Epilepsy

EPILEPSY

What is epilepsy and seizure??

Epilepsy is a chronic neurological condition in the brain that causes recurring seizures that happen without warning. This neurological condition is also known as seizures disorder. Epilepsy is more prevalent in young children and older adults than those in other age groups.


A seizure is like a disordered electrical activity in the brain. Seizures are short episodes of a few seconds to a few minutes when the normal pattern of activity in the brain is temporarily disturbed and brain cells begin to fire abnormally. Nerve cells communicate with each other through electrical impulses. During a seizure, these impulses become overactive or occur at the same time, which leads to irregular brain activity. This can cause changes in behavior and body functioning.


Mild seizures can last for a few seconds and are difficult to realize. Strong seizures can result in spasms and muscle twitches which can last for a few seconds to several minutes. During a strong seizure, a person may become confused or become unconscious. Having a single seizure does not mean that a person has epilepsy. Lots of people have a single seizure and epilepsy does not develop further.


Many people with epilepsy manage the disorder well through medication, diet or medical treatments, but complications with epilepsy can lead to serious health concerns or death.


Types of epilepsy seizures

The type of seizure defines the type of epilepsy you have. Here are types of seizures:


Generalized seizures:  These seizures affect both sides of the brain.

Myoclonic seizures:  With this type of seizure, the person may experience brief, shock-like jerks of muscle(s) which last few seconds and can result in a fall at times. Person might have multiple myoclonic seizures within a short time period.

Tonic-clonic seizures (Grand Mal Seizures):  With this type of seizure, the person’s body muscles stiffens (the tonic phase). Their limbs then begin to jerk in strong and rhythmic movements (the clonic phase). The person may cry out, fall to the ground, lose consciousness. The person may have headache, confusion or tiredness after a tonic-clonic seizure. Tonic-clonic seizures generally last one to three minutes.

Atonic Seizures (Drop Attacks):  With this type of seizure, the person may experience a sudden loss of muscle tone, causing a person’s body to limp or fall which may result in injury due to fall.

Absence seizures (Petit Mal Seizures):  With this type of seizure, the person’s awareness and responsiveness are impaired. Person may blink rapidly, blank stare into space for a few seconds. These brief and non-convulsive events start suddenly which last a few seconds and then stop suddenly. They usually occur in children and they can occur many times in a day.


Focal (Partial) seizures:  These seizures affect just one part of the brain.

Simple focal seizures:  With this type of seizure, the person may experience twitching or a change in sensation, such as a strange taste or smell. The person does not lose consciousness during a simple focal seizure and remembers it. This seizure usually lasts less than 1-2 minutes.

Complex focal seizures:  With this type of seizure, the person may lose consciousness and do not remember the seizure after it is over. The person will be unable to respond to questions or direction for up to a few minutes. This seizure may last around 1-2 minutes and go up to 10 minutes in some cases.

Secondary generalized seizures:  With this type of seizure, it begins in one part of the brain but then spreads to both sides of the brain. In simple words, the person first has a focal seizure and then a generalized seizure. This seizure may last around 5 minutes.


Causes of epilepsy

In the majority of cases, the specific cause(s) of epilepsy are unclear. For many people with epilepsy, no cause is ever found. The most common conditions that can trigger epileptic seizures are:


  Genetic conditions

  Brain tumors

  Brain infections such as meningitis, encephalitis and HIV/AIDS

  Brain injury

  Brain surgery

  Brain stroke

  Brain diseases such as alzheimer’s disease

  Lack of oxygen to the brain

  Chemical or metabolic imbalances such as phenylketonuria

  Immune disorders

  Problems during pregnancy such as infections

  Lack of oxygen or other problems during or at the time of birth such as congenital brain defects

  Serious illness or high fever

  Medication side effects

  Drug use

  Frequent and prolonged alcohol use


Symptoms of epilepsy

The primary symptom of epilepsy is seizures, which usually lasts for a few seconds to a few minutes. The major type of seizures and symptoms observed in the corresponding types are listed below:

Myoclonic seizures:  With this type of seizure, the person may experience symptoms such as:

  Shock-like jerks of muscle(s)

  Fall of the body


Tonic-clonic seizures (Grand mal seizure):  With this type of seizure, the person may experience symptoms such as:

  Body muscles stiffness (the tonic phase)

  Strong and rhythmic jerks (the clonic phase)

  Fall to the ground

  Lose consciousness

  Cry out


Atonic Seizures (Drop Attacks):  With this type of seizure, the person may experience symptoms such as:

  Sudden loss of muscle tone

  Limp or fall of the body


Absence seizure (Petit mal seizure):  With this type of seizure, the person may experience symptoms such as:

  Rapid blinking

  Blank stare in space

  Lose consciousness for a while

  Chewing-like movements


Simple focal (partial) seizures:  With this type of seizure, the person may experience symptoms such as:

  Twitching

  Strange smell or taste

  Jerking movements in a particular part of the body

  Unexplained fear, rage or other emotional symptoms


Complex focal (partial) seizure:  With this type of seizure, the person may experience symptoms such as:

  Lose consciousness

  Repetitive movements of the hand

  Make a blank stare

  Chewing or smacking lips


How is epilepsy diagnosed?

