372 Ch 371. Seizures and Epilepsy

Seizure = transient occurrence of signs/symptoms due to abnormal excessive/synchronous neuronal activity in the brain；epilepsy (ILAE 2014) = (1) ≥ 2 unprovoked seizures > 24 hr apart, OR (2) one unprovoked + ≥ 60% recurrence risk over 10 years, OR (3) epilepsy syndrome diagnosis；ILAE 2017 classification: (1) Onset — focal vs generalized vs unknown, (2) Awareness — aware vs impaired, (3) Motor vs non-motor features；focal seizures: aware (simple partial) vs impaired (complex partial); motor (clonic, tonic, automatisms) vs non-motor (sensory, emotional, autonomic, cognitive)；generalized: tonic-clonic, absence (3 Hz spike-wave), myoclonic, atonic, tonic, clonic；provoked vs unprovoked: provoked = acute symptomatic (stroke, metabolic, drug withdrawal, fever) — NOT epilepsy；workup: history (witnessed account critical) + EEG + MRI brain + labs；ASMs (antiseizure medications) — newer drugs preferred for safety, fewer interactions：levetiracetam + lacosamide + lamotrigine + brivaracetam + cenobamate (2019) + perampanel + clobazam；SUDEP (Sudden Unexplained Death in Epilepsy) — ~ 1.2/1000 patient-years, higher in refractory；newer 2023-2024: cenobamate gaining traction, gene therapies in trials。