Epilepsy is a tendency to have recurring unprovoked seizures. It is caused by abnormal electrical activity in the brain and is one of the most common neurological diseases, affecting around 1 in 200 people worldwide. Seizures can involve changes in movement, awareness, or sensations. Epilepsy is diagnosed if a person has two or more unprovoked seizures. While the specific cause is unknown in many cases, risk factors include brain injuries, infections, genetic predispositions, and developmental and vascular issues. Proper diagnosis and treatment are important to manage the condition.

1. WHAT IS EPILEPSY?
Professor (Dr.) Ennapadam S. Krishnamoorthy
Founder & Director
Neurokrish & Trimed
Adjunct Professor: Public Health Foundation of India

2. Seizures and Epilepsy
• A fit or seizure represents a transient abnormal
electrical discharge in the brain with or without:
alteration in consciousness, motor (movement) or
sensory (perceptual) symptoms
• Seizures represent a focal (ex: Tumor) or
generalized (ex: infection) abnormality in
electrical brain activity
• Seizures represent underlying brain dysfunction
Seizures¹Epilepsy

3. What is Epilepsy?
• A tendency to have recurring unprovoked
seizures
• Does not include single or occasional seizures or
those occurring during acute illness (symptomatic
seizures)
• Unprovoked seizures occurring on two separate
occasions are required for epilepsy diagnosis
• A cluster of seizures is considered as a single
seizure for the purpose of epilepsy diagnosis

4. How common is epilepsy?
•Most common serious neurological disease
• Affects 1/200 people worldwide
•Could be as much as 1/100 in developing
nations like India due to increased:
- poor antenatal care and perinatal injury
- infections (tuberculosis & cysticercosis)
- road traffic accidents

5. Who is at risk?
•About one half of people affected
develop epilepsy before 15 years of age
• Increasing prevalence in older
individuals- probably due to
demographic change and the increasing
prevalence of degenerative
cerebrovascular disease
• Slightly higher in males
• Slightly higher in lower socio-economic
groups

6. What causes epilepsy?
• Causes vary worldwide and with age
• Unknown in two-thirds of cases overall
• Known causes are
- Cerebrovascular disease (15%)
- Cerebral tumor (6%)
- Alcohol related (6%)
- Post-traumatic (2%)
- Neuroinfections (tuberculosis & cysticercosis)
• Refractory epilepsy is most often due to
- Hippocampal sclerosis, malformations of cortical
development, small foreign tissue lesions

7. Hippocampal Sclerosis

8. Brain Infections

9. Genes and Epilepsy
• Over 200 disorders showing a Mendelian pattern
of inheritance feature epilepsy as a manifestation
• Single gene disorders where epilepsy is the sole
or major manifestation are being discovered but
will account only for a small proportion of cases
(10%)
• In most forms of epilepsy the inheritance is
probably polygenic (i.e. many genes are
responsible for the disorder)

10. Mechanisms
• Generalized Seizures: Reciprocal cortico-thalamic
interaction
• Partial Seizures: Local excitation-inhibition
imbalance
• Disorder of membrane ion channels: complex
changes in brain receptor, membrane and system
levels in most cases
• Pathological, functional imaging and genetics will
probably redefine our understanding and promote
rational drug design

11. Epileptic Seizures
• Epileptic seizures are paroxysmal events
• Symptoms:
- Generalized convulsive movements, drop
attacks, transient focal motor or sensory
attacks (including facial and eye movements),
psychic experiences, episodic phenomena in
sleep, prolonged confusional states are all
possible
• Several well described types of seizure are
recognized and are usually stereotyped in an
individual

12. Diagnosis
• Almost always clinical: a detailed history and an
eyewitness account are essential
• Information about:
- The circumstances of the episode
- Patterns of occurrence
- Preceding symptoms- localizing or diagnostic
- Timing, pattern, tempo and evolution of symptoms
- Reported behaviors- before, during and after
- Investigations are seldom necessary for making
diagnosis: but are helpful in terms of
management

13. Differential Diagnosis
• Syncope
vasovagal, micturition,
postural, vascular,
respiratory, cardiac
• Cardiac Disorders
arrhythmias, aortic or
mitral stenosis, cardio-myopathies,
myxoma..
• Metabolic/ Endocrine
hypoglycemia,
phaeochromocytoma,
porphyria, carcinoid
syndrome
• Neurological
TIA, cataplexy-narcolepsy,
basilar
migraine, III ventricle
cyst, Meniere’s disease,
episodic ataxias,
movement and sleep
disorders
• Psychogenic
hyperventilation, panic
attacks, non-epileptic
attack disorder, episodic
dyscontrol syndrome,
malingering,
Munchausen

14. Type of Seizure
• Partial: Begin focally in cortex- may become
generalized involving entire cortex
• Generalized: Involve much of the cortex bilaterally
from the outset and therefore loss of consciousness
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15. Status Epilepticus
• Usually occurs in a person with history of
seizures
• Repeated seizures lasting 30 minutes or
longer without recovery of consciousness
• Usually due to AED withdrawal (non-compliance),
acute infections or metabolic
states
• GTC status is a medical emergency
• Complex partial and absence status present
with impaired awareness

16. Issues in Caring for the person with
epilepsy
• Investigations, Medical Treatment, Non-Medical
Therapies, Counseling and Support
• Learning, Behavior, Education, Employment,
Marriage, Pregnancy, Driving, Safety in Home,
Safety in the Work Place, Social Stigma
• Awareness and Empowerment

17. Thank you for your attention &
interest