Epilepsy can feel like a massive topic to tackle, but breaking it down into classification, diagnostics, and management makes it much more manageable. Since you're prepping for the UKMLA AKT, focusing on the ILAE (International League Against Epilepsy) classifications and NICE guidelines is key.

1. Seizure Classification (ILAE 2017)

The current classification is based on where the seizure begins in the brain:

• Focal Onset: Starts in one hemisphere.
  • Aware: Patient remains conscious (formerly "Simple Partial").
  • Impaired Awareness: Consciousness is affected (formerly "Complex Partial").
  • Focal to Bilateral Tonic-Clonic: Starts focally and spreads to both sides.
• Generalized Onset: Engages both hemispheres simultaneously from the start.
  • Motor: Tonic-clonic, myoclonic, atonic.
  • Non-motor: Absence seizures.
• Unknown Onset: When the beginning of the seizure wasn't witnessed.

2. EEG Patterns

EEG is used to support the diagnosis and help classify the seizure type, but remember: ==a normal EEG does not rule out epilepsy==.

3. First-Line Antiepileptics (NICE Guidelines)

The choice of medication depends heavily on the seizure type and the patient's profile (especially childbearing potential).

• Focal Seizures:
  • First-line: Lamotrigine or Levetiracetam.
• Generalized Tonic-Clonic:
  • First-line: Sodium Valproate (unless female of childbearing age) or Levetiracetam.
  • Second-line: Lamotrigine.
• Absence Seizures:
  • First-line: Ethosuximide or Sodium Valproate.
• Myoclonic Seizures:
  • First-line: Sodium Valproate or Levetiracetam.
  • Avoid: Lamotrigine (can worsen myoclonic jerks).

Important Safety Note: Sodium Valproate Due to high teratogenic risk, Sodium Valproate must not be used in girls or women of childbearing potential unless a Pregnancy Prevention Programme is in place and no other treatment is effective.

Let me pull up some high-yield lessons and a flowchart to help you visualize the management pathways.

I've pulled up some high-yield lessons that cover both the pediatric and adult perspectives on epilepsy, along with a pharmacology deep-dive into antiepileptic drugs.

The flowchart above summarizes the NICE management pathways. A quick tip for the AKT: if you see a question about a young woman with newly diagnosed generalized epilepsy, the answer is almost always Levetiracetam or Lamotrigine because of the strict rules surrounding Sodium Valproate.

Would you like to try a few practice questions on this to see how it's tested, or should we look at some EEG images?