Epilepsy

General Illness Information


Medical Term:

EPILEPSY

Common Name: Seizures

Description: Epilepsy is a disorder characterized by recurrent seizures. These are attacks of abnormal brain function characterized years. by brief periods of altered consciousness, motor activity or inappropriate behavior. A seizure (or a fit) is an abnormal focus of sudden electrical activity in the brain.

It affects approximately 0.5% of the population in the United States and Canada and affects males and females equally.

It is not contagious. Can affect all ages, but usually begins between the ages of 2 and 20.

Seizures are classified into 3 major groups:

1) Partial seizures (seizures begin locally), (A) without impairment of consciousness, (B) with complex symptoms (with impairment of consciousness).

2) Generalized seizures (bilaterally symmetrical and without local onset).

3) Unclassified epileptic seizures.

Causes: No cause can be found in 40 to 70% of patients with seizures.

Epilepsy is a symptom caused by many non-specific acute and chronic central nervous system (CNS) injuries or disorders such as:

  • Brain damage;
  • Alcohol or drug abuse;
  • Brain infection;
  • Brain tumor;
  • Chronic subdural haematoma;
  • Vascular disease;
  • Degenerative diseases of the central nervous system;
  • Toxins;
  • Genetic and metabolic disorders.

Prevention: No specific prevention. However, seizures may be avoided by maintaining adequate epileptic drug therapy and by ensuring compliance of treatment.

Signs & Symptoms

Epilepsy is usually classified by its clinical signs and symptoms.

Partial seizures: Simple partial seizures and complex partial seizures. Partial seizure : sometimes initiated with an aura such as an unpleasant taste or unexplained fear. If the patient remains remains alert, it is defined as “simple partial seizure”, if there is an alteration or complete loss of consciousness it is termed a “complex partial seizure”. This may be accompanied by jerking movement of a part of the body depending on the part of the brain affected e.g. jerking or shaking of the right leg.

Generalized Seizures including:

  • Absence seizures (Petit mal). This mostly affects children and frequently ceases by the age of 20 years. The affected person suddenly loses consciousness with motionless stare  lasting about 30 seconds. This may occur several or more times a day It may be associated with rhythmic eye blinking or automatisms such as lip smacking, chewing, swallowing or fumbling hand movements. Seizure ends suddenly with patient fully alert afterwards.
  • Atypical absences. These are more gradual in onset and the spells last longer than Petit mal.
  • Myoclonic seizures: sudden, brief, irregular involuntary contractions of limbs, trunk or facial muscles, usually without loss of consciousness.
  • Tonic-clonic (Grand mal) seizures. This is common and may affect all ages. It is characterized by a sudden loss of consciousness, followed by sudden uncontrollable twitching and jerking movements. There may be associated loss of bladder control and tongue biting. The seizure lasts for 1 to2  minutes and is followed by a deep sleep or mental confusion. Prior to the seizure, the patient may experience a tense feeling, or visual disturbance, or strange smell, or hear strange noises. This is termed an “aura”.

Atonic seizures: there is sudden loss of postural tone that may result in a fall, is extremely short in duration, and may or may not occur with loss of consciousness.

Risk Factors

  • Family history of seizure disorders.
  • Excess alcohol consumption.
  • Use of mind-altering drugs.
  • Low blood sugar.
  • History of prior head injury. Birth injury- breech deliveries have a higher incidence of developing epilepsy as opposed to vertex deliveries.
  • Exposure to toxic fumes.
  • Certain prescription medications increase the risk of seizures as a side effect e.g. wellbutrin (zyban).

Diagnosis & Treatment

  • Diagnosis is based on the description of the seizure behavior. Diagnostic tests include CT scan or MRI of the brain, electroencephalogram (EEG), and laboratory blood studies which include blood work. urine test for drug screen and may include a lumbar puncture..Â
  • AN electroencephalogram (EEG) is a recording of the brain’s electrical activity. The procedure is simple and painless. About 20 small electrodes are pasted to the scalp, and the brain’s activity is recorded under normal conditions. Then, the person is exposed to various stimuli, such as bright light or flashing lights, to help provoke a seizure. During a seizure, electrical activity in the brain accelerates, producing a jagged waveform pattern. Such recordings of the brain waves helps identify epilepsy. Different types of seizures have different wave patterns.
  • EEG is the most important test and helps differentiate partial from primary generalized seizures i.e. focal EEG abnormality indicates a partial seizure disorder, generalized abnormality indicates primary generalized seizure. A normal EEG does not rule out a seizure disorder. An abnormal EEG does not necessarily confirm the diagnosis. Diagnosis is primarily based on a consistent clinical history.
  • 24 hour ambulatory EEG monitoring, or continuous in-hospital monitoring with video recording can distinguish epileptic seizures from non-epileptic events.

General Measures:

  • Wear a medical alert type bracelet or pendant that shows you have epilepsy in case you have a seizure.
  • Avoid any circumstance that has triggered a seizure previously.
  • Treatment for epilepsy consists of drug therapy specific to the type of seizure.
  • In event of seizure, loosen clothing, lay person flat and protect from injury. Although frightening, seizures are rarely harmful in themselves
  • If seizures are uncontrolled, avoid operating heavy equipment, swimming, heights and driving. Seizure free period of 6 to 12 months is required by most states before patients with epilepsy can drive.
  • Periodic visits to the doctor, every 3 to 6 months ,to evaluate seizure control and side-effects to anticonvulsants.

Medications:

Anticonvulsant drugs. Your response to treatment will be monitored. Medication changes or adjustments are often necessary. Choice of anticonvulsant depends on the type of seizure and the patients ability to tolerate the side-effects.

Activity:

No restrictions. Most states allow persons with epilepsy to drive a vehicle after being seizure-free for 1 year.

Diet:

No special diet. Don’t drink alcohol. It may decrease the effectiveness of your medication and provoke seizures.

Possible Complications :

  • Continuing seizures (despite treatment) and mental deterioration (rare).
  • Drug toxicity.

Prognosis

Epilepsy is incurable, except in relatively rare cases where epilepsy is caused by treatable brain damage, tumors or infection. However, anticonvulsant drugs can prevent most seizures and allow a near-normal life. Seizure activity may become quiescent. If a patient has been seizure-free for 2 years, withdrawal of medication may be considered. Relapse rate after 3 years of being off medications is 33%.

Other

‘Nothing Specified’.

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