epilepsy
EPILEPSY
Epilepsy is a clinical multiaxial diagnosis.
Epileptic seizure is a transient occurrence of signs/symptoms brought about by abnormal excessive or synchronous neuronal activity in the brain.
It is recommended that all patients having a first seizure be referred as soon as possible to a specialist to ensure accurate and early diagnosis and initiation of treatment appropriate to the needs of the patients.

Definition

Unprovoked seizure 

  • Seizures that occur without a potentially responsible clinical condition or beyond the interval estimated for the occurrence of acute symptomatic seizures
  • Classified as either seizures of unknown etiology or seizures that occur due to preexisting brain lesion or progressive nervous system disorder

Epilepsy

  • Epilepsy may be defined by any of the following conditions:
    • At least two unprovoked (or reflex) seizures occurring >24 hours apart
    • One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
    • Diagnosis of epileptic syndrome

Epidemiology

  • In the United States, an estimated 150,000 adults annually present with an unprovoked first seizure
    • An estimated 40-50% of these incident seizures recur to be classified as epilepsy
    • Lifetime cumulative risk of developing recurrent unprovoked seizures or epilepsy by the age of 80 years ranges from 1.4-3.3%

Pathophysiology

  • Epilepsy is a clinical multiaxial diagnosis 
    • Epileptic seizure is a transient occurrence of signs/symptoms brought about by abnormal excessive or synchronous neuronal activity in the brain
    • An epileptic seizure represents a disruption in the normal balance between excitatory and inhibitory currents or neurotransmission in the brain
      • Drugs or pathogenic processes that augment excitation or impair inhibition tend to be epileptogenic, while anti-seizure drugs tend to facilitate inhibition and dampen excitation
    • It is a disorder of the brain characterized by enduring predisposition to generate epileptic seizures, and by the neurobiologic, cognitive, psychological, and social consequences of this condition

Signs and Symptoms

Clinical Symptoms (During Seizure)

  • Aura
  • Cyanosis
  • Sudden falls
  • Motor symptoms: Involuntary stiffening or jerky movements of limbs in an awake, unaware or asleep patient
  • Sensory symptoms: Blank spells with or without automatisms
  • Autonomic symptoms: Urinary incontinence or tongue biting with loss of awareness, or during sleep
  • Alteration of mental status: Episodes of confused behavior with lack or loss of awareness and/or recollection
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