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Epilepsy

Epilepsia · Epilepsie

What it is

Repeated unprovoked seizures from synchronised electrical discharge.

Symptoms & signs

  • Convulsions
  • staring spells
  • jerking
  • tongue biting
  • incontinence
  • post-ictal confusion
  • aura

🚩 Get help if…

  • call 112 / 911 now Seizure lasting over 5 minutes
  • call 112 / 911 now Seizures one after another without waking between
  • call 112 / 911 now Seizure with a head injury, in water or in pregnancy
  • see a doctor soon Seizures becoming more frequent or changing type

Where it strikes

Medical treatment

  • Levetiracetam, lamotrigine, carbamazepine
  • valproate — strong in generalised epilepsy; in pregnancy about 1 baby in 10 has a malformation and up to 4 in 10 developmental problems, and warnings to women came late
  • surgery for a single focus
  • vagus nerve stimulator
  • responsive neurostimulation
  • cannabidiol (Epidiolex/Epidyolex) — licensed (FDA 2018, EMA 2019) for Dravet, Lennox–Gastaut and tuberous sclerosis seizures

Natural & lifestyle

  • Ketogenic or modified Atkins diet (strong evidence in children)
  • sleep regularity
  • alcohol avoidance
  • stress management

Emerging & experimental

  • Focused ultrasound ablation
  • gene therapy for genetic epilepsies
  • closed-loop implants

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Neurofeedback — small trials reduce seizures early / small studies
  • Melatonin — small trials, better sleep and fewer seizures in some early / small studies
  • Seizure-alert dogs — owners report warnings; not tested anecdotal / traditional
  • Shop-bought CBD oil — doses too low and too variable; the licensed cannabidiol drug is what worked in trials anecdotal / traditional

ICD codes