Epilepsy Assessment

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Note, epilepsy is a medical (neurological) condition and should be managed by a medical team (ideally by a neurologist). Childhood epilepsy should be managed by paediatrics. Traditionally, however, adult epilepsy has been managed by mental health in Malawi so the following section is included to support mental health staff during the period of transition to epilepsy being managed by medicine (neurology).

 

Epilepsy is a brain disorder. It is defined by recurring, unprovoked seizures also known as fits or convulsions. About one in every 100 people is affected by epilepsy. The severity of a seizure can vary greatly; from spells of absence (staring into space with no movement) to loss of consciousness and violent convulsions. The type of seizure a person has depends on the underlying cause of the seizure. Most start before age 30. Children may have febrile seizures if they have a fever, this is different to Epilepsy.  There are two main types of epileptic seizure:

Convulsive seizures

This type of seizure affects the whole brain and the person having the seizure becomes unconscious. They may also:

• Fall to the floor
• Bite their tongue
• Become stiff and shake
• Their eyeballs may roll upwards
• Froth at the mouth
• Lose control of their bladder / bowels
• Their lips may turn blue
• Feel drowsy and confused after the event

Non-convulsive seizures

This type of seizure affects one part of the brain.

The person may be awake but confused or lose touch with their surroundings and may experience the following:

• Jerky movements in one part of their body (e.g. their arm or leg)
• Their lips may smack together repeatedly
• They may stare into space and appear as if they are in a trance (absence seizure)

‘Conversion’ seizures

Before diagnosing someone with epilepsy, it is important to assess if these are conversion seizures, also known as psychogenic non-epileptic seizures (PNES). PNES are attacks that may look like epileptic seizures but are not caused by abnormal brain electrical discharges. Instead, they are an indicator of psychological distress. PNES is a real condition that happens in response to real stressors.

These seizures are not consciously produced and are not the patient’s fault. During an attack, findings such as asynchronous or side-to-side movements, crying, and eye closure suggest PNES, whereas occurrence during sleep indicates epilepsy.

These seizures are more common in young women and are associated with psychological stress. See resources referenced in introduction for more information on management.