الفهرس 
Diagnosis of epilepsy in usually done through the following stepsOnly 14 pages are availabe for public view
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Abstract
Epilepsy is the most common serious neurological disease. Its incidence varies due to a number of factors, with higher incidence in developing countries for reasons which are not entirely clear. Epilepsy is a complex disease with diverse clinical characteristics. To gain insight into potential mechanisms of epilepsy, we need to reduce the features of epilepsy to its basic components: seizures, epileptogenesis, and the state of recurrent unprovoked seizures that defines seizures, as epilepsy is defined as recurrent unprovoked abnormal cerebral electrical discharge, associated with clinical changes, but usually including impairment of consciousness.
Seizures in a normal individual are due to disruption in the normal balance of excitation and inhibition. The fact that multiple mechanisms exist is not surprising, in contrast, understanding seizures in the brain of an individual with epilepsy is more difficult because seizures are superimposed on an altered nervous system. The different environment of the brain includes diverse changes, making mechanistic predictions a challenge; also understanding the mechanisms of seizures is more complex because epilepsy is not necessary a static condition but can continue to evolve over the lifespan.
These factors make the diagnosis of epilepsy more difficult that’s why 20-30% of cases are misdiagnosed, although diagnosis of epilepsy is the key factor for management of seizures. History taking from an eye witness can be considered the most important element; evaluation of the patient should focus on excluding any underlying neurologic or medical condition. EEG is the most important, and the most recommended investigation in case of seizure occurrence. CT-scan and MRI together with some laboratory investigations are important to exclude any underlying causes of seizures.
Complications of seizures are easily triggered by emotional stress, as the limbic structure which is concerned with emotion and motivation causes these patients to develop cognitive and behavioral difficulties. Also complications of seizures itself may involve fractures, cardiac arrhythmias and pulmonary edema. Status epilepticus and SUDEP are the most significant concern for mortality among patients with epilepsy.
Management of patients with epilepsy is often challenging as the goal of therapy is to completely control seizures without producing any unacceptable medication side effects. AEDs are drugs that try to prevent rapid, repetitive stimulation of the brain; they are grouped according to their mechanism of action, although most of them have various mechanisms of action. Monotherapy is preferable because it decreases the likelihood of adverse effects, in addition it may be cheaper than polytherapy.
Achieving the various goals of anesthesia for epileptic patients is difficult. Safe anesthesia requires a high degree of preparation and attention to detail. Alfentanyl with isoflurane is perhaps the best choice. For EEG low concentration of isoflurane or propofol with fentanyl is ideal. Management of refractory status epilepticus needs to be tailored according to the neurological and haemodynamic status of the patient. As for regional anesthesia, it is not contraindicated for patients with a history of a seizure disorder.
However, the likelihood of postoperative seizure is increased regardless of the anaesthetic or analgesic technique. Therefore, it is essential to be prepared to treat seizure activity.
Epilepsy surgery is recommended for patients whose seizures are not well controlled by medications, this is called refractory epilepsy. In the past, patients were referred for surgery after 10 years or more of failure of treatment.
Today the definition of refractory epilepsy has changed and surgery is being performed early. Success rates for epilepsy surgery are constantly improving and advances in preoperative assessments are largely responsible; in addition to the introduction of new less invasive techniques.