Epilepsy is a condition that affects the brain and causes repeated seizures.
The brain is a delicate mix of nerve cells, electrical impulses and chemicals, known as neurotransmitters.Any damage has the potential to disrupt the workings of the brain and cause seizures. The cells in the brain, known as neurons, conduct electrical signals and communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses, which can cause the brain and body to behave strangely. The severity of seizures can differ from person to person. Some people simply experience an odd feeling with no loss of awareness, or may have a "trance-like" state for a few seconds or minutes; while others lose consciousness and have convulsions (uncontrollable shaking of the body).
Epilepsy can start at any age,but it most often begins during childhood.It's often not possible to identify a specific reason why someone develops the condition, although some cases – particularly those that occur later in life – are associated with damage to the brain.
Epilepsy can be caused by:
1. Cerebrovascular disease ( disease condition caused by a problem that affects the blood supply to the brain)
a. Stroke - a serious medical condition where one part of the brain is damaged by a lack of blood supply (clot) or bleeding into the brain from a burst blood vessel (hemorrhage).
b. Subarachnoid hemorrhage - a type of stroke where blood leaks out of the brain's blood vessels on to the surface of the brain below the middle layer of the 3 brain coverings).
2. Brain tumors (tumor is a growth of cells in the brain that multiplies in an abnormal, uncontrollable way. It can either be cancerous (malignant) or noncancerous (benign).
3. Severe head injuries (require immediate medical attention because there's a risk of serious brain damage).
4. Hereditary - gene inheritance.
The trigger may be:
- Lack of sleep (sleep deprivation).
- Drinking alcohol.
- Some medications and illegal drugs.
- In women, monthly periods.
- Flashing lights (this is an uncommon trigger that affects only 5% of people with epilepsy, and is known as photosensitive epilepsy)
- Not eating well, low blood sugar.
- Specific foods, excess caffeine or other products that may aggravate seizures.
- Keeping a seizure diary is a good way to help find out what might trigger your seizures. Every time you have a seizure, record it and make a note of what you were doing. Over time, you might notice some potentially avoidable things that seem to trigger your symptoms.
There are two main categories of epilepsy:
1. Idiopathic (or primary) epilepsy – where no apparent cause for epilepsy can be found, but there may be a family history, suggesting that the condition is inherited. Current research is looking for defects in certain genes that may affect electrical transmission in the brain.
2. Symptomatic (or secondary) epilepsy – where there is a known cause for a person’s epilepsy (refer causes).
The main symptoms of epilepsy are repeated seizures. Seizures can occur when you are awake or asleep. There are many different types of seizure, depending on the area of the brain affected.
1. Partial (or focal) seizures – where only a small part of the brain is affected.
a. Simple partial seizures: The patient remains fully conscious throughout. There is unusual taste or smell, feeling of fear or joy, pins or needles, stiffness or twitching, or déjà vu.
b. Complex partial seizures: The patient loses consciousness and cannot remember the event. There is smacking of the lips, rubbing of the hands, moving of the arms, fiddling with objects, chewing or swallowing, unusual postures, and picking at clothes.
2. Generalized seizures – where most or all of the brain is affected. There are six main types of generalized seizure.
a. Absence seizures: Used to be called petit mal, mainly affect children, but they also occur in adults. The patient loses awareness of their surroundings, usually for up to 15 seconds. The patient stares vacantly into space with fluttering of the eyes or smacking of the lips.
b. Myoclonic seizures: The arms, legs, or upper body jerks or twitches, as if you have received an electric shock. They often only last for a fraction of a second.
c. Clonic seizures: Same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to two minutes.
d. Atonic seizures: Cause all your muscles to suddenly relax, so there is a chance you may fall to the ground and risk injury.
e. Tonic seizures: The muscles suddenly become stiff causing you to lose balance and fall over.
f. Tonic-clonic seizures: Convulsions called grand mal have two stages. Your body will initially become stiff and then your arms and legs will begin twitching. You will lose consciousness, and some people will wet themselves. The seizure normally lasts a few minutes, but can last longer.
3. Unclassified seizures - that do not fit into these categories.
4. Status epilepticus: Lasts longer than 30 minutes and the person does not regain consciousness in between. This is a medical emergency and requires treatment as soon as possible.
Epilepsy is usually difficult to diagnose quickly. In most cases, it cannot be confirmed until you have had more than one seizure. EEG and MRI are the usual tools employed.
An EEG test can detect unusual brain activity associated with epilepsy by measuring the electrical activity of your brain through electrodes placed on your scalp.
In some cases, an EEG may be carried out while you are asleep (sleep EEG) or you may be given a small,portable EEG recording device to monitor your brain activity over 24 hours (ambulatory EEG).
Magnetic resonance imaging (MRI) scan:
An MRI scan is a type of scan which uses strong magnetic fields and radio waves to produce detailed images of the inside of your body.
It can be useful in cases of suspected epilepsy because it can often detect possible causes of the condition, such as defects in the structure of your brain or the presence of a brain tumor.
Treatment for epilepsy is used to control seizures, although not everyone with the condition will need to be treated.
1. Medicines: Anti-epileptic drugs (AEDs) are usually the first choice of treatment for epilepsy. About 70% of people with the condition are able to control their seizures with AEDs. Examples of commonly used AEDs include sodium valproate, carbamazepine, lamotrigine, levetiracetam, oxcarbazepine, ethosuximide and topiramate.
2. Surgery: If AEDs do not help, you are referred to a specialist epilepsy center to see if you are suitable for surgery to remove the part of your brain causing seizures without causing much brain damage.
3. Vagus nerve stimulation (VNS): If surgery is not an option, an alternative may be to implant a small device under the skin of your chest. The device sends electrical messages to the brain. This is called vagus nerve stimulation.
4. Deep brain stimulation (DBS): DBS involves implanting electrodes into specific areas of the brain to reduce the abnormal electrical activity associated with a seizure.
Tags: Epilepsy , Brain tumors , Cerebrovascular disease , Stroke , Seizures Triggers , Blood Sugar , Stress , VNS