Epilepsy is a neurological disorder characterized by recurring seizures. A seizure occurs when there is a sudden surge of electrical activity in the brain. About 2.3 million Americans have epilepsy. While the specific cause is unknown in many cases, common causes include head trauma, brain tumors, strokes, genetic factors, and developmental issues. Treatment involves medications, surgery, dietary therapies and lifestyle modifications, with the goal of eliminating seizures without side effects. The choice of treatment depends on the seizure type, underlying causes, age, and other individual factors.

1. Epilepsy
from,
Meghana G S
M-pharm

2. What Is the Difference Between
Epilepsy & Seizures?
 A seizure is a brief, temporary
disturbance in the electrical activity of the
brain
 Epilepsy is a disorder characterized by
recurring seizures (also known as “seizure
disorder”)
A seizure is a symptom of epilepsy

3. Who Has Epilepsy?
• About 2.3 million Americans have epilepsy
(0.5-1% of the population)
• Roughly 181,000 new cases of seizures and
epilepsy occur each year
• 50% of people with epilepsy develop seizures
by the age of 25; however, anyone can get
epilepsy at any time
• Now there are as many people with epilepsy
who are 60 or older as children aged 10 or
younger

4. The Brain Is the Source of Epilepsy
• All brain functions -- including feeling, seeing,
thinking, and moving muscles -- depend on
electrical signals passed between nerve cells in the
brain
• A seizure occurs when too many nerve cells in the
brain “fire” too quickly causing an “electrical
storm”

5. What Causes Epilepsy?
• In about 70% of people with epilepsy, the cause is not known
• Idopathic epilepsy
• Cryptogenic epilepsy
• Symptomatic epilepsy
• In 30%, most common causes are:
- Head trauma
- Infection of brain tissue
- Brain tumor and stroke
- Heredity
- Prenatal disturbance of brain development

6. Pathophysiology
• A variety of different electrical and chemical
stimuli can easily give rise to seizure
• A rhythmic and repetitive hyper-synchronous
discharge of neurons either localised in an area of
the cerebral cortex or generalised throughout the
cortex which can be observed on
electroencephalogram

7. Pathophysiology
• Neurons are interconnected in a complex network in which
each neuron is linked through synapses with hundred of
others
• A small current is discharged by neurons to release
neurotransmitters at synaptic levels to permit
communication with each other
• Inhibitory or exhibitory
• If neurons are damaged, injured or suffer a chemical or
metabolic insult, a change in the discharge pattern may
develop

8. Pathophysiology
• In epilepsy regular low frequency discharges are replaced
by bursts of high frequency discharges followed by periods
of inactivity
• When a whole population of neurons discharge
abnormally an epileptic seizure is triggered
• It may remain localised or spread
• It may also be generalised through out the brain via
cortical and subcortical routes

9. Clinical Manifestation
• The area from which abnormal discharge originates is
known as epileptic focus
• Clinical manifestation depends on location of focus
• Seizures divided into two main group according to the
area of focus
• Initial activation of both hemispheres simultaneously
termed as generalised
• Discharge in localised area of the brain –partial or focal

10. What Happens During a Seizure
• Generalized seizure
• Involve the whole brain and loss of consciousness
• Absence: “petitmal” – rare form exclusively in children, child goes blank and stares,
fluttering of eyelids and flopping of the head, attacks lasts for few seconds
• Tonic-clonic: often called as grandmal , commonest, without warning patient goes
stiff, falls and convulses with laboured breathing and salivation.
cynaosis, incontience and tongue bitting,

11. • Myoclonic seizures : abrupt, very brief involuntary shock-
jerks, which may involve the whole body, or arms,head
• Usually happen morning , shortly after waking, sometimes cause
patient to fall, but recover immediately
• Atonic seizures : sudden loss of muscle tone, person
collapse, recovery is quick.
• Rare, but common in patient with severe epilepsy starting in infancy

12. • Partial seizure
• Simple partial seizures
• Discharge remains localised, and conciousness is
preserved. What happens depends on the area of
discharge, localised jerking of limb or the face, stiffness or
twitching of one part of the body, numbness or abnormal
sensation
• Complex partial seizure
• Altered or autonomic behaviour, plucking his clothes,
fiddling with various objects and acting in confused manner

13. • Lip smacking, chewing, grimacing, undressing, performing
aim less activities and wandering , in a drunken fashion
• Seizures originate in the frontal or temporal lobes
• Secondary generalised seizures
• Discharge spreads entire brain, person may have warning,
convulsive attack

14. • Everything you do, you
do with your brain!

15. • Clinical Assessment
• Patient history
• Tests (blood, EEG, CT, MRI or PET scans)
• Neurologic exam
• ID of seizure type
• Clinical evaluation
to look for causes
How Is Epilepsy Diagnosed?

