The term refers to two or more unprovoked seizures in one year. The seizures are sudden and uncoordinated. Epilepsy is normally a manifestation of underlying disorders. If they are linked to a particular part of the brain, then they are called focal or partial epilepsy. However, if they cause unconsciousness and general brain dysfunction, they are called generalised epilepsy.

The manifestations of focal epilepsy are hallucinations of taste, smell or hearing. Jacksonian epilepsy affects motor functions, leading to twitching of particular areas. Generalised epilepsy can either be petit mal seizures or grand mal seizures.

Grand Mal Seizures

In grand mal epilepsy, the patient may be aware that the seizure is imminent. This is followed by an aura phase after which there is a generalised tonic contraction. The third phase is the clonic phase where muscles have jerky movements. The tonic and clonic phases are collectively referred to as the ictal phase. Finally the patient enters the phase of relaxation and moves from coma to sleep. This is the post-ictal phase

Petit Mal Seizures

Petit mal seizures are characterised by a phase of transient loss of consciousness. Perhaps you have seen patients who stare expressionlessly for some time before they continue with their function without being aware. This is a characteristic of petit mal seizures

Primary epilepsy has no known cause. Some of the causes of secondary epilepsy are cerebral scarring due to head injury, cerebral vascular accidents, infections, degenerative CNS diseases and childhood febrile illnesses. It is important to bear this in mind so that you control febrile illness well and avoid head injury in neonates during obstetric care.

Seizures that occur spontaneously in succession are called status epilepticus. These normally occur without recovery. This condition is considered a major medical emergency. Vigorous muscular contractions impose a heavy metabolic demand and can interfere with respirations. At the height of each seizure, some respiratory arrest occurs which produces venous congestion and hypoxia of the brain. Repeated episodes may lead to irreversible and fatal brain damage.

Factors that precipitate status epilepticus include:

•       Withdrawal of anti epileptic drugs

•       Fever and infection

•       Cerebral oedema

Management of status epilepticus includes positioning the patient to lie on the lateral position to prevent inhalation of secretions from the mouth. Give IV (not IM) diazepam 10-30mg STAT slowly over three minutes, repeat if there is no response. If no response put 80mg in 500mls of normal saline, adjust rate to control seizures.

Other useful drugs include phenobarbitone sodium – IM 125mg to 250mg, phenytoin sodium (Epanutin) 100mg tds. Treat hyperpyrexia by temperature reducing measures.

Give care as for the unconscious patient. Oral anti convulsants are given as soon as the patient gains consciousness.