Epilepsy should be diagnosed only when the person had at least two seizures. The affected person or affected person’s family members or any other observers may require to share the following important details with the neurologist:


  Genetic disorder

  Warning signs

  Place and activity at the time of seizure

  Time of seizure

  Time period of seizure

  Frequency of seizures

  Experience before during or after seizure

The doctor will perform several tests, the results of these tests will help the doctor to make a diagnosis. These tests include:


Blood tests:  To rule out possible causes of seizures such as diabetes or low blood sugar.

Atonic Seizures (Drop Attacks):  

Electroencephalography (EEG):  To record the brain’s electrical activity.

Magnetic resonance imaging (MRI):  To take images of the brain to confirm epilepsy.

Computerized tomography (CT) scan:  To take images of the brain using X-rays to rule out other seizure causes such as tumors, bleeding and cysts.

Electrocardiogram (ECG):  To record the heart’s electrical activity to rule out any heart-related problems.

Positron emission tomography (PET) scans:  To take images of the brain and record chemical changes in the brain to confirm epilepsy.

Single photon emission computed tomography (SPECT):  To identify the hotspots in the brain by verifying the part of the brain that has the highest blood flow. Generally, the regions with the most increased blood flow are at the spot where a seizure begins.

Neuropsychological tests:  To test a person's thinking, memory and speech skills to find out areas of the brain that are affected.

Treatment of epilepsy

There is no known way to prevent epilepsy. Treatment for epilepsy is considered only when the affected person had at least two seizures. Treatment of epilepsy is done by a neurologist or a general physician based on your symptoms. The treatment options for epilepsy include:


Vagus nerve stimulator:  A stimulator-like device is placed under the chest skin and electrical stimulation is sent to the nerves of the neck. This can prevent the occurrence of seizures.

Anti seizure, anticonvulsant drugs:  These medications should be taken exactly as the doctor prescribes you. These medications work by reducing electrical activity in the part of the brain responsible for seizures which help to reduce and sometimes completely eliminate seizures. The dose of the medicine may vary from person to person based on their symptoms. The following medicines can be taken to control epilepsy:

  Briviact

  Epidiolex

  Carbamazepine  (Epitol, Tegretol)

  Xcopri

  Clonazepam  (Klonopin)

  Diazepam  (Diastat, Valium, Valtoco)

  Divalproex  (Depakote)

  Aptiom

  Ethosuximide  (Zarontin)

  Felbamate  (Felbatol)

  Fintepla

  Gabapentin  (Neurontin)

  Vimpat

  Lamotrigine  (Lamictal, Subvenite)

  Levetiracetam  (Keppra, Spritam)

  Lorazepam  (Ativan)

  Oxcarbazepine  (Trileptal, Oxtellar XR)

  Fycompa

  Phenytoin  (Dilantin, Phenytek)

  Pregabalin  (Lyrica)

  Tiagabine  (Gabitril)

  Topiramate  (Topamax)

  Valproic acid

  Zonisamide  (Zonegran)

Brain surgery:  The part of the brain which causes seizure like a tumor or cyst may be removed or can be altered surgically. Surgery is only considered if medicines are ineffective.

Deep brain stimulation:  Surgeons implant electrodes into a brain layer called the thalamus. Electrodes are placed in the chest region and attached to the generator. The generator regulates electrical impulses. This therapy reduces the number of episodes but does not cure epilepsy. This therapy is recommended only when medicines are ineffective and surgery is not possible.

Alternative treatments:  These alternative treatments may help some people in their efforts to deal with epilepsy. These treatments are not meant to replace your regular medical treatments but they are done in addition. Alternative treatments may include:

  Nutritional dietary supplements

  Yoga

  Acupuncture

  Massage therapy

Diet:  Many people who do not respond to medications benefit from high fat and low carbohydrate diet.

  Fruits and Vegetables:  Avocados, coconuts, berries, cherries, citrus fruits, tomatoes, spinach, kale, broccoli, brussels sprouts

  Fruits and Vegetables:  

  Fruits and Vegetables:  

  Unrefined Carbohydrates:  Whole grains, brown rice, wheat bread, pasta, yogurt, nuts

  Lean Protein:  Beans, tofu, soy milk, eggs, milk, cottage cheese

  Meat and Seafood:  Red meat, poultry, fish, shrimp, scallops, lobster


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