Epilepsy.
Causes: 0ften none is found. Trauma, tumour, alcohol withdrawal.
Physical: space occupying lesions, stroke, raised BP, Tuberous sclerosis, SLE, PAN, sarcoid and vascular malformations.
Metabolic causes: hypoglycaemia, hyperglycaemia, hypoxia, uraemia, hypo and hypernatraemia, hypocalcaemia, liver disease, drugs (phenothiazines, tricyclics, cocaine or withdrawal of benzodiazepines).
Infections: encephalitis, syphilis, cysticercosis and HIV.
Refer: Blackouts.
Commonly used drugs: carbamazepine: toxic effects: rash, nausea, dizziness, diplopia, fluid retention, hyponatraemia and blood dyscrasias.
Phenytoin: toxic effects: rash, sedation memory and behaviour disturbance, gum hypertrophy, acne, facial coarsening, blood dyscrasias, folate deficiency and cerebellar syndrome.
Sodium valproate: monitor liver function and give after food. Toxic effects: sedation, tremor, weight gain, hair thinning, ankle swelling, hyperammonaemia (causing encephalopathy) and liver failure.
Other drugs: ethosuximide, vigabatrin or lamotrigine as second line treatment for partial seizures, phenobarbitone and benzodiazepine.
Only consider maintaining on two drugs if all appropriate drugs tried singly at maximum dose.
Refer: Epilepsy counseling.