Epilepsy: definition, complications, and treatment

  Definition of

  Epilepsy is defined as the recurrence of sudden, excessive and / or simultaneous secretions in cerebral cortical neurons resulting in disturbance of consciousness, disturbance of sensation, movements, impaired mental function, or a combination of these signs.  Because of its sudden nature, seizures are called events of ictal, from Latin ictus meaning "multiplication".  The terms epilepsy, seizures and convulsions are not synonymous

 

  Epilepsy brain and normal brain

  Types of epileptic seizures

  There are three diagnoses a doctor may make when treating a patient with epileptic seizures

  Idiopathic - this means that there is no clear cause

  Cryptogenic - This means that the doctor thinks there is likely a cause, but he cannot determine it

  There are three descriptions of seizures, depending on which part of the brain the epilepsy started

  Partial seizure

  Partial seizure means that epilepsy activity occurred in only part of the patient's brain.  There are two types of partial seizures

  Simple partial seizure - the patient is conscious during the seizure.  In most cases, the patient also realizes his surroundings, although the seizure is in progress

  Complex partial seizure - poor patient awareness.  The patient will generally not remember the seizure, and if this happens, his memory will be vague

  Generalized seizure

  Generalized seizures occur when the brain hemispheres have epilepsy activity.  The patient lost consciousness while the seizure occurred

  Concussive spells (formerly known as major epileptic seizures) - these are probably the best general type of seizures.  They cause unconsciousness, body stiffness, and vibration

  Absentia seizures (formerly called small epileptic seizures) - they involve short lapses in consciousness as a person appears to stare into space.  Attack attacks often respond well to treatment

  Seizures - muscles become stiff.  May cause falls

  Atony epileptic seizures - loss of muscle control, causing the individual to suddenly drop

  Concussive seizures - associated with rhythmic and shaking movements

  General Secondary Nuba

  A general secondary seizure occurs when epilepsy activity begins as a partial seizure, and then spreads to the two hemispheres of the brain.  With this development, the patient loses consciousness

 Some causes of epilepsy

  In most cases, no cause of epilepsy can be found and is described as idiopathic.  However, there are a number of recognized factors that increase a person's risk of epilepsy.  These include

  Brain scarring or brain damage, for example due to birth injuries, accidents, physical assaults, and excessive use of alcohol / drugs

  Infections and fever, such as meningitis, rubella, encephalitis and AIDS

  Benign and malignant tumors

  Genetic factors, such as tuberous sclerosis

  Dementia and degenerative neurological disorders, for example Alzheimer's disease

  Stroke that can occur at any age

  Parasitic infections, for example malaria

  Developmental disorders - for example, autism or neurofibromatosis

  Genetics

 Risk factors

  Sometimes the risk factor can cause brain scarring or cause the brain to not grow or function properly.  Risk factors include

  Babies born young for their ages

  Children who have had seizures in the first month of life

  Babies born in abnormal areas of the brain

  Brain bleeding

  Abnormal blood vessels in the brain

  Serious brain injury or hypoxia in the brain

  Brain tumors

  Brain infections: abscess, meningitis, or encephalitis

  Stroke caused by clogged arteries

  Cerebral Palsy

  Cases of intellectual and developmental disability

  Seizures that occur within days after a head injury ("early post-traumatic seizures")

  A family history of epilepsy or seizures associated with fever

  Alzheimer's disease (late in disease)

  Autism spectrum disorder

  Unusually long (febrile) episodes

  Prolonged seizures or recurrent seizures called epilepsy

  Use of illegal drugs such as cocaine

  Mild head injuries, such as concussion with a very brief loss of consciousness, do not cause epilepsy.  But the effects of frequent mild head and epilepsy injuries are unknown

 Symptoms of epilepsy

  The main symptoms of epilepsy are frequent seizures.  In the event that one or more of the following symptoms exist, the individual should visit the doctor, especially if it recurs

  Spasms without temperature (without fever)

  Short bouts of blackout or muddled memory

  Intermittent fainting episodes, during which bowel or bladder control is lost, often followed by extreme fatigue

  For a short period, the person does not respond to instructions or questions

  A person becomes solid, suddenly, for no apparent reason

  The person suddenly falls for no apparent reason

  Sudden bouts of flash without apparent stimuli

  Sudden bouts of chewing, for no apparent reason

  For a short time, the person appears stunned and unable to communicate

  Repetitive movements that seem inappropriate

  The person becomes frightened without an apparent reason;  They may panic or become angry

