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• Developed countries :
annual incidence 50-70 cases per
100.000
• Developing countries : prevalence 1%
Incidence varies with age
Incidence of epilepsy in relation to age
ETIOLOGY
• Idiopathic
• Cryptogenic
• Symptomatic
Congenital anomalies
Tuberous sclerosis
Storage diseases
Intracranial
haemorrhage Intracranial Head Injuries
Infections
Febrile
Seizures
Drugs Cerebrovascular
Hypoxia and degenerations
Hypoglycaemia alcohol
Hypocalcaemia
0 1 5 10 20 60
Age (years)
Factors lowering seizure threshold
Common Occasional
•Sleep deprivation •Barbiturate withdrawal
•Alcohol withdrawal •Dehydration
•Television flicker •Benzodiazepine
•Epileptogenic drugs withdrawal
•Systemic infection
•Hyperventilation
•Head trauma
•Flashing lights
•Recreational drugs
•Diet and missed meals
•AED non-compliance
•Menstruation
•Specific “reflex” triggers
•Stress
•Intense exercise
International Classification of Epileptic Seizures
Partial seizures (beginning locally)
• Simple partial seizures (without impaired
consciousness)
– with motor symptoms
– with somatosensory or special sensory symptoms
• Complex partial seizures (with impaired
consciousness)
– simple partial onset followed by impaired consciousness
– impaired consciousness at onset
• Partial seizures evolving into secondary generalized
seizures
Generalized seizures (convulsive or non-
convulsive)
• Absence seizures
– Typical
– Atypical
• Myoclonic seizures
• Clonic seizures
• Tonic seizures
• Tonic clonic seizures
• Atonic seizures
• Unclassified seizures
Simplified Classification of Epileptic Seizures
Partial seizures
• Simple – preservation of awarness
• Complex – impairment of consciousnesss
• Secondary generalized
Generalized seizures
• Absence
• Myoclonic
• Tonic-clonic
• Tonic
• Atonic
International Classification of Epilepsies
and Epileptic Syndrome
Structural lesion
MRI
MRI
MRI
Scan
Scan should be repeated periodically :
• Suspicion of a tumour
• Worsening in neurological examination
or cognitive function
• Deterioration in the frequency or
severity of the seizures
Single Photon Emission CT (SPECT)
Positron Emission Tomography (PET)
MRI spectroscopy
Functional MRI
47%
First drug Seizure-free
13%
Second drug Seizure-free
40%
Refractory
Type of SE
– SE Convulsive (general tonic seizure)
– SE Non Convulsive
Classification of SE
– Focal
– General