A seizure is defined as transient signs or symptoms due to abnormal, excessive or synchronous neuronal activity in the brain.
Epilepsy is a tendency towards recurrent seizures unprovoked by systemic or neurological insults. It is a functional disorder of complex cortical circuits. For a given patient, seizures tend to be stereotyped.
A convulsion is the motor signs of a seizure.
Anti-epileptic drugs (AEDs)
If a single epileptogenic focus can be identified such as hippocampal sclerosis or a small low-grade tumor, neurological resection e.g. temporal lobectomy may be indicated and offers up to 70% chance of cure.
Vagal nerve stimulation
Vagal nerve stimulation has been shown to reduce seizure frequency and duration in 1/3 of patients.
Patients with epilepsy must be seizure free for at least 12 months to be legally permitted to drive in the UK/EU. The patient must inform the DVLA.
Teratogenicity of AEDs: 5 mg/d folic acid supplements should be taken by all women of child-bearing age. Valproate should be avoided. Lamotrigine is recommended.
The risk of fetal abnormality is 5%. Pre-conceptual counselling should be offered.
Breastfeeding: Most AEDs present in breast milk (except carbemazepine and valproate). Lamotrigine is is not known to be harmful to infants.
Enzyme inducing AEDs may interfere with the effectiveness of oral contraceptives, so higher doses may be required (≥50µg oestrogen).
Clark M, Kumar P. 2009 Kumar & Clark’s Clinical Medicine 7/e Saunders
Longmore M, Wilkinson I, Davidson E, Foulkes A, Mafi A. 2010 Oxford Handbook of Clinical Medicine 8/e Oxford OUP
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