Practice diagnosing and treating epilepsy

2021-03-25 12:00 AM

Diagnosing epileptic seizures is often difficult because it is very rare to get much information from the patient himself

A disorder of brain activity with abnormal electrical brain activity, causing seizures with a loss of control of body activities, usually manifested by convulsions, stiffness, irregular breathing or stop breathing. The attack usually appears only a short time and then passes, but it usually takes a few hours for a person to fully recover to a normal state. Some people with epilepsy can live normally and have no unusual symptoms between attacks.

Some people experience epilepsy in adolescence and go away on their own in adulthood without treatment. Others have to be on medication all the time, and others are less fortunate, even with medication, to keep seizures in remission.


Seizures occur due to disturbances in brain activity. This disorder can be caused by a number of diseases, or it can also be caused by trauma. The specific causes are usually:

Injury to the head.

Injury during childbirth.

Infection of the brain or meningitis.

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Drug poisoning.

Drug withdrawal or alcohol withdrawal disorder.

Metabolic disorder.

Some epilepsy cases are completely unexplained, and others may be hereditary.


The diagnosis needs to distinguish two cases: local epilepsy (involving a limited area in the brain) and generalized epilepsy (affecting a large area of ​​the brain, causing loss of consciousness). However, cases of local epilepsy also spread very easily into generalized epilepsy. Therefore, it can be based on the impact level of the seizure to distinguish:

Severe attacks: During a seizure, the patient loses consciousness, the whole body is stiff and then convulses continuously, breathing irregularly or may stop breathing. When the attack passes, the muscles weaken, sometimes the patient has incontinence, disturbed perception, disorientation, headache, drowsiness. All symptoms disappear after a few hours, due to loss of consciousness, the patient cannot remember anything about what happened. If severe attacks are not treated promptly, it can lead to death.

Mild seizures: Seizures occur very quickly, usually do not last more than 1 minute, so it is often called the absence of consciousness, sometimes very difficult to recognize, as manifested only by transient loss of consciousness, not accompanied by falls. fall or convulsions. Mild episodes are more common in children than in adults. Watching closely during an attack may reveal slight twitching, blinking, or lip brushing.

Simple localized attack: During epilepsy, the patient is still conscious, there are only some transient abnormal disorders such as mild seizures, some hallucinations of vision, smell, taste. In general, the patient is still conscious, aware of the attack and can remember to tell.

Complex partial seizures: also called temporal lobe epilepsy. The patient loses awareness of his surroundings, becomes dazed, unresponsive to circumstances, looks awkward, clumsy, or unconsciously scribbles his lips. Because of the loss of consciousness, the person often does not remember anything about what happened.

Diagnosing epileptic seizures is often difficult because it is very rare to get much information from the patient himself. Further attention is needed in people who have witnessed seizures.

Some tests are meant to aid in the diagnosis but usually do not help lead to conclusions, such as:


Electrocardiogram (to diagnose and exclude arrhythmia).

Brain tomography X-ray.

Blood tests.

The following cases need to quickly refer patients to hospital treatment:

Seizures occurred for the first time.

The cause cannot be diagnosed.

Prolonged seizures.

Patients with trauma to the head.


As soon as a seizure occurs, emergency treatment is required

Lay the patient on his or her left side. Soft pillows should be placed under the head and avoid placing any hard objects near the patient's lying ground.

Loosen clothes, especially in the neck.

Examination of the carotid artery.

Make sure the airways are clear and the patient is still breathing.

Immediately use diazepam 10mg anal suppository (5mg for children).

Call an ambulance right away if

Seizures continue for up to 5 minutes or longer.

After the attack stopped, another one started.

The seizure has passed but the patient has not recovered consciousness.

After a seizure, it is necessary to teach relatives of the patient how to manage first aid during an attack. Assign diazepam 10mg anal insert for recurrence.

Before continuing to take anticonvulsants, it is important to check the medications the patient is taking to determine if they interact with anticonvulsants, especially the oral contraceptive pills. . The contraceptive efficacy of both oral contraceptive pills (combination pills and tablets) is reduced when used with carbamazepine, phenytoin, phenobarbitone and primidone. To ensure the contraceptive effect, to use a contraceptive with oestrogen content greater than 50μg, or should choose another method of contraception.

Watch for side effects of anticonvulsants

Carbamazepine: drowsiness, dizziness, headache, gastrointestinal disturbance.

Phenytoin: acne, hirsutism, hyperplasia, lethargy, fibrillation of the eyeballs, increased degree of heart failure.

Sodium valproate: weight gain, hair loss, abdominal pain, nausea, tremor, menstrual disturbances in women, thrombocytopenia, toxic hepatitis (liver function must be checked before taking the drug as well as regularly monitored. during drug use).

Instruct the patient to find the triggers of epilepsy to avoid. Some patients often develop seizures due to flashes of light, fatigue or after drinking alcohol ...

If seizures continue to recur after taking the medication, increase the dose of anticonvulsants enough to control the seizures without causing undue side effects.

In order to effectively adjust the dose used, it may be necessary to monitor the drug concentration in the patient's blood. The target concentration when using carbamazepine is 20-50μmol / L and when using phenytoin is 40 - 80μmol / L.

If the seizure is uncontrolled even after the maximum dose of anticonvulsants has been taken, refer the patient to a specialist or recommend hospital treatment.

If the seizure is controlled, maintain use of the drug and follow up every month continuously for 6 months to 1 year. The requirements for each inspection are:

Monitor the extent of medication side effects.

Appropriateness of the drug being used: dosage, number of seizures if any, drug interactions ...

Liver function tests.