DR ZULFIQAR ALI RIZVI
CONSULTANT PSYCHIATRIST
PIMH LAHORE
Changing concepts of EPILEPSY from ancient
times to 21st century
What can be the biggest desire of patients suffering from
epilepsy?
Who will help me back from exclusion to inclusion in society?
YES, IT IS
Our Executive director Dr Nusrat Habib Rana, with the team of Doctors of
PIMH, Lahore have raised their hands and taken responsibility to create
awareness about epilepsy and bring epilepsy patients back in society with
sense of dignity and respect.
Epilepsy is one of the oldest
disorders known to mankind.
Over 50 million people
worldwide.
No racial, social, cultural,
economical ethnic and
geographical boundaries.
 In ancient times, associated
with religious experiences and
demonic possessions.
 Hippocrates ( Greek Physician
500 BC) wrote the first book
about epilepsy.

Saint Cyriakus
In 17th and 18th century,
In 20th century,
21st century and concept of epilepsy:.
Actually what epilepsy is?
Epilepsy is a neurological condition with tendency
to recurrent seizures. At least two unprovoked
seizures:
•
•
24 hours apart,
of cerebral origin
are necessary to make a diagnosis of epilepsy.
Life time prevalence of seizures: 5-10 %.
Prevalence of active epilepsy 1-2%.
ETIOLOGY
: About 60-65 percent (two third) idiopathic
It is more common in 2-14 years age group
In symptomatic cases, one can find physical
basis of seizures:
Younger and early adulthood patients:
Adults and elderly:
Pathophysiology
Multifactorial. Determining factor is the
result of interaction between genetically
determined seizure threshold, underlying
pathological and metabolic conditions, and
acute precipitating factors.
Reflex seizures
Caused by certain stimuli in predisposed
persons.
Precipitating stimuli for reflex seizures:
Visual stimuli- flickering light
Thinking
Music - certain frequencies
Reading
CLASSIFICATION
The ILAE classification
• Partial-onset seizures
• Generalized-onset seizures.
Generalized-onset
• Tonic-clonic seizures (grand mal) lasts 1-2 min
• Absence seizures ( petit mal ) (10-30 seconds) with no
postictal symptoms.
Clonic involve tonic clonic contractions.
•
• Myoclonic
• Tonic seizures( sustained contractions ) last 10-15 sec.
• Atonic
Partial onset
• Simple partial
• Complex partial
The origin of symptoms and signs in focal seizures
DIAGNOSIS
1)History and clinical findings
2)Physical evaluation.
3) Electroencephalography:
4) Lab Studies :
5) CT SCAN:.
6) MRI:
7)PET scanning
Principal of treatment
• New cases, 2/3 of cases go into spontaneous
•
•
•
•
remission. Only 1/3 of cases will have 2nd
seizure in next 5 years
If left untreated, about 75% cases show 2nd
seizure
A single drug, controls 60%.
If seizures are difficult to control ( in 30-40% )
, 2 or > 2 drugs may be required.
In intractable cases ( refractory) 20% 2 or >
drugs.
Drug treatment
1) Primary generalized tonic-clonic seizures
First-line monotherapy
Carbamazepine
Phenytoin
Valproate ( epival )
Topiramate ( topamax )
2nd-line monotherapy or adjunctive therapy
Lamotrigine
Levetiracetam ( lerace )
2) Partial seizures with or without secondary
generalizations
First-line monotherapy
Carbamazepine( seiznil)
Lamotrigine ( lojin )
Oxcarbazepine (oxalepsy )
Topiramate
Levetiracetam
2nd-line monotherapy or adjunctive therapy
Gabapentin ( neogab )
Pregabalin
Valproate
3rd-line monotherapy or adjunctive therapy
Felbamate
Vigabatrin
3) Absence seizures
First-line monotherapy
Ethosuximide
Lamotrigine
Valproate
2nd-line monotherapy
Levetiracetam
Topiramate
MESSAGE
• Epilepsy has nothing to do with mental
disease or retardation. This has been
proved beyond all doubt by the "epileptic
geniuses", people who achieved great
things in spite of suffering from epilepsy.
Margaux Hemingway
American Actress
Alexander the Great
Macedonian King

G. Julius Caesar
Roman Statesman
Alfred Nobel
Swedish Chemist