Epilepsy: Seizure Types, Diagnosis, Treatment & Prognosis

What Is Epilepsy?

A chronic neurological disorder characterized by recurrent unprovoked seizures (≥2 >24 hrs apart, or 1 with high recurrence risk).

Seizure Manifestations

• Focal (partial): Aware or impaired awareness; motor, sensory, autonomic, psychic symptoms.
• Generalized: Tonic-clonic (convulsions), absence (staring), myoclonic (jerks), atonic (drop), tonic, clonic.
• Unknown onset.

Etiology

• Genetic (channelopathies, familial syndromes).
• Structural: stroke, tumor, TBI, cortical malformation, hippocampal sclerosis.
• Infectious: neurocysticercosis, meningitis, encephalitis.
• Metabolic, immune, unknown (~50%).

Diagnosis

• Detailed history (witness account crucial).
• EEG (interictal/ictal); may be normal.
• MRI brain (epilepsy protocol) for structural lesions.
• Labs: glucose, electrolytes, CBC, toxicology, genetic panel if indicated.

Treatment

• ASMs (Anti-Seizure Medications): ~70% achieve seizure freedom. Choice by seizure type, syndrome, comorbidities, side-effect profile, drug interactions, childbearing potential.
  • Focal: Lamotrigine, levetiracetam, carbamazepine, oxcarbazepine, lacosamide.
  • Generalized: Valproate (avoid in women of childbearing potential), levetiracetam, lamotrigine, topiramate, perampanel.
• Surgery: For drug-resistant focal epilepsy—resective (temporal lobectomy), laser ablation, neuromodulation (VNS, RNS, DBS).
• Diet: Ketogenic, modified Atkins, LGIT—especially for pediatric refractory epilepsy.
• Lifestyle: Sleep hygiene, alcohol avoidance, stress management, seizure action plan.

Prognosis

• ~70% controlled on first/second ASM.
• ~30% drug-resistant → consider surgery, devices, diet.
• Most people with epilepsy live full lives with proper management.

Resources

• Epilepsy Foundation (epilepsy.com)
• American Epilepsy Society (aesnet.org)
• CDC Epilepsy Program