PE27.7 | Epilepsy — Summary & Reflection

KEY TAKEAWAYS

Epilepsy is defined by the ILAE (2014) as ≥2 unprovoked seizures >24 h apart, or 1 seizure with ≥60% recurrence risk, or an epilepsy syndrome diagnosis. The ILAE 2017 classification proceeds from seizure onset type (focal/generalised/unknown) to epilepsy type to syndrome — the syndrome level drives treatment selection. Pathogenesis involves excitatory-inhibitory imbalance from genetic (SCN1A, GABRG2), structural (cortical dysplasia, hippocampal sclerosis), metabolic (pyridoxine-dependent, biotinidase), immune (anti-NMDAR encephalitis), or infectious (neurocysticercosis) causes. EEG is the cornerstone investigation — 3 Hz spike-wave (CAE), hypsarrhythmia (West syndrome), centrotemporal spikes (BECTS), polyspike-wave (JME). MRI is indicated for focal epilepsy, drug resistance, or infantile spasms. AED choice by epilepsy type: valproate or ethosuximide for typical absence (CAE), valproate/levetiracetam for JME, carbamazepine for focal — carbamazepine is absolutely contraindicated in absence and myoclonic epilepsies. All dosing is weight-based. Infantile spasms (West syndrome) with hypsarrhythmia is a neurodevelopmental emergency requiring urgent ACTH/prednisolone + vigabatrin.

REFLECT

Return to the 7-year-old girl from our opening scenario. She has been 'staring' for two years — her teachers thought she was daydreaming and her parents thought she was being inattentive. During those two years, she has been having 20–30 absence seizures daily: moments of lost awareness, lost learning, and social invisibility. Reflect on: What was missed, and by whom, during those two years? What screening question in a developmental assessment would have identified this earlier? If you prescribe ethosuximide successfully and she becomes seizure-free, at what age would you consider withdrawing the AED — and what would you tell her parents about the timeline and process? Finally, consider how the Kolb learning cycle applies to a child with epilepsy learning to self-monitor their seizures as they enter adolescence.