuse
Anti-epileptic drugs
Lorazepam 4 mg i.v. at 2mg/min
Reinstate previously used AED
If continues i.v. phenytoin 15mg/kg (dilute 10 mg per ml)-rate < 50
mg/min
(Or Fosphenytioin 1.5mg = phenytoin 1 mg)
If continues, phenobarbital/clonazepam/peraldehyde