Epilepsy is a brain disorder that results when clusters of nerve cells or neurones in the brain send out wrong signals resulting in surges of electrical signals inside the brain and causing people to have recurring seizures (convulsions) overtime. Signs and symptoms may vary. This may cause a change in behavior and attention. During seizures some people may stare blankly for a few seconds, others may have violent muscle spasms and some people may loose consciousness in severe cases. Some people may experience one unprovoked seizure in a life time. Epilepsy is suspected only when a person experiences at least two unprovoked seizures. Although there is no cure for epilepsy, immediate treatment is necessary to reduce or eliminate frequency and intensity of seizures. Some special diets may also help children with epilepsy although some children may outgrow the condition with age.
The cause of epilepsy in most people is unknown. However certain factors have been traced to the disease. These include the following:
Medical diseases or disorder – Diseases that cause damage to the brain like stroke or transient ischemic attack (TIA) or heart attacks can cause epilepsy. A stroke is responsible for up to half of this disease in people ages 35 years or older.
Traumatic brain injury - Brain injuries that are sustained during a car accident or other traumatic injuries can also cause epilepsy.
Prenatal injuries – An infection in a pregnant women is likely to cause brain damage to the unborn baby. Also if the baby is deprived of good nutrition and oxygen, brain damage can occur. This can lead to diseases like cerebral palsy – this contributes to about 20% of seizures in children.
Brain blood vessels abnormalities
Genes – Some types of seizures runs in families
Congenital brain defects
Dementia – an example is Alzheimer’s disease. It is the leading cause of epilepsy in adults.
like AIDS, viral encephalitis
and meningitis can all cause epilepsy.
Certain medications like antidepressants, amphetamines and cocaine.
Metabolism disorder present at birth like phenylketonuria
All other diseases that damage or destroy brain tissues
Although the seizures can occur at any age, epilepsy seizure usually begin between ages 5- 20 years.
Factors that increase your risk of epilepsy include the following:
Family history - You are likely to develop a seizure disorder if you have a family member with epilepsy.
Sex – Men are more likely to develop epilepsy than women.
Age – Although epilepsy can occur at any time, it is more likely to start between the ages of 5 – 20 years or after age 65 years.
Infections of the brain – Meningitis and other infections that causes inflammations of the brain and spinal cord puts you at high risk.
Head injuries – Any type of head injury will also put you at increased risk.
Prolonged childhood seizure - In children, high fevers are usually associated with seizure which may later cause epilepsy especially if you have a family history of the disease.
Vascular diseases – Strokes and other vascular diseases may trigger epilepsy because they damage the brain.
Symptoms may vary from person to person depending on the type of seizure – ranging from simple staring spells to violent shaking and loss of consciousness. However, a person with epilepsy will have the same type of seizure from episode to episode. Seizures are generally classified as generalized or focal depending on type of behavior and brain activity
GENERALIZE SEIZURE – This involves all areas of the brain. It is the most common and dramatic. The person experiencing this kind of seizure may make some sound or cry out loud, stiffen for some seconds to a minute followed by rhythmic movements of the legs and arms which usually slows down before stopping. During this period their eyes are generally open and the person may appear not to be breathing and turn blue. This is usually followed by deep noisy breathes and then conciousness returns gradually. A common problem with this type of seizure is urinary incontinence, tongue biting and confusion. There are six types of generalized seizures. These include:
Absence seizures (petit mal) – This type is very common in children. It is characterized by a short loss of consciousness ( usually for seconds) with little or no symptoms. The patient usually interrupt an activity and stares blankly causing a brief loss of awareness. This may occur several times in a day and patients are usually not aware they had a seizure except that they lost time. They may begin and end abruptly.
Tonic seizures – These are characterized by stiffening of muscles usually in the back, arms and legs. This may cause you to fall.
Clonic seizures - These are associated with repetitive, rhythmic jerks usually affecting arms, legs and face. They usually involve both sides of the body at the same time.
Myoclonic seizures – These are characterised by sporadic jerks or twitches of your arms and legs usually on both sides of the body. These seizures may result in dropping and involuntarily throwing of objects.
Atonic seizures – These may cause loss of normal muscle tone particularly in the arms and legs usually resulting in a fall or collapse.
Tonic-clonic seizures (grand mal) - This is the most intense and its characterized by body stiffening, shaking, loss of consciousness, urine loss and tongue biting.
FOCAL OR PARTIAL SEIZURE – This involves only part of the brain and hence only part of the body. Symptoms vary depending on the part of the brain experiencing the abnormal brain activity. For example if the part of the brain controlling hand movement is involved, then only the hand may show jerky movements. Symptoms may also include small repetitive movements like smacking of the lips and strange sensations like feeling full in the stomach if other parts of the brain are involved. People experiencing this type of seizure may also appear confused or dazed. There are two categories of this seizure. They include:
Simple focal seizures - There is no loss of consciousness. The individual may get memory and emotional disturbances, spasms, jerking, muscle rigidity and changes in vision, taste, touch and hearing.
Complex focal seizure - Awareness is impaired for a period of time. It is also characterized by staring, fidgeting, walking in circles, lip smacking chewing and other nonpurposeful movements.
TYPES OF EPILEPSY
There are four main types of epilepsy, each having different causes, symptoms and treatments. These include:
Idiopathic generalized epilepsy - With this type the cause of the disease is unknown. It usually occurs in childhood or adolescence but in rare cases may be diagnosed in adulthood. An MRI will show no abnormalities in the brain however an electroencephalogram (EEG) may show epileptic discharges affecting the entire brain. People with this type of epilepsy usually experience absence, myoclonic or tonic-clonic seizures. This type is treated with medication. Individuals with childhood absence seizures or juvenile myoclonic seizures may outgrow this condition and stop having seizures.
