Welcome to today's Medical Monday! Our question today is from Stephanie, who asks:
"What kind of complication from epilepsy could land someone in the hospital?"
First, let's do a quick overview of epilepsy.
Epilepsy occurs when neurons in the higher levels of the brain fire abnormally.
There are generally two types of seizures in adults.
Partial seizures occur in only a part of the brain, usually in one hemisphere.
- In Simple Partial Seizures, the person is usually aware of what's happening and can have symptoms such as a jerking limb, smelling something strange, belly discomfort, or fear.
- In Complex Partial Seizures, consciousness is altered. They may exhibit staring or repetitive movements such lip-smacking and chewing. They do not remember the seizure.
- Grand mal (tonic-clonic) are the seizures we often see in movies or stories. The person will start off stiff, followed by jerking of the entire body.
- In Petit mal or absence seizures, the person doesn't jerk or go stiff, but instead stares straight ahead.
Now, what would land a person with epilepsy in the hospital? I'll give Stephanie a selection of possibilities.
- Injury. People with epilepsy have a higher risk of injury from falls, motor vehicle accidents, and drowning. For a hospitalization, it should be a pretty serious injury. A drowning, major accident with severe head injury or multiple body injuries (broken bones that require surgery), would buy a hospitalization.
- Psychosocial Issues. Patients are also at higher risk for depression, anxiety, and have a three-time higher risk of suicide. Severe depression or a suicide attempt would do here.
- Drug side effect. Commonly used anti-epileptic medications such as carbamazepine, oxcarbamazepine, phenytoin, and lamotrigine can rarely cause life threatening skin reactions (Stevens-Johnsons and toxic epidermal necrolysis (TEN)) which can land someone in hospital ward, or if very severe, a burn unit for care because of the high probability of death.
- Status Epilepticus. This is an unrelenting seizure that last for longer than 5-10 minutes, or recurrent seizure that doesn't give the person a chance to return to baseline from the post-ictal states. Causes are usually stopping anti-epileptic meds, heavy drinking or withdrawal from alcohol, prior head injury or brain damage, metabolic disturbances (abnormal electrolytes, extremely low blood sugar), medications (certain antibiotics, tricyclic antidepressants).