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ICD-9-CM Code


  • 345.9 Epilepsy


ICD-10-CM Code


  • G40.909 Epilepsy, epileptic, epilepsia (attack) (cerebral) (convulsion) (fit) (seizure)


Preferred Practice Patterns


Key Features




  • Chronic disorder of various causes characterized by recurrent seizures

  • Seizures result from sudden and excessive electrical discharge of large groups of neurons


Essentials of Diagnosis


  • Diagnosis requires that the individual experience seizures, but not all seizures are indicative of epilepsy

  • Epilepsy can be caused by any major category of serious disease or human disorder

  • Approximately 1% of cases result from genetic disease

  • People with idiopathic or primary epilepsies share the following features

    • Variable family history

    • Generalized spike-wave abnormality on electroencephalogram (EEG)

    • Onset in childhood or adolescence

  • Development of epilepsy in an individual who suffers brain injury is influenced by family history and pre- and post-morbid EEG abnormalities


General Considerations


  • Third most common serious neurologic disease in the elderly, following stroke and dementia

  • Depression commonly occurs in people with epilepsy

    • Suggested that the hippocampus, implicated in both mood disorders and seizures, is likely link between depression and epilepsy

  • Events that may trigger seizure in people with epilepsy include

    • Stress

    • Poor nutrition

    • Missed medication

    • Skipping meals

    • Flickering lights

    • Illness

    • Fever and allergies

    • Lack of sleep

    • Strong emotions

    • Heat and humidity

  • Fear of seizure may cause self-restriction of activities resulting in deconditioning, reduced balance strategy, loss of muscle strength and endurance




  • Affects approximately 45 million people worldwide

  • Highest incidence in young children and elderly populations; 75% of cases have onset before age 20 years

  • Men affected slightly more than women


Clinical Findings


Signs and Symptoms


  • Many people with epilepsy have no outward signs or symptoms except during seizure

  • Most signs and symptoms related to medication use, such as

    • Ataxia

    • Nystagmus

    • Dizziness

    • Confusion

    • Slurred speech

    • Nausea

    • Vomiting

    • Fatigue

    • Lethargy


Functional Implications


  • Injury from fall at onset of seizures or collision with objects during the seizure

  • Asphyxia if seizure occurs while eating, drinking, swimming

  • Deconditioning resulting in poor activity tolerance and increased fall risk


Possible Contributing Causes


  • Stroke

  • Intracranial mass

  • Traumatic brain injury

  • Subdural hematoma

  • Pneumonia

  • Hypoxia

  • Alcohol abuse

  • Brain abscess

  • High doses of caffeine can trigger seizure in people with epilepsy


Differential Diagnosis


  • Transient ischemic attack

  • Hypoglycemia


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