If you are on right path and you are not
facing difficulties… then think for a while:
you may be on wrong path…because right
path always contains difficulties.
HAZRAT ALI R.A
A young girl of age 10 is brough to
medical OPD with c/o deteriorating
performance in her studies. According to
her teacher, she stops doing her work &
seems to have day-dreaming. This
happens at home too. No h/o loss of
consciousness or any altered mental
What may be the possible cause?
A 40 yrs old
gentleman is brought
to ER with h/o
drowsy. there is h/o
low grade fever,
cough & anorexia for
last 1 month. CXR is
shown. Give your
His CT brain is shown
A 35 years old lady is brought to ER with
c/o left sided weakness. Pt is slightly
confused & shows features of left UMN
lesion. There is history of epilepsy for
which she takes medicine
continuously.her weakness recovered
within 6 hrs. give your diagnosis.
A 67 yrs old man is brought to ER with
H/O focal fits in right arm. There is h/o
some neurosurgical procedure 14 yrs
back. Pt remained well since then.
What may be the cause?
A 34 yrs old gentleman with history of
epilepsy for last 15 yrs, on regular
treatment presents with c/o multiple
swellings over his body. No h/o fever,
anorexia or weight loss. o/E there is
What rare possibility comes to your mind?
A 34 yrs old lady comes to gynaecology
OPD with bad obstetric history. There is
h/o 2 abortions & 1 baby with cleft palate.
She is also an epileptic and takes
What advice should be given to her?
A 13 yrs old boy is brought to ER with c/o
GTCF at home about 30 min back. In ER
again he has an episode of GTCF. He is
given INJ DIAZEPAM 10mg IV. The boy is
mentally retarded. Examination reveals
small white oval lesions on skin. There is
family history of epilepsy.
What condition comes to your mind?
A 65 yrs old gentleman is brought to OPD
with c/o abnormal movements of right
hand. According to patient, this problem
aggravates when he attempts to write or
perform some skilled work .his uncle also
had similar problem. No other finding in
history and examination.
What may be the cause?
A 45 yr old diabetic is brought to OPD with
2 days history of difficulty in walking and
inability to hold the objects. O /E:
Pt is conscious oriented
There are intention tremors on right side
Patient falls to right side when asked to
What is your diagnosis?
A young girl of age 17 is brought to
hospital with c/o difficulty in walking and
increasing clumsiness of hands for last 6
months. o/e a young girl with rapid
involuntary movements of both hands.
She has a broad-based gait. eye
examination reveals a characteristic
lesion. What is your impression?
Epilepsy is a tendency to have recurrent
seizures. It is a symptom of brain disease
rather than a disease itself.
A seizure is any clinical event caused by
abnormal electrical discharge in the brain.
It has four types:
Childhood absence epilepsy
Juvenile absence epilepsy
Juvenile myoclonic epilepsy
GTCS on awakening
PRIMARY GENERALISED EPILEPSY
Onset mostly in childhood or adolescence
Mostly due to genetic predisposition
without a structural cause
It comprises upto 10% of all epilepsies
and upto 40% of tonic clonic seizures.
It may be caused by:
Spread of partial seizures due to structural
May be secondary to drugs or metabolic
Epilepsy presenting in adult life is almost
always secondarily generelised.
Guidelines for anticonvulsant
Start with one first-line drug.
Start with low dose & increase to effective
If first drug fails, start second drug while
gradually withdrawing first.
Try three agents singly before using
Don’t use more than 2 drugs at a time.
Withdrawal of AEDs
After complete control of seizures for 2-4 yrs,
consider AED withdrawal.
Childhood epilepsy carries the best prognosis for
successful drug withdrawal.
Seizures that begin in adult life particularly those
with partial features are likely to recur esp if
there is underlying structural cause.
Overall recurrence rate after withdrawal is 40%
Withdrawal should be gradual over 6-12 months.
Status epilepticus exists when a series of
seizures occur without the patient
regaining awareness between attacks
over a period of 30 minutes.
Diazepam 10mg IV or rectally, can be repeated
once OR lorazepam 4mg IV
If seizures continue after 30 minutes :
IV infusion phenytoin or phenobarbital
If seizures still continue after 30 -60 min:
Intubation & ventilation
Once status controlled:
Commence longterm anticonvulsant medication
EPILEPSY OUTCOME AFTER 20 YRS
50% seizure free
without drugs for last
20% seizure-free for
last 5 years but
continue to take
continue inspite of