Epilepsy

Diagnosis

• Epileptic seizure not always equal to epilepsy (chronic condition with recurrent seizures)

• Newley diagnosed epilepsy: (1) is it an epileptic seizure? (2) is there an identifiable/treatable cause? (3) is anti-epileptic treatment required?

• Brief LOC with convulsions: (1) epileptic seizure (abnormal electrical activity in the brain=a brain problem [often long re-orientation time, post-ictal sleepy/confused]) (2) syncope (lack of blood in the brain=a problem of circulation [feel lightheaded before fall, pale, brief re-orientation phase] ) (3) psychogenic non-epileptic attack "pseudoseizure" (abnormal reaction to a personal problem=a psychological problem [eyes closed, often long duration])

Aetiology

• genetic, acquired (uterine, infections, trauma, circulation, toxins...)

• High incidence/prevalence in the tropics: head trauma, perinatal brain injury, CNS infections: parasites (cerebral malaria, toxoplasmosis, neurocysticosis), bacteria (acute bacterial meningitis, cerebral abscess, TB meningitis/tuberculoma), fungi (cryptococcal meningitis), virus (encephalitis, PML, PML-IRIS)

Treatment

• Acute epileptic seizure (establish +/- treat the cause, acutely prevent more seizures), chronic epilepsy (establishing the cause less rewarding, long-term management)

• Start with one drug (monotherapy) and aim for initial maintenance dose e.g. phenobarbital (phenobarbitone)