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Ten Step Approach For Successful Diagnosis and Management of Epilepsy
- Dr AV Srinivasan

Epilepsy is a disorder of the brain and not of the mind.
Epilepsy is broadly classified as Generalised or Partial.
It is a fascinating disorder affecting the mind and consciousness.
(cognition, conation and affect).
Cognition - in simple definition means perception + thinking.
Conation - movement in general
Affect - motor expression of an emotion.
It represents four types of partial seizures coming from four lobes of the brain.
- I Frontal lobe - supplementary motor area
- Parietal lobe - sensory seizure (sudden benumbed feeling of the limb/face)
- Temporal lobe (auditory, smell/aura, vertigo) - Clinically of three types
  - stare - automatism - resolution
  - automatism - resolution
  - loss of consciousness with automatism
  - Occipital lobe - visual aura
Seizures arising from all four lobes can result in secondary generalisation.
There are five type of generalised seizures - Tonic, Clonic, Tonic-clonic, Absence and Myoclonic.
Differential diagnosis for epilepsy to be thought of before concluding the diagnosis of epilepsy are only six:
- Migraine
- Transitional ischemic attacks (TIA)
- Syncope
- Nacrolepsy
- Hypoglycemia/Hyperglycemia
- Psychogenic
In any epilepsy patient seven investigations are mandatory; (rest are optional):
- Haemogram
- Blood sugar
- Renal function tests (urea & creatinine)
- Liver functions (SGOT, SGPT, serum NH3 and g -GT)
- EEG (with telemetric recording)
- CT/MRI (if partial seizures are present)
- Screening for malignancy (epilepsy in elderly)
Optional: SPECT, PET, functional MRI
Treatment - Common effective epilepsy treatment:
- Commonly used: CPS
  Carbamazepine/ Phenytoin / Sodium valproate
- Latest drugs: TGL
  Topiramate - use it as an add on or as monotherapy
  Gabapentine - primary drug in partial seizures
  Lamotrigine
- Sparingly used: PV
  Old - Phenobarbitone
  New - Vigabatrin
Etiology - Etiology of epilepsy is in the finger tips.

T (thumb) - trauma, toxic, tumour
I (index finger) - infection (bacterial/viral)

M (middle finger) - metabolic

D (diamond ring finger) - degeneration, demyelination

L (little finger) - little flow or absent flow of blood - vascular

H (hand) - hereditary
Epilepsy education:
3S - support group T - telefilm & video
- self-help groupI - information service
- social skillP- patient professional personal education
P - patient-physician give & talk
D - drugs do's & don't

R - role play

C - compliance calendar

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