Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. A seizure occurs due to sudden abnormal electrical activity in the brain. Epilepsy can affect people of all ages, and its severity can range from mild episodes to life-threatening convulsions. Early diagnosis and appropriate treatment help improve quality of life and reduce seizure-related complications.
1. Causes of Epilepsy
Epilepsy has many possible causes, but in some patients, the exact cause is unknown.
- Genetic factors
- Head injuries or trauma
- Brain infections such as meningitis or encephalitis
- Stroke
- Brain tumors
- Congenital brain abnormalities
- Metabolic disorders (hypoglycemia, electrolyte imbalance)
- Drug withdrawal (alcohol, benzodiazepines)
2. Types of Seizures
A. Generalized Seizures
These involve both sides of the brain.
- Tonic-clonic seizures: Sudden loss of consciousness, stiffening, jerking movements
- Absence seizures: Brief staring episodes
- Myoclonic seizures: Sudden jerky movements
- Atonic seizures: Sudden loss of muscle tone causing falls
B. Focal (Partial) Seizures
Seizures start in a specific part of the brain.
- Simple partial: No loss of consciousness
- Complex partial: Impaired consciousness, repeated movements
- Focal to bilateral tonic-clonic: Focal seizure spreading to the whole brain
3. Symptoms of Epilepsy
- Sudden loss of awareness
- Uncontrolled jerking movements
- Staring spells
- Strange sensations or aura (smell, fear, déjà vu)
- Confusion after seizures
- Temporary breathing problems
4. Diagnosis
Diagnosing epilepsy involves identifying the type and cause of seizures.
- Electroencephalogram (EEG): Detects abnormal electrical activity
- MRI or CT scan: Looks for structural abnormalities
- Blood tests: Check metabolic or electrolyte issues
- Medical history: Detailed description of seizure events
5. Treatment of Epilepsy
Treatment aims to control seizures, prevent recurrence, and improve quality of life.
1. Antiepileptic Drugs (AEDs)
The drug choice depends on the type of seizure, age, comorbidities, and side-effect profile.
Common AEDs
- Sodium valproate: Broad-spectrum, effective for many seizure types
- Carbamazepine: Used for focal seizures
- Phenytoin: Tonic-clonic and focal seizures
- Lamotrigine: Broad-spectrum, well-tolerated
- Levetiracetam: Safe and commonly used for various seizures
- Ethosuximide: First choice for absence seizures
- Topiramate and Zonisamide: Broad-spectrum options
2. Emergency Seizure Management
- Diazepam or lorazepam (IV/IM) for status epilepticus
- Midazolam nasal spray for out-of-hospital seizure control
3. Non-Drug Therapies
- Ketogenic diet for drug-resistant epilepsy
- Vagus nerve stimulation
- Epilepsy surgery in selected patients
6. Monitoring Therapy
- Check drug levels for phenytoin, valproate, carbamazepine
- Monitor liver and kidney function
- Watch for side effects such as sedation, rashes, weight changes
- Check for drug interactions (especially with enzyme-inducing AEDs)
7. Patient Counseling
- Take medicines regularly at the same time
- Do not stop AEDs suddenly
- Avoid driving or swimming alone if seizures are uncontrolled
- Limit alcohol consumption
- Maintain proper sleep and stress control
- Women should discuss pregnancy planning due to teratogenic risks
8. Complications
- Status epilepticus
- Injuries during seizures
- Depression and anxiety
- Medication side effects
- Sudden Unexpected Death in Epilepsy (SUDEP)
9. Role of the Pharmacist
- Ensure correct AED selection and dosage
- Monitor for interactions and side effects
- Educate patients on medication adherence
- Assist in emergency management protocols
- Support lifestyle and safety counseling
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