![]() ![]() An aura is a “simple” partial seizure - a manifestation of epileptic activity confined to a small portion of the brain, without impairment of awareness or memory. Since epilepsy carries substantial psychosocial impact, the diagnosis should not be made unless the clinician has a high degree of certainty.Īura: Rising epigastric sensations and deja vu commonly occur in auras of seizures that have a focal onset. As patients almost invariably have limited recall of events during a seizure, a witness account is essential. The first step is to consider whether the episodes result from convulsive electrical activity in the cerebral cortex, as opposed to other causes of acute behavioural change.Ĭareful history-taking, including a detailed account of the circumstances and behaviour before, during and after the episode, is essential. Interpretation of history and examinationĪlthough the history of episodic altered awareness with abnormal movements and behaviour suggests a diagnosis of focal epilepsy, other conditions must be excluded ( Box 1). Her only medication was the oral contraceptive pill. Of a neurological examination were nomal. Janice’s medical history was unremarkable apart from a prolonged febrile seizure at 11 months of age, and results She was confused for several minutesĪfter both these episodes, one of which involved turning On two occasions, the episodes progressed to a witnessed generalised tonic–clonic seizure of 1–2 minutes that terminated spontaneously. The episodes would typically last 1–2 minutes, but it would be several more minutes before Janice became fully responsive and she had no memory of the episodes beyond the premonitory sensations. Occasionally, she would pick at her clothes with her left hand and hold her right arm in an odd fixed posture. Her partner reported that Janice then suddenly becomes unresponsive, has a blank look, and makes chewing movements with her mouth. She described the episodes as starting with “butterflies in the stomach”(rising up to her throat and lasting about 20 seconds) and intense deja vu. Janice, who is 23 years old, presented to her general practitioner with a history of stereotyped episodes that her partner had observed every 1–2 weeks over the previous year. The risk of major congenital malformations is highest with valproate, particularly in high doses. Poorly controlled epilepsy in pregnancy imparts significant risks to the mother and baby, which need to be weighed against the risks of teratogenicity. Lifestyle advice, such as advice about driving restrictions, is important for the safety of the patient and others.Īll anticonvulsants are potentially teratogenic. Dose adjustments should be made according to clinical response (seizure frequency and adverse effects), rather than on serum drug concentrations alone. The choice of medication should be individualised to a patient’s seizure characteristics, circumstances and preferences. ![]() The goal of treatment should be to achieve a life free of seizures, with minimum adverse effects from anticonvulsant medication. Recurrent unresponsive episodes associated with seizures may indicate a diagnosis of focal epilepsy or complex partial epilepsy.Īdults with a clinical diagnosis of a focal seizure disorder require investigation with electroencephalo-graphy and magnetic resonance imaging. It should focus on ascertaining whether the episodes are seizures or a seizure mimic such as syncope. ![]()
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