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  • 345.9 Epilepsy

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

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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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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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Differential Diagnosis

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  • Transient ischemic attack
  • Hypoglycemia
  • Other seizure disorder
  • Syncope
  • Transient cerebral anoxia
  • Recurrent cardiac arrhythmia
  • Nonspecific dizziness or episodic vertigo

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Imaging

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  • EEG
  • MRI to rule out other pathologies causing ...

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