General Medicine
Epilepsy and Seizures
Epilepsy and seizures for MBBS: seizure classification, the electroencephalogram, antiseizure drug therapy and the management of status epilepticus.
MedNext Academy | 3 min read
Epilepsy and Seizures
Epilepsy and seizures for MBBS: seizure classification, the electroencephalogram, antiseizure drug therapy and the management of status epilepticus.
This supplementary chapter covers seizures and epilepsy, from the classification of seizure types to the role of the electroencephalogram and imaging. It emphasises the principles of antiseizure drug therapy, the emergency management of status epilepticus and practical counselling on safety and pregnancy.
High-yield: Epilepsy and Seizures
- A seizure is a transient event of abnormal excessive neuronal activity, while epilepsy is a tendency to recurrent unprovoked seizures.
- Seizures are classified into focal, generalised and unknown onset, which guides investigation and treatment.
- A generalised tonic-clonic seizure has a tonic phase followed by clonic jerking and a post-ictal drowsy phase.
- Focal seizures may show retained or impaired awareness and can secondarily generalise.
- Absence seizures are brief lapses of awareness common in children with a characteristic electroencephalogram pattern.
- Provoked seizures from causes such as hypoglycaemia, alcohol withdrawal or infection are treated by addressing the cause.
- The electroencephalogram supports the diagnosis and classification but a normal study does not exclude epilepsy.
- Neuroimaging is used to identify a structural cause, especially in focal or new-onset seizures in adults.
- The choice of antiseizure drug depends on the seizure type, and monotherapy is preferred.
- Sodium valproate is broad-spectrum but is avoided in women of childbearing potential because of teratogenicity.
- Status epilepticus is a prolonged or recurrent seizure without recovery and is a medical emergency.
- First-line treatment of status epilepticus is a benzodiazepine, followed by a longer-acting antiseizure drug.
- Sudden withdrawal of antiseizure medication can precipitate seizures and status epilepticus.
- Counselling on adherence, driving, safety and pregnancy is an essential part of epilepsy care.
- Most people with epilepsy achieve good seizure control with appropriate single-drug therapy.
Epilepsy essentials
- **Seizure types:** Focal, generalised or unknown onset; classification guides drug choice.
- **Investigation:** Electroencephalogram and imaging; a normal electroencephalogram does not exclude epilepsy.
- **Drug therapy:** Monotherapy tailored to seizure type; valproate avoided in women of childbearing potential.
- **Emergency:** Status epilepticus is treated first with a benzodiazepine, then a longer-acting agent.
Frequently Asked Questions
What is the difference between a seizure and epilepsy?
A seizure is a single transient event of abnormal excessive neuronal activity, while epilepsy is a lasting tendency to have recurrent unprovoked seizures.
How is status epilepticus managed?
Status epilepticus is a medical emergency treated first with a benzodiazepine to abort the seizure, followed by a longer-acting antiseizure drug and supportive care.
Why is sodium valproate avoided in some women?
Sodium valproate is teratogenic and is avoided in women of childbearing potential unless there is no suitable alternative and effective contraception is in place.
How does this chapter help for NEET-PG?
Seizure classification, drug selection by type and the emergency management of status epilepticus are common exam themes in general medicine and neurology.
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