Categories: Neurology

Overview of Epilepsy

Epilepsy is a chronic disease, the sign of which is intermittent, unprovoked seizures. An individual is diagnosed to have epilepsy if they have two unprovoked seizures that were not brought about by some known and reversible medical conditions like alcohol withdrawal or low glucose levels. The seizures in epilepsy might be identified with brain damage or family history, but often the reason is unrecognized. “Epilepsy” doesn’t indicate anything about the reason for the individual’s seizures or their severity.  Individuals with epilepsy have more than one type of seizure and may have other symptoms of neurological disease also. Sometimes EEG (electroencephalogram) testing, clinical history, family history, and outlook are similar among a group of individuals with epilepsy. In these circumstances, their condition can be characterized as a particular epilepsy syndrome. In spite of the fact that the symptoms of a seizure may affect any part of the body, the electrical events that produce the symptoms happen in the brain. The area of that event, how it spreads, its influence on the brain, and to what extent it keeps going all have significant impacts. These elements determine the character of a seizure and its effect on the person. Having seizures and epilepsy can influence one’s safety, relationship, work, driving and more. Public observation and treatment of individuals with epilepsy are more serious issues than actual seizures.

Types of Epilepsy:

Doctors can identify the reason for an individual’s seizures. There are two primary kinds of seizure based on whether they can determine the cause:

  • Idiopathic, or cryptogenic: There is no clear reason, or the specialist can’t pinpoint one.
  • Symptomatic: The specialist knows what the cause is.

There are additionally three seizure descriptors — partial, generalized, and secondary generalized — depending upon which area of the brain the seizure starts in. An individual’s encounter during a seizure will rely upon the affected brain area and how the electrical activity in the brain spreads from that initial area.

Causes of Epilepsy:

For 6 out of 10 individuals with epilepsy, the reason can’t be determined. A wide range of things can prompt seizures like –

  • Traumatic brain injury
  • Scarring on the brain after a brain injury (post-traumatic epilepsy)
  • Serious illness or very high fever
  • Stroke, which is a leading cause of epilepsy in people over age 35
  • Other vascular diseases
  • Lack of oxygen to the brain
  • Brain tumor or cyst
  • Dementia or Alzheimer’s disease
  • Maternal drug use, prenatal injury, brain malformation, or lack of oxygen at birth
  • Infectious diseases such as AIDS and meningitis
  • Genetic or developmental disorders or neurological diseases

Heredity plays a crucial part in certain types of epilepsy. In the general public, there’s a 1 per cent possibility of developing epilepsy before 20 years of age. If you have a parent whose epilepsy is connected to genetics, that increases your risk to 2 to 5 per cent. Genetics may likewise make a few people exposed to seizures from ecological triggers. Epilepsy can come at any age. Diagnosis usually happens in early youth or after the age of 60.

Symptoms of Epilepsy:

Since epilepsy is brought about by unusual activity in the brain, seizures can influence any procedure your brain coordinates. Seizure signs and side effects may include:

  • Temporary confusion
  • A staring spell
  • Uncontrolled jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Psychic symptoms like fear, nervousness or Deja vu

Symptoms change depending upon the kind of seizure. By and large, an individual with epilepsy will, in general, have a similar kind of seizure each time, so the side effects will be comparable from episode to episode.

Diagnosis of Epilepsy:

In the event that you suspect you’ve had a seizure, consult your doctor at the earliest. A seizure can be a sign of a serious medical condition. Your medical history and symptoms will enable your doctor to choose which tests will be useful. You’ll likely have a neurological diagnosis to test your motor capacities and mental functioning. To diagnose epilepsy, different conditions that cause seizures should be ruled out. Your doctor will likely request a total blood check and chemistry of the blood.

Blood tests may be used to look for –

  • Signs of infectious diseases
  • Liver and kidney function
  • Blood glucose levels

Electroencephalogram (EEG) is the most recognized test utilized in diagnosing epilepsy. To start with, electrodes are attached to your scalp with glue. It’s a noninvasive, painless test. You may be asked to play out a particular task. At times, the test is performed during sleep. The electrodes will record the electrical activity of your brain. Regardless of whether you’re having a seizure or not, changes in typical brain wave patterns are normal in epilepsy. Imaging tests can reveal tumors and other abnormalities that can cause seizures. These tests may include –

  • CT scan
  • MRI
  • PET scan
  • Single-photon emission computerized tomography

Epilepsy is usually diagnosed if you have seizures for no apparent or reversible reason.

Treatment of Epilepsy:

The vast majority of people can manage epilepsy. Your treatment plan will be based on the seriousness of symptoms, your wellbeing, and how well you react to treatment. Some treatment choices include:

  • Anti-epileptic (anticonvulsant, antiseizure) drugs – These prescriptions can diminish the number of seizures you have. In certain individuals, they end seizures. To be successful, the medication must be taken as recommended.
  • Vagus nerve trigger – This device is put under the skin on the chest and stimulates the nerve that goes through your neck. This can help prevent seizures.
  • The ketogenic diet – More than half of individuals who don’t react to prescriptions benefit by this high fat, low sugar diet.
  • Brain surgery – The area of the brain that causes seizure activity can be removed or altered.

Medication for Epilepsy:

The mainline treatment for epilepsy is antiseizure medicine. These medications help reduce the recurrence and seriousness of seizures. They can’t stop a seizure that is already in progress, nor is it a solution for epilepsy. The medication is consumed by the stomach. At that point, it ventures to every part of the bloodstream then to the mind. It influences neurotransmitters in a way that decreases the electrical activity that prompts seizures. Antiseizure prescriptions go through the digestive tract and leave the body through urine.

Common epilepsy medicines include –

  • Levetiracetam (Keppra)
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
  • Valproic acid (Depakote)
  • Carbamazepine (Tegretol)
  • Ethosuximide (Zarontin)

These drugs are commonly accessible in tablet, fluid, or injectable forms and are taken once or twice a day. You’ll begin with the lowest possible dose, which can be balanced until it starts to work.

In the event that medications can’t decrease the number of seizures, another choice is a medical procedure. The most well-known medical procedure is resection. This includes removing the part of the brain where the seizures start. Most often, the temporal lobe is removed in a procedure known as temporal lobectomy. At times, this can stop the seizure activity. If the region of the brain is too large or critical to remove, there’s another method called multiple subpial transection, or disconnection. The doctor makes an incision in the brain to interrupt the nerve pathway. This keeps the seizures from spreading to different parts of the brain.

There are dangers to any medical procedure, including an awful response to anesthesia, bleeding, and infection. Medical procedures of the brain can sometimes bring about psychological changes. Talk about the pros and cons of the various strategies with your doctor and look for a second opinion before settling on a final decision.

Dr. Radhika Manohar, Consultant – Neurology | Mazumdar Shaw Medical Center, Bommasandra

Narayana Health

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