Idiopathic partial epilepsy – This usually have a family history and is diagnosed in children between the ages of 5 and 8 years. This is the mildest type of epilepsy, outgrown by puberty and never diagnosed in adults. It is also called benign focal epilepsy of childhood (BFEC). Seizures usually occur during sleep. This type is usually diagnosed by an EEG.
Symptomatic generalized epilepsy - This is caused by widespread brain damage with the most common cause being injury during birth. Individuals may also have other neurological problems like mental retardation and cerebral palsy in addition to the seizures. Certain inherited brain diseases like adrenoleukodystrophy (ADL) may also be the cause. Brain infections like encephalitis and meningitis may also be the cause. In some cases the cause is unknown. This is referred to as cryptogenic epilepsy. People with this type usually experience generalized tonic-clonic, myoclonic, tonic, atonic, and absence seizures and can be difficult to control.
Symptomatic partial (or focal) epilepsy – This is the most common type diagnosed in adults but it can frequently occur in children too. It is caused by a localized abnormality in the brain caused by trauma, strokes or tumors. It may also be caused by scarring, cysts, infections or brain abnormalities present at birth. Although it can be diagnosed with an MRI, it’s microscopic nature makes it impossible to see most of the time. This type may be treated with surgery.
TESTS AND DIAGNOSIS
Doctors usually aim at determining the type of seizure, causes and best treatment option for the specific type. Numerous tests are done ranging from neurological examinations to imaging tests. Your doctor will first ask questions about your medical history, family history of seizure, any medical conditions and medications the patient is taking. He may also check your intellectual and behavior capacity to determine how the seizures have affected you. He may also do an IQ and speech assessment.
Blood tests - Your doctor will order a blood test to check for the presence of infections, red and white blood cell count, electrolyte imbalance, blood sugar, blood calcium , liver and kidney function and anemia to rule out the presence of other illness associated with seizures.
Imaging techniques will also be used to look into the brain and detect any abnormalities that may be present. These include:
Electroencephalogram (EEG) – This is the most common test for diagnosing epilepsy because it is the only test that directly detects electrical activity in the brain. During this test electrodes are temporarily attached to your brain to record electrical activities of the brain. If you have epilepsy an abnormal pattern of brain waves will show even if you are not having a seizure. Doctor will monitor you during this test in hopes of you getting a seizure so that they will know which type of seizures you get. Some doctors may even provoke a seizure just to be able to know the type of seizure you get.
Magnetic resonance imaging (MRI) – This provides detailed images of the brain revealing any abnormalities associated with epilepsy if any is present. This is more detailed than a computerized tomography (CT) scan.
Computerized tomography (CT) scan – This test uses X-rays to give a cross-sectional image of the brain and skull revealing any abnormalities that may be associated with the seizures.
Functional MRI - This detects changes in blood flow when specific parts of the brain are working.
Positron emission tomography (PET) – During this test a small amount of low-dose radioactive material is injected into the vein to help visualize active areas of the brain and detect abnormalities.
Singel-photon emission computerized tomography (SPECT) – A small amount of low-dose radioactive material is injected into the vein to give a detailed 3-D of blood flow activity in your brian during seizures. This test is usually done if an MRI or EEG did not pinpoint the exact location of the brain where the seizures originate from.
Surgery or medication is used to treat epilepsy. Doctors usually recommend medication, Surgery is however done if medication is not working. The ultimate goal of treatment is to prevent seizures or decrease the frequency and intensity of the seizure. In children, medication-controlled seizure can eventually lead to medication discontinuation and seizure-free life. In most adults medication is discontinued after 2 or more years without seizure. It is a complex task to find the right medication to control your seizures. Doctors initially give low doses of a single drug and increase the dosage slowly until the seizure stops. Note that anti-seizure medication have side effects like:
- weight gain
- skin rashes
- speech problems
- loss of coordination
- loss of bone density and in severe cases depression, severe rash and inflammation of certain organs
To attain treatment goal do the following:
Take medication as prescribed.
Talk to your doctor before switching to a generic version.
Do not stop taking medication without doctors permission.
Talk to your doctor immediately if you notice signs of depression.
Surgery – If the seizure originate from a small well-defined part of the brain that does not affect functions like language, speech or hearing, surgery is an option. However, when the part of the brain affected cannot be removed the surgeon usually makes cuts in the brain which is intended to prevent the seizure from spreading to other parts of the brains. Most people still need medication after surgery but in lower doses.
Your doctor may also recommend therapy. These include :
Vagus nerve stimulation – A device called the vagus nerve stimulator is implanted underneath the skin of your chest to prevent seizure by delivering burst of electrical energy to the brain. Most people still need anti-epileptic medication with this therapy. Side effects of this therapy include shortness of breath, tingling and muscle pain, throat pain, hoarseness and coughing.
Ketongenic diet - This is a strict diet high in fats and low in carbohydrates. This causes a break down of fat instead of carbohydrates for energy. It is normally used in children and most children go off it after a few years and still remain seizure free. Side effects include constipation, build-up of uric acid in the blood, dehydration and kidney stones. These side effects are very rare if the diet is used properly.
Due to the fact that most seizures causes loss of consciousness complications like falling, drowning and car accidents are very common. Certain epileptic medications may also cause child defects in pregnant women. Other complications include depression, anxiety and in rare cases suicide.
Life threatening complications include;
Status epilepticus – This may cause brain damage or death and it occurs in people with frequent seizure episodes or seizures lasting more than 5 minutes.
Sudden unexplained death in epilepsy (SUDEP) – In people with uncontrolled epilepsy death may be possible although this is rare.