## Epilepsy: Understanding the Basics
Your brain contains billions of cells known as neurons. Neurons transmit and relay chemical and electrical signals to each other.
At any given time, neurons can be resting or exciting (triggering) or inhibiting (blocking) other neurons.
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## What is Epilepsy?
– Epilepsy is a neurological disorder characterized by recurrent and unprovoked seizures.
– It is defined as the presence of two or more unprovoked seizures occurring more than 24 hours apart i.e. a tendency for the brain to suffer from recurrent epileptic attacks, more than one attack and perhaps an ongoing tendency.
## Seizures vs. Epilepsy
– A seizure is a sudden and uncontrolled change in the electrical and chemical activity in the brain that can cause various stereo typic repetitive symptoms.
– A single seizure that does not happen again is NOT epilepsy.
– An epileptic attack may be called: a fit, a seizure, or a convulsion.
## Key Facts, Incidence and Prevalence of Epilepsy
– Epilepsy is one of the most common neurological disorders.
– Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.
– In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.
– The incidence of epilepsy is estimated to be between 40-70 per 100,000 people per year.
– The prevalence of epilepsy is around 0.5-1% of the global population.
## Predisposing Factors for Epilepsy and Seizures
– Genetic factors: Certain genetic mutations can increase the risk of developing epilepsy.
– Structural brain abnormalities: Brain tumors, head injuries, strokes, and other structural brain lesions can lead to seizures.
– Metabolic disorders: Conditions like low blood sugar, electrolyte imbalances, and inherited metabolic disorders can trigger seizures.
– Infections: Certain viral or bacterial infections of the brain, such as meningitis or encephalitis, can cause seizures.
– Alcohol and drug abuse: Withdrawal from alcohol or certain drugs can precipitate seizures.
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## Types and Classifications of Epilepsy
– Focal (partial) seizures: Originate from a specific area of the brain e.g. Temporal lobe epilepsy and Frontal lobe epilepsy.
– Generalized seizures: Involve the entire brain from the onset and awareness is usually impaired.
– Non motor:
-Absence seizures: Brief episodes of staring or loss of awareness.
– Motor:
– Tonic-clonic (grand mal) seizures: Characterized by loss of consciousness, muscle stiffness, and jerking movements.
– Myoclonic seizures: Sudden, brief contractions of a muscle or group of muscles.
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Temporal Lobe Epilepsy:
Temporal lobe epilepsy is a type of focal epilepsy that originates in the temporal lobe of the brain. Patients often experience auras, such as déjà vu or olfactory hallucinations, prior to the seizure onset. Typical symptoms include impaired consciousness, automatisms (repetitive movements), and occasionally, secondary generalized tonic-clonic seizures. Diagnosis involves EEG monitoring and neuroimaging to identify structural abnormalities in the temporal lobe. Anti-seizure medications are the first-line treatment, but some patients may require surgical intervention for medically refractory cases. -
Frontal Lobe Epilepsy:
Frontal lobe epilepsy is characterized by seizures originating from the frontal lobes of the brain. Seizures can often be brief, sudden, and may involve motor symptoms, such as head turning, body jerking, or dystonic posturing. Patients may also experience altered awareness, confusion, and hypermotor behavior. Diagnosis relies on EEG findings and neuroimaging to detect structural lesions in the frontal lobe. While anti-seizure medications are the primary treatment, surgical resection of the epileptic focus may be considered for patients with drug-resistant seizures. -
Febrile Seizures:
Typically, seizures are a common type of seizure that occurs in young children, typically between the ages of 6 months and 5 years, in association with a fever. These seizures are usually brief, lasting less than 15 minutes, and can be either focal or generalized. Febrile seizures are generally benign and do not indicate the presence of an underlying neurological disorder. However, in a small percentage of cases, they may progress to epilepsy. Management involves addressing the underlying fever and providing supportive care, with anti-seizure medications reserved for prolonged or recurrent febrile seizures.
## Diagnostic Tools for Epilepsy
– Electroencephalogram (EEG): Measures the electrical activity of the brain and can help identify abnormal patterns associated with seizures.
– Neuroimaging: Techniques like MRI, CT scan, and PET scan can detect structural abnormalities in the brain that may cause seizures.
– Blood tests: Can help identify underlying metabolic or infectious causes of seizures.
