Neurology

Epilepsy

Enduring predisposition to recurrent unprovoked seizures affecting ~1% of population. Classification by seizure onset (focal, generalised, unknown) and aetiology guides therapy.

Last reviewed 14 Jul 2026 - MedicoMedics editorial team

Pathophysiology

Imbalance between glutamate excitation and GABA inhibition. Aetiologies: structural (stroke, tumour, MTS), genetic (Dravet - SCN1A), metabolic, immune, infectious.

Sources: ILAE 2017 (Epilepsia 2017;58:522); ESETT (NEJM 2019;381:2103)

Presentation

Focal: aware or impaired awareness with automatisms. Generalised: tonic-clonic, absence (staring, 3 Hz spike-wave), myoclonic, atonic. Post-ictal confusion supports epileptic origin.

Diagnosis

Detailed semiology, EEG (interictal epileptiform discharges), MRI epilepsy protocol. Video-EEG for drug-resistant cases.

Management

Focal: lamotrigine, levetiracetam, lacosamide. Generalised: valproate (avoid in reproductive women), levetiracetam, lamotrigine. Status epilepticus: IV lorazepam then fosphenytoin, valproate or levetiracetam.

Sample USMLE-style MCQs

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Question 1

A 19-year-old in status epilepticus. After ABC and glucose, first drug?

Question 2

Woman planning pregnancy on AED. Which to avoid?

Question 3

Child with staring spells and 3 Hz spike-wave EEG. Diagnosis?

Question 4

AED that can worsen absence and myoclonic seizures?

Question 5

ILAE drug-resistant epilepsy definition?

References

Primary guidelines and peer-reviewed sources used for this entry. Reviewed 14 Jul 2026 by MedicoMedics editorial team.

Frequently asked

Status epilepticus definition?

Seizure >=5 min or recurrent without recovery.

Safest AED in pregnancy?

Lamotrigine or levetiracetam.

SUDEP?

Sudden unexpected death in epilepsy - reduced by seizure control.

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