Essential disease information
Epilepsy is a chronic disease, usually of unknown cause. It is characterized by repeated seizures varying from partial (e. g focal motor symptoms) to generalized (impaired consciousness, jerking movements, temporary paralysis) often preceded by a warning sensation known as ‘aura’. Sometimes it may develop several weeks or months after a head injury. Seizures may secondarily be caused by infections (neurocysticercosis, syphilis, encephalitis, HIV ),physical lesions (brain tumor or other SOL, stroke, very high BP),metabolic causes alcohol withdrawal, hypo/hyper-glycemia, hypoxia, hypocalcemia, renal failure, liver disease, drugs),eclampsia.
Important symptoms
- Aura,
- partial or generalized convulsion,
- tongue biting,
- incontinence,
- frothy month,
- unconscious during fit,
- headache.
Important signs
- Sign of trauma sign of tongue biting,
- weakness of limbs ,
- still unconscious at presentation.
- Exclude pseudo seizure by letting the arm fall into the patients face.
Differential diagnosis
- Febrile convulsion,
- pseudo seizures,
- hypoglycemic seizure,
- eclampsia.
Screening at risk factors
- History of alcohol abuse,
- Hygiene,
- occurs when watching TV?
Investigations
- RBS,
- WBC (may be elevated due to seizure)+LP associated fever,
- CT scan if possible.
- Other investigations as suggested by history and exam for secondary causes (see above)
First aid and emergency management
- Lay the patient in the comfortable bed in left lateral position.
- Maintain ABC
- Open airway remove false teeth insert oral airway
- Oxygen + suction if required
- Check vitals and physical examination
- Iv access and blood for investigation
- Thiamine 250 mg iv if alcoholic or malnourished
- 50 ml of 25% dextrose unless known not to be hypoglycemic
- Remove all tight clothes
- Inform the doctors immediately
Treatment
a.After consultation with doctor
- Phenobarbitone or phenytoin or carbamazepine
b.if status epilepticus
- Diazepam 10 mg pr/ iv for adult ; if ongoing repeat at 5mg/ 2min upto 20 mg
- Diazepam 0.2 mg/kg iv or 0.5 mg /kg pr child
Doctors action
Confirm diagnosis. Determine cause and treat secondary cause. Control secondary seizures .admit all status epilepticus (more than 30 min duration)
world epilepsy day
2nd Monday of February
International Epilepsy Day, celebrated each year on the 2nd Monday of February, is an occasion to raise awareness of epilepsy.
International Epilepsy Day 2022: The theme of International Epilepsy Day of this year is ‘50 Million Steps For Epilepsy‘.
