Tendency to recurrent unprovoked seizures; diagnosis after ≥2 unprovoked seizures or one with high recurrence risk.
Causes
- • Idiopathic / genetic
- • Structural: tumour, stroke, trauma
- • Infection, autoimmune
- • Metabolic
Clinical features
- • Generalised tonic-clonic
- • Focal aware / impaired awareness
- • Absence
- • Post-ictal confusion, Todd's paresis
Investigations
- • EEG
- • MRI brain
- • Bloods, ECG, glucose to exclude mimics
Management
- • Lifestyle: sleep, alcohol, driving rules
- • Focal: lamotrigine, levetiracetam
- • Generalised: sodium valproate (avoid in women of childbearing potential), levetiracetam
- • Status epilepticus: lorazepam → phenytoin/levetiracetam → ICU
Complications
- • SUDEP
- • Injury, drowning, burns
- • Cognitive, psychosocial
Clinical pearls
- • Counsel on driving (UK: 6 months seizure-free for car)
- • Valproate teratogenicity — pregnancy prevention programme
Related in WardRound
Educational — verify locally.