  Strange changes in the senses, such as smell, touch and sound

  Children, arms, legs, or body tremors appear as a group of rapid jerking motion

 Complications of epilepsy

  If you fall during a seizure, you can injure your head or break a bone

  If you have epilepsy, you are likely to drown while swimming or bathing 15 to 19 times more than the rest of the population due to the possibility of a seizure while in the water

  Car accidents.  A seizure that causes either loss of consciousness or control can be dangerous if you are driving a car or operating other equipment

  Complications of pregnancy.  Seizures during pregnancy pose a risk to both the mother and the baby, and some antiepileptic drugs increase the risk of birth defects.  If you have epilepsy and are considering pregnancy, talk to your doctor while you plan to become pregnant

  Emotional health problems.  People with epilepsy are more likely to experience psychological problems, especially depression and anxiety, and in extreme cases, suicide.  Problems may be the result of difficulties in dealing with the condition itself as well as the side effects of the medications

  Sudden unexplained sudden death in epilepsy (SUDEP).  People with epilepsy also have a risk of sudden, unexplained death.  The cause is unknown, but some research shows it may be caused by heart or respiratory disease

  Diagnosis and testing of epilepsy

  The evaluation of epilepsy patients aims to determine the type and cause of seizures, because different types respond better to specific treatments.  The diagnosis is based on

  The patient's medical history, including any family history of seizures, associated medical conditions, and current medications

  A complete physical and neurological examination is examined - your muscle strength, reactions, eye sight, hearing, and the ability to discover different sensations are tested so that doctors can better understand the cause of your seizures

  EEG, which measures electrical impulses in the brain.  This is the only test that directly detects electrical activity in the brain, and seizures are determined by abnormal electrical activity in the brain.  During the EEG, electrodes (small metal discs) are attached to specific locations on your head.  The electrodes are connected to a monitor to record the electrical activity of the brain.  EEG is not only useful to confirm the diagnosis of epilepsy, but also to determine the type of epilepsy

  

  A routine EEG records about 20 minutes of brain waves (however, a routine EEG takes about 90 minutes).  Because 20 minutes is a short period of time, the results of routine EEG studies are often normal, even in people known to have epilepsy.  Therefore, it may be necessary to monitor EEG for long periods

  EEG video monitoring is a better diagnostic method.  During this type of observation, EEGs monitor brain activity and video cameras for body movements and behavior during a seizure.  Prolonged monitoring often requires the patient to spend time in a private facility for several days.  Prolonged EEG video monitoring is the only way to diagnose epilepsy.

  Brain imaging studies, such as those provided by magnetic resonance imaging (MRI).  This can determine the cause of the seizures, but the majority of epilepsy patients have a normal MRI

 Medication and treatment

  Drug treatment

  Several medications are available to treat epilepsy, and many have been launched recently.  Old and large medications used to treat epilepsy include

  Phenytoin (Dilantin)

  Phenobarbital

  Carbamazepine (Tegretol, Carbatrol)

  Primidone (Mesulin)

  Ethosuximide (Zarontin)

  Valproic acid (Depakote)

  Diazepam (Valium) and its derivatives

  Modern medications to treat epilepsy includ

  Felbamate (Felbatol)

  Gabapentin (Neurontin)

  Lamictal

  Oxcarbazepine (Trileptal)

  Topiramate (Topamax)

  Tiagabine (Gabitril)

  Levitiracetam (Kebra)

  Zonisamide (Zonegran)

  Other treatment options

  Epilepsy surgery is safe and effective, and is the preferred treatment when medications do not work.  (See the brochure on Epilepsy Surgery)

  The ketogenic diet is effective in treating certain types of epilepsy.  Specifically, it is effective in children with generalized epilepsy with severe symptoms with more than one type of seizure and brain damage.  However, diet requires careful planning and may be difficult to follow, so this is not possible in older children or adults.  The diet begins in the hospital, and when it succeeds, it is usually kept for 2 to 3 years.  A highly motivated family and a qualified dietician require

  Vagus nerve stimulation (VNS).  This treatment requires a simple implant, and is the size of a pacemaker.  It is placed under the skin in the upper left chest, like a pacemaker.  This treatment appears to be effective for seizures that do not respond well to medication alone