Epilepsy

Epilepsy is a chronic neurological condition characterised by recurrent, unprovoked seizures resulting from abnormal electrical activity in the brain.

• Recurrent seizures, which may be convulsive (jerking movements, loss of consciousness) or non-convulsive (brief lapses in awareness, staring spells, unusual sensations)
• Confusion or fatigue after a seizure is common

• In many cases, no specific cause is identified (idiopathic epilepsy).
• Recognised causes include birth injury, brain infections such as meningitis or cerebral malaria, head trauma, stroke, and, in some regions, onchocerciasis-associated epilepsy.
• Genetic factors may also contribute.

• Primarily a clinical diagnosis, based on a detailed history of seizure type, frequency, and triggers from the patient and witnesses.
• Electroencephalography (EEG) and brain imaging, where available, support diagnosis and help identify an underlying cause, particularly for new-onset seizures in adults.

Long-term seizure control is achieved with an antiepileptic medicine; phenobarbital and carbamazepine are commonly used first-line options depending on seizure type and patient factors, with sodium valproate as an alternative outside pregnancy.

Treatment is usually started at a low dose and adjusted gradually, aiming for seizure control on a single medicine where possible.

During an active convulsive seizure, the priority is to protect the person from injury; a benzodiazepine such as diazepam is given for prolonged seizures (status epilepticus), with urgent referral if seizures do not stop.

• Take antiepileptic medicine consistently and avoid sudden discontinuation.
• Seek prompt treatment for infections that can cause seizures, such as cerebral malaria and meningitis.
• Support safe delivery practices to reduce the risk of birth-related brain injury.
• Attend regular follow-up to review seizure control and medicine side effects.