11.7. EPILEPSY
A discrete recurrent abnormality in electrical
activity of the brain, resulting in behavioural, motor
or sensory changes. There may be associated
changes in consciousness.
Causes
Idiopathic
Brain infections
Brain trauma
Metabolic disorders, eg. hypoglycaemia
Congenital malformation, brain tumour
Clinical features
Will depend on the type of epilepsy:
Grand mal
May commence with a warning sensation in the
form of sound, light or abdominal pain (aura)
There may be a sharp cry followed by loss of
consciousness and falling
Tonic contraction of muscles occurs followed by
jerking movements (clonic phase)
There may be urinary incontinence, frothing and
tongue biting
A period of deep sleep follows
Episodes of mental confusion may follow
(post-ictal psychosis)
Petit mal
Mainly a disorder of children
The attack is characterized by a brief loss of
consciousness (5-10 seconds) in which posture is
retained but other activities cease
The child has a vacant stare
Previous activities are resumed at the end of the
attack
Several attacks may occur in a single day
11. Neurological/Psychiatric conditions
UCG 2010 235
Complex–partial seizures (Temporal lobe
epilepsy)
Has varied symptoms
Signs of autonomic nerve dysfunction, i.e.
sweating, flushing and gastric sensation
Mental confusion with perceptual disorders
(illusions, hallucinations), memory loss or
distortion, mood variation, abnormal repetitive lip
movement, automatism.
Focal epilepsy
Fits begin with motor contraction or sensory
change in a particular point of the body such as
the thumb.
Myoclonus epilepsy
Abnormal jerking movements occur usually in the
limbs but may involve the whole body.
Status epilepticus
Convulsive state in which the seizure lasts >30
minutes or several epileptic seizures occur in
succession without recovery of consciousness in
between.
Differential diagnosis
Syncope
Hypoglycaemia
Migraine
Hypocalcaemia
Conversion disorder
Hyperventilation and panic attacks
Investigations
Electroencephalogram (EEG)
– useful in petit mal and temporal lobe epilepsy
X-ray: skull
Other investigations are guided by suspected
cause.
11. Neurological/Psychiatric conditions
UCG 2010 236
Management (depends on type of epilepsy)
Petit-mal
ethosuximideinitially 500mg daily in 2 divided doses
– increase if necessary by 250mg every 4-7 days
up to a usual daily dose of 1-1.5g
child >6 yrs: as above
<6 yrs: initially 250mg single dose at night
increased gradually as required to usual
20mg/kg daily in 2 divided doses
Grand-mal
phenytoin initially 3-4mg/kg (150-300mg) daily
as single dose or 2 divided doses
− increase gradually prn to usual 200-500mg daily
or carbamazepine
initially 100-200mg 1-2 times HC4
daily increased prn in 100mg increments every 2
weeks to usual 800-1,200mg daily in divided doses
or phenobarbitone 60-180mg at night HC4
child:
phenytoin initially 5mg/kg daily in 2 divided
doses HC3
− usual range: 4-8mg/kg daily, max: 300mg daily
or carbamazepine 10-20mg/kg daily
in at least 2 divided doses
or phenobarbitone 8mg/kg daily
Temporal lobe epilepsy
carbamazepine – doses as for Grand mal above
Focal epilepsy
phenytoin – doses as for Grand mal above
Myoclonic epilepsy
Management as for focal epilepsy
Status epilepticus
diazepam 10mg rectally child <4: 5mg
– repeat once prn after 5 mins
or diazepam 10-20mg slow IV (5mg/min)
– repeat once prn after 30-60 mins
11. Neurological/Psychiatric conditions
UCG 2010 237
child: 200-300 micrograms/kg IV or IM per dose
Note:
Diazepam: in serious cases of status epilepticus,
doses of 20-40mg, titrated to individual patient
response, may be needed
Treatment should always continue until patient is
seizure-free for at least 2 years then gradually
taper off the doses
Prevention
Good antenatal care and delivery
Control causative factors
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