- Seizure: sudden and transient symptoms (altered level of consciousness, motor manifestations) due to abnormal neuronal electrical activity
- Epilepsy: two or more unprovoked seizures apart in a >24-hour period or one unprovoked seizure with a risk of further seizures that is similar to the risk after two unprovoked seizures (at least 60%)
- Status epilepticus: epileptic seizure that lasts >5 minutes or multiple seizures without returning to normal between them; classifications: generalized, simple and complex partial, absence, nonconvulsive; based on three key features:
- Seizure origin: focal (previously partial), focal to bilateral, generalized
- Awareness: aware, focal impaired, or generalized
- Clinical features: motor, nonmotor (absence, behavior, cognitive, autonomic)
- System(s) affected: nervous
- Synonym(s): convulsion, attacks, spells
- Pregnancy: Avoid valproate as possible. Monitor AED levels every trimester for dose adjustment, continue folic acid supplementation, and screen for congenital abnormalities.
- Levetiracetam, topiramate, and lamotrigine are alternatives for women of childbearing potential (1).
200,000 new cases of epilepsy are diagnosed in the United States annually with 45,000 new cases in children <15 years of age.
Etiology and Pathophysiology
- Synchronous and excessive firing of neurons, resulting in an imbalance of regulatory mechanisms in favor of excitatory activity
- Acute symptomatic seizures: triggered by acute insult to the brain, medical illness, metabolic disturbance, substance/medication ingestion or withdrawal (such seizures do not necessarily define the presence of epilepsy)
- Stroke, subdural hematoma, subarachnoid bleed, traumatic brain injury, hypoxic-ischemic injury, acute infection
- Metabolic and endocrine disorders, drug intoxication/poisoning/overdose
- Medications: opioids, anticancer drugs, various antibiotics, hypoglycemic agents, immunosuppressants, psychotropic medications, and decongestants
- Vascular malformations
- Familial/genetic seizure syndromes
- Benign neonatal seizures, benign familial neonatal epilepsy, EME, Ohtahara syndrome
- Infancy (age <2 years): febrile seizures, metabolic causes (e.g., hypoglycemia, vitamin B6 deficiency)
- Childhood (ages 2 to 10 years): absence or febrile seizure
- Adolescent (ages 10 to 18 years): AV malformation
- Late adulthood (age >60 years); stroke, metabolic disturbances (hypoglycemia, uremia, hepatic failure, electrolyte abnormality), and drugs
Family history increases risk by 3-fold.
History of congenital brain malformations, CNS infections, head trauma, stroke, tumors
Prevent head injuries. Avoid sleep deprivation and excessive alcohol intake.
Commonly Associated Conditions
Genetic syndromes (Angelman, tuberous sclerosis, Sturge-Weber), infections, tumors, drug abuse, alcohol and drug withdrawal, trauma, metabolic disorders
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