Adult epilepsy and anaesthesia

Abstract

Access the CPD MCQs for this issue online here ### Key points Epilepsy is a disorder of the brain characterized by a predisposition to generate abnormal synchronous neuronal activity. This results in recurrent and unpredictable interruptions of normal brain function, observed clinically as epileptic seizures.1 Epilepsy is common; 50 million people worldwide are affected and the estimated prevalence of active epilepsy [continuing seizures or the need for antiepileptic drug (AED) treatment] is 4–10 per 1000 people.2 Within the UK, ∼600 000 people have a diagnosis of epilepsy and take antiepileptic medication.3 All anaesthetists will regularly encounter patients with epilepsy in their practice and should be aware of the special considerations when managing patients with this disorder. Planned and thoughtful care of these patients can minimize the risk of seizure occurrence in the perioperative period. ### Diagnosis of epilepsy Epilepsy is conventionally diagnosed after two unprovoked seizures occurring at least 24 h apart. This reflects the fact that after two non-febrile seizures, more than 70% of people will have another seizure within 4 yr,4 whereas only 40–50% of people will go on to develop epilepsy after a single unprovoked seizure.5 The diagnosis of epilepsy depends on a convincing history, witnessed seizures, or both in combination with investigations including …