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Epilepsy

Overview

Epilepsy is a central nervous system illness in which brain activity becomes aberrant, resulting in seizures or episodes of odd behavior and occasionally loss of awareness. It is a common brain disorder that causes seizures regularly. It's usually permanent; however, it can improve gradually over time. The clinical features of a seizure can be rather varied. Some persons stare blankly during a seizure while others move their limbs frequently. Seizure for the very first time does not necessarily indicate epilepsy.
Seizures can be well controlled by medications in most people or surgery when needed. In some people, seizures fade away with time, while others may need medicines for the rest of their life.

Risk Factors And Epidemiology

Epilepsy can strike a person at any age; however, it most commonly strikes children or persons over 60.
Younger persons are more likely to have epilepsies caused by genetic, congenital, or developmental problems, whereas older adults are more likely to have brain tumors and strokes.
If one of the identical twins is affected, there is a 50–60% probability that the other will be as well.
The risk is 15 percent in non-identical twins. These problems are magnified in persons who have diabetes.

Causes

Epilepsy can be caused by both inherited and acquired factors, and in many cases, these factors interact.

Genetics: In most cases, genetics is thought to be involved directly or indirectly. Some epilepsies are caused by a single gene abnormality (1–2%), while the majority are caused by a combination of genetic and environmental factors.

Acquired: Epilepsy can be caused by various disorders, including tumors, strokes, head trauma, past central nervous system infections, genetic abnormalities, and brain injury around the time of delivery. The temporal lobe and slowly growing tumors are of significant concern. Epilepsy is more common in people with cerebral palsy, with half of those with spastic quadriplegia and spastic hemiplegia having the disorder.

Symptoms

 The following are some of the symptoms of a seizure:

  • Confusion
  • Loss of smell or taste
  • Tingling
  • Muscle stiffness
  • Rapid Jerking of the arms and legs (uncontrollable)
  • Loss of consciousness
  • Blank stare
  • Anxiety, fear, or a sense of déjà vu are all psychological symptoms.

Types Of Epilepsy

Seizures can be divided into two categories:

Generalized seizures

Seizures involving the entire brain are known as generalized seizures. The six primary forms of generalized seizures are Tonic-clonic, tonic, clonic, myoclonic, absence, and atonic seizures. They're all characterized by a loss of consciousness and usually occur without warning.
Tonic-clonic seizures: Tonic-clonic seizures last 10–30 seconds and start with a contraction of the limbs followed by their extension and curving of the back (the tonic phase). A scream may be heard as the chest muscles tense, followed by a coordinated shaking of the limbs (clonic phase). People who have a seizure may bite their tongue on the tip or the sides; bites to the sides are more likely in tonic-clonic episodes.
Tonic seizures: Muscle contractions are persistent during tonic seizures. When a person's breathing is halted, they often become bluish.
Clonic seizures: Clonic seizures are characterized by synchronized shaking of the limbs. Once the shaking phase has ceased, it may take 10–30 minutes for the patient to return to normal; this interval is known as the "postictal state" or "postictal phase." During a seizure, you may lose control of your bowels or bladder.
Myoclonic seizures: Myoclonic seizures are characterized by very short muscle spasms in one or more locations. These can lead the person to fall, resulting in trauma.
Absence seizures: Absence seizures can be modest, resulting in only a tiny turn of the head or blinking of the eyes with altered consciousness; in most cases, the person does not fall over and returns to normal immediately after the seizure stops.
Atonic seizures: Atonic seizures occur when muscular activation is lost for more than one second, usually affecting bilaterally.

Focal seizures
These seizures are commonly known as partial seizures, involve just one portion of the brain.

Simple partial seizures: symptoms include:

  • No signs of loss of consciousness in a simple partial seizure.
  • Taste, smell, sight, hearing, and touch senses are all affected.
  • Dizziness
  • Limb tingling and twitching

Complex partial seizures: symptoms include;

  • Loss of awareness or consciousness
  • Looking at nothing
  • Lip-smacking
  • Clothes picking
  • Unresponsiveness
  • Repetitive movements

Diagnosis

Epilepsy is usually diagnosed by observing the seizures onset, medical history, and determining the underlying cause. It will be helpful to your specialist if you can describe your seizure in as much detail as possible, including more information such as: when it occurred, what you were doing at the time, what you felt like before, during, and after. It’s also a good idea to bring someone who has seen you have a seizure with you.
Your doctor may advise you an electroencephalogram (EEG) that detects aberrant patterns of brain waves and neuroimaging, including a CT scan or MRI of the Brain. While trying to pinpoint a specific epileptic syndrome is common, it is not always attainable.


Electroencephalogram: The electroencephalogram (EEG) is the most common test for an epilepsy diagnosis. A paste is used to adhere electrodes to your scalp. It's a painless, non-invasive investigation. You may be requested to complete a certain activity. In some situations, the test is carried out while the patient sleeps. The electrodes will capture your brain's electrical activity. Changes in normal brain wave patterns are prevalent in epilepsy, whether or not you're having a seizure.
If you suffer seizures for no apparent or reversible reason, you may have epilepsy.

Treatment

Once a second seizure has occurred, epilepsy is usually managed with regular medication. Medication can be started after the first seizure in people at a high risk of having more seizures. Supporting people's ability to self-manage their illnesses could be beneficial. In drug-resistant situations, several therapy alternatives such as a particular diet, the implantation of a neurostimulator, or neurosurgery may be considered.

Anticonvulsant medicine is the cornerstone of seizure treatment. Because the response to various anticonvulsants differs among different epileptic syndromes, the medicine of choice is determined by an accurate diagnosis of the epileptic condition. Phenytoin, carbamazepine, and valproate are just a few of the drugs available. According to research studies,  Phenytoin, carbamazepine, and valproate may be similarly helpful in both focal and generalized seizures.

vagus nerve stimulator is a device that is implanted surgically beneath the skin of the chest and stimulates the vagus nerve electrically. This may aid in the prevention of seizures.

Ketogenic diet: This high-fat, low-carbohydrate diet helps more than half of those who don't react to the medicine.

Surgery: The brain region that generates seizure activity can be removed or altered through surgery.

Lifestyle Modification

Clinicians should talk to patients who experience epileptic seizures or other sudden-onset seizures about the following seizure precautions:

  • Driving
  • Working with flames or preparing food
  • Using power tools or other potentially hazardous machinery
  • Bathing without supervision, and swimming

Some people will certainly benefit more from these lifestyle precautions than others. A patient who has a lot of poorly managed daytime seizures might need to be more cautious than someone who only gets nighttime seizures. Encourage the person to wear a helmet while riding, skiing, or participating in other high-risk activities to avoid head injuries.

Prognosis

The chance of having more seizures is determined by whether the initial attack was caused by an external source (i.e., an acute symptomatic seizure), a structural brain lesion, or hereditary factors. There is a substantially higher risk of more seizures in the second case. Certain kinds of epilepsy appear in childhood and then fade away on their own during puberty. Epilepsies affecting the frontal, temporal, and parietal lobes that began in childhood or young adulthood have also been recorded to subside spontaneously. The majority of people who have epilepsy have a high chance of going into remission.

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 17, 2023

References

Epilepsy – Seizure Types, Symptoms and Treatment Options

https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy#:~:text=Epilepsy%20is%20a%20disorder%20of,impulses%20in%20an%20orderly%20pattern.

Epilepsy

https://www.who.int/news-room/fact-sheets/detail/epilepsy

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