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Pseudo-Seizures:
Pseudo-seizures, also known as psychogenic non-epileptic seizures (PNES), are episodes that resemble epileptic seizures but are not accompanied by abnormal electrical activity in the brain. These events are often related to underlying psychological or psychiatric conditions, such as conversion disorder or post-traumatic stress disorder. Diagnosis involves a comprehensive evaluation, including video-EEG monitoring, to differentiate pseudo-seizures from true epileptic seizures. Treatment often requires a multidisciplinary approach, including psychotherapy and sometimes anti-depressant or anti-anxiety medications.
##Complications of Epilepsy
-Fractures and bruising from injuries related to seizures.
-Psychological conditions, including anxiety and depression.
##Treatment for epilepsy includes
Pharmacological and non-pharmacological
Medicines to prevent seizures are called anticonvulsants or antiepileptic drugs. These may reduce the number of future seizures.
Epilepsy that is not well controlled after trying several antiseizure drugs is called “medically refractory epilepsy.” In this case, the doctor may recommend some nonpharmacological therapies including:
Surgery to:
- Remove the abnormal brain cells causing seizures.
- Place a vagal nerve stimulator (VNS). This device is like a heart pacemaker. It can help reduce the number of seizures by controlling abnormal brain electric discharges at its onset.
Some patients are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet.
Discontinuing antiseizure medicine can be considered in some cases after 2 years without seizures.
A documented etiology of the seizure and an abnormal electroencephalography (EEG) pattern are the two most consistent predictors of seizure recurrence.
Antiseizure medications work in different ways to either reduce excitation or promote inhibition of processes that result in electrical signals. Specifically, they can act by:
- Changing electrical activity in neurons by affecting ion (sodium, potassium, calcium and/or chloride) channels.
- Changing chemical transmission between neurons by affecting neurotransmitters (like GABA).
The old generation anticonvulsants as Phenobarbital, Carbamazepine, Valproate, Phenytoin and Ethosuximide were the mainstays of seizure treatment until the 1990s, when newer AEDs with good efficacy, fewer toxic effects, better tolerability, and less need for blood level monitoring were developed. Some of the newer-generation AEDs include lamotrigine, oxcarbazepine, topiramate, gabapentin, and levetiracetam.
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Every seizure medicine can sometimes cause side effects of fatigue, dizziness, unsteadiness, blurry vision, stomach upset, headaches, and reduced resistance to colds, memory and thinking problems.
Weight gain tends to occur with: valproic acid (Depakine), gabapentin, pregabalin (Lyrica) and carbamazepine (Tegretol).
Weight loss tends to occur with: topiramate, zonisamide and felbamate.
Effects on internal organs: All seizure medicines can cause problems with blood counts (white cells, red cells, and platelets), or liver or other internal organs, so doctors usually order blood tests to screen for these problems.
Antiseizure medications (anticonvulsants) help treat epilepsy and other causes of seizures. They can treat other conditions as well. Some of them can be used as like mood stabilizers, headache prophylaxis and for neuropathic pain.
Broad-spectrum antiseizure medications: These medications treat a wide variety of seizure types. include valproate, levetiracetam, lamotrigine, zonisamide and topiramate.
Narrow-spectrum antiseizure medications: These medications mainly treat focal or partial seizures. Some narrow spectrum antiseizure medications include ethosuximide, pregabalin, gabapentin and carbamazepine.
Follow-up for patients on anti-seizure medications require regular blood tests to monitor drug levels and potential side effects.
## First Aid for Seizures and When to Seek Emergency Help:
If a person experiences a seizure, it is essential to provide appropriate first aid. This includes clearing the area of any hazards, placing the person on their side to prevent aspiration, and ensuring their breathing is not obstructed. Do not restrain the person or place any objects in their mouth. Time the seizure and call emergency services if it lasts longer than 5 minutes, if the person does not regain consciousness, or if they have a history of seizures and the seizure is unusually prolonged or severe. Prompt medical attention is crucial, as prolonged, or recurrent seizures can be life-threatening and may require immediate intervention.
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Prolonged nonstop seizures are called a status epilepticus.
Consultant of Neurology – MD/PHD of Neurology,
Member of the American Academy of Neurology,
Ta’heal Neurology and Rehabilitation Centers C.E.O..
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