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ICD-9-CM Code

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  • 345.9 Epilepsy

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ICD-10-CM Code

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

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Preferred Practice Patterns

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Key Features

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Description

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  • Chronic disorder of various causes characterized by recurrent seizures

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

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Essentials of Diagnosis

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  • 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

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General Considerations

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  • 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

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Demographics

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  • 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

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Clinical Findings

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Signs and Symptoms

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  • 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

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Functional Implications

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  • 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

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Possible Contributing Causes

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  • 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

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Differential Diagnosis

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  • Transient ischemic attack

  • Hypoglycemia

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