Epilepsy is a neurological disorder characterized by recurrent seizures that result from abnormal neuronal activity in the brain. A seizure occurs when there is a sudden surge of electrical activity in the brain, which can cause changes in behavior, movements or feelings. Epilepsy is defined as two or more unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a high risk of further seizures. Treatment involves identifying and treating any underlying causes, medication to control seizures, surgery to remove the seizure focus in the brain, or vagus nerve stimulation.

1. Epilepsy
Dr. Imdadul Magfur
MD Phase-B Resident (RSOMC-04)
Department of Psychiatry , SOMC

2. Definition
 Seizure: time-limited paroxysmal events that result from abnormal, involuntary,
excessive or synchronous neuronal discharges in the brain.
 Epilepsy: is a disorder characterized by the occurrence of at least 2
unprovoked seizures 24 hours apart. A person is considered to have epilepsy if
they meet any of the following conditions.
 At least two unprovoked (or reflex) seizures occurring greater than 24 hours
apart or 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. (Clinical definition)

3. (Contd.)
 Epilepsy is a disorder of the brain characterized by an enduring
predisposition to generate epileptic seizures, and by the
neurobiological, cognitive, psychological, and social consequences of
this condition. The definition of epilepsy requires the occurrence of at
least one epileptic seizure. (Conceptual Definition)
 CONVULSION : Primarily a lay term. Episodes of excessive,
abnormal muscle contractions, usually bilateral, which may be
sustained or interrupted

4. (Contd.)
 Status epilepticus: traditionally defined as a condition in which
epileptic seizures continue, or are repeated without regaining
consciousness, for a period of 30 mins or more (different authorities
debate time range of 5-60 mins)
 Provoked seizures: seizures which have an obvious and immediate
preceding cause (eg acute systemic, metabolic or toxic insult; or acute
cerebral event such as stroke, trauma, infections)

5. (Contd.)
 FOCAL : A seizure whose initial semiology indicates, or is consistent
with, initial activation of only part of one cerebral hemisphere.
 GENERALISED: A seizure whose initial semiology indicates, or is
consistent with, more than minimal involvement of both cerebral
hemispheres.
 ICTUS : A sudden neurological occurrence such as a stroke or an
epileptic seizure

7. EPIDEMIOLOGY
 One of the commonest neurological
disorder before the age of 15.
 Incidence:20-120 per 1lac.
 2-5% life time chance
 More common in female, in rural
areas, in low socioeconomic
condition.

8. Pathogeneses
 It is likely that many seizures result from
an imbalance between this excitation and
inhibition.
 Intracellular recordings during seizures
demonstrate a paroxysmal depolarization
shift in neuronal membrane potential,
predisposing to recurrent action potentials.

10. Motor
Tonic-clonic
Other motor
Non-Motor (Absence)
Unknown Onset
Motor
Non-Motor
focal to bilateral tonic-clonic
Generalized OnsetFocal Onset
Motor
Tonic-clonic
Other motor
Non-Motor
ILAE 2017 Classification of Seizure Types Basic Version 1
Unclassified 2
1 Definitions, other seizure types and descriptors are listed in the accompanying paper & glossary of terms
2 Due to inadequate information or inability to place in other categories
Aware
Impaired
Awareness
From Fisher et al. Instruction manual for the ILAE 2017 operational
classification of seizure types. Epilepsia doi: 10.1111/epi.13671

11. Motor
tonic-clonic
clonic
tonic
myoclonic
myoclonic-tonic-clonic
myoclonic-atonic
atonic
epileptic spasms2
Non-Motor (absence)
typical
atypical
myoclonic
eyelid myoclonia
Unknown Onset
Motor Onset
automatisms
atonic2
clonic
epileptic spasms2
hyperkinetic
myoclonic
tonic
Non-Motor Onset
autonomic
behavior arrest
cognitive
emotional
sensory
focal to bilateral tonic-clonic
Generalized OnsetFocal Onset
Aware
Impaired
Awareness
Motor
tonic-clonic
epileptic spasms
Non-Motor
behavior arrest
ILAE 2017 Classification of Seizure Types Expanded Version1
Unclassified3
1 Definitions, other seizure types and descriptors are listed in the
accompanying paper and glossary of terms.
2 These could be focal or generalized, with or without alteration of awareness
3 Due to inadequate information or inability to place in other categories
From Fisher et al. Instruction manual for the ILAE 2017 operational
classification of seizure types. Epilepsia doi: 10.1111/epi.13671

12. O L D T E R M N E W T E R M
Unconscious (still used, not in name) Impaired awareness (surrogate)
Partial Focal
Simple partial Focal aware
Complex partial Focal impaired awareness
Dyscognitive (word discontinued) Focal impaired awareness
Psychic Cognitive
Secondarily generalized tonic-clonic Focal to bilateral tonic-clonic
Arrest, freeze, pause, interruption Behavior arrest
Wording Changes

21. Diagnosis of EpilepsyDiagnosis of EpilepsyDiagnosis
Detailed history
EEG
Labs
Imaging technique

26. Treatment of underlying condition
 Correction of metabolic disturbance e.g, serum glucose or
electrolyte disturbances. No need of antiepileptics.
 If due to drugs-avoid the drugs ,no need of antiepileptic
 If structural brain lesion-e.g; Brain tumour, vascular
malformation or brain abscess, treatment of underlying lesion.
continue antiepileptic for one year.

27. Antiepileptic drug therapy
 Several factors should be considered
– the likelihood of recurrent seizures,
– the risk of the treatment itself,
– ability of the treatment to decrease the risk of
recurrent seizures
– and the consequence of further seizures to the patient.
 Since these factors vary from patient to patient, it seems
unlikely that a single approach can be recommended.

28. Indications of Treatment
 Diagnosis of epilepsy must be firm
 Recurrence of fits within six months.
 Single seizure with structural brain lesion.
 Single seizure with abnormal EEG.
 Single seizure with high-risk job.
 Single seizure with mental disorder.

29. (Contd.)
 A single seizure is not always an indication for treatment. But presence of
important risk factors for seizure recurrence such as preexisting
neurological conditions, partial or focal seizures, neurological deficits
including postictal signs, status epilepticus as a first manifestation of
epilepsy (excluding acute symptomatic status epilepticus), positive family
history of seizures, age at presentation younger than 16 years and older
than 59 years and epileptiform discharges on the interictal EEG warrants
early treatment.

38. Indications of monitoring blood levels of AED
 To determine the baseline plasma dose level.
 When the patient is believed to be noncompliant.
 When the does not respond adequately to the usual dosage of an AED.
 When symptoms & sign of clinical toxicity are suspected.
 When there is a question of drug interaction.
 To establish the correct dosage of an AED for a patient with diseases
affecting absorption, metabolism or excretion (hepatic, renal or
gastrointestinal disorder, pregnancy).

39. When and How to withdraw drugs
 At least 3-5 years after the last attack
 Then withdraw gradually over 6 months.
 During and 6 months after withdrawal, patients should
follow the general safety advices.

40. Surgery
 Focal resection -Lesionectomy
-Temporal Lobectomy
-Frontal Lobectomy
 Multifocal resection -Hemispherectomy
 Functional procedure - Corpus callosectomy
- Multiple subpial
transection
- Sterotactic ablation

41. Vagal Nerve Stimulation
 Limited for localization
related epilepsy
 Implanted device
 Stimulates the left
vagus nerve for 30
seconds every five
minutes
 30% experiences 50%
reduction in seizure
activity

44. REFERENCES