16. What to TellYour Doctor About Your
Seizures
• Symptoms
• Seizure patterns
• Pre-seizure activity (if any)
• How you felt after the seizure
Consider keeping a seizure record

17. Tools to Confirm the
Diagnosis of Epilepsy
EEG Imaging Scans
(Abnormal electricity) (Lesions)

18. Seizure Triggers
• Missed medication (#1 reason)
• Stress, anxiety
• Hormonal changes, Menses
• Dehydration
• Lack of sleep, extreme fatigue
• Photosensitivity
• Illicit Drug, alcohol use
• Certain Medications
• Fever in Some Children

19. Treatment Goals in Epilepsy
• Help person with epilepsy lead full and productive life
• Eliminate seizures without producing side effects
• Tailor treatment to needs of individuals/special
populations :
Women, Children, Elderly, Hepatic or renal failure and other diseases

20. What if not treated?
• Seizures can be potentially life threatening with
brain failure, heart and lung failure, trauma,
accidents
• Sudden Unexpected Death in Epilepsy (SUDEP)
• Even subtle seizures can cause small damage in
brain
• LongTerm problems: fall in IQ, depression, suicide,
Social Problems, Quality of Life

21. • Stay calm and track time
• Protect head, remove glasses, loosen tight neckwear
• Move anything hard or sharp out of the way
• Turn person on one side, position mouth to ground
• Check for epilepsy or seizure disorder ID
• Understand that verbal instructions may not be obeyed
• Stay until person is fully aware and help reorient them
• Call ambulance if seizure lasts more than 5 minutes or if it
is unknown whether the person has had prior seizures
First Aid for Seizures

22. Potentially Dangerous Responses to
Seizure
• Don’t restrain person
• Don’t put anything in the person’s mouth
• Don’t try to hold down or restrain the person
• Don’t attempt to give oral antiseizure medication
• Don’t keep the person on their
back face up

23. Types of Treatment
 Medication
 Surgery
 Nonpharmacologic treatment
 Ketogenic diet
 Vagus nerve stimulation
 Lifestyle modifications

24. Considerations in
Epilepsy Management
Age and
Gender
Seizure
Frequency
Underlying
Pathology
Comorbidities
Medication
Side Effects
Syndrome
vs
Seizure Type

25. Factors That Affect the
Choice of Drug
 Seizure type/
Epilepsy syndrome
 Side effects &
safety
 Patient age
 Ease of Use
 Lifestyle
 Age, Sex,
Childbearing
potential
 Other medications

26.  Consistent use
 Inadequate dosage or
ineffective medication
 Drug factors
 Disease
Seizures eliminated
(50% of people)
Seizures markedly
reduced (30%)
Seizures do not
respond (20%)
Factors That Influence
Response to Medication

27. Tolerating Medications
Most Common Side Effects
 Rash
 Clumsiness
 Drowsiness
 Irritability
 Nausea
 Side effects may be related to
dose
 Care must be taken in
discontinuing drug due to risk of
seizure recurrence
Warning Signs of Possible
Serious Side Effects
 Prolonged fever
 Rash, nausea/vomiting
 Severe sore throat
 Mouth ulcers
 Easy bruising
 Pinpoint bleeding
 Weakness
 Fatigue
 Swollen glands
 Lack of appetite
 Abdominal pain

28. Safety Issues for Patients
with Epilepsy
• Cant Drive for about a year after the last
seizure (NY State)
• Climbing altitudes
• Swimming/ Bathing alone
• Operating heavy machinery or weapons
that can be dangerous
• Cooking, hot water
• Taking care of babies
• Bone Health

29. Treatment
• Status epilepticus is an epileptic seizure of
greater than five minutes or more than one
seizure within a five-minute period without the
person returning to normal between them
• Initial treatment is supportive, positioning, support respiration,
maintain blood pressure, correcting hypoglycaemia
• IV lorazepam or diazepam
• Midazolam as alternative
• Severe cases: phenytoin, clonezepam, phenobarbital

30. Treatment
• Febrile convulsions- convulsions associated with
fever
• Reducing temperature, tepid sponging, paracetamol
• Diazepam IV or rectal

31. Treatment
Different types of seizure
Seizure type First line Second line
Partial seizure Carbamazepine
Lamotrigine
Oxacarbazepine
levetiracetam
Topiramate
Valporate
Clobazam
Zonisamide
Pregabalin
Phenytoin
Gapapentin
Generalized seizure
Tonic clonic
Tonic
Clonic
Absence
Valporate sodium
Carbamazepine
Lamotrigine
Ethosuxi mide
Sodium valporate
Lamotrigine
Clobazam
Phenobarbital
Clonazepam
Lamotrigine
Myoclonic Sodium valporate
clonazepam
Levetiracetam
Acetazolamide
Topiramate
Atonic clonazepam Lamotrigine, CBZ

32. Anti epileptic drugs
• Carbamazepine, clonazepam, ethosuximide,
gapapentin, lacosamide, lamotrigine,
phenobarbital, phenytoin, sodium valporate,
vigabatrin,

33. Newer AED
• Lamotrigine, vigabatrin, gabapentin, tiagabine,
topiramate, zonisamide, lacosamide

34. Characteristics
of New Seizure Medications
 Efficacy at least equal to older agents.
 Should be used as add on therapy.
 Most also good as single agent eg.
Lamotrigine in pregnancy
 Second line alternative where older drugs
are unsuitable
 Safer, better tolerated, improved quality of
living.
 Blood testing often not necessary.

35. Other Treatment Approaches
 Behavioral therapy
 Biofeedback
 Relaxation
 Positive reinforcement
 Cognitive therapy
 Aromatherapy