Epilepsy

Few experiences match the drama of a convulsive seizure. In this scenario, someone having a severe seizure may cry out, fall to the floor unconscious, twitch or move uncontrollably, drool, or even lose bladder control. The attack is over within minutes and the person regains consciousness but is exhausted and dazed.

This is typically what the norm thinks when they hear epilepsy. However, this type of seizure is a generalized tonic-clonic seizure. It’s only one kind of epilepsy. There are many other kinds, each with different symptoms.It was one of the first brain disorders to be described (ancient Babylon more than 3,000 years ago). This strange behavior caused by some seizures contributed through the ages to many superstitions and prejudices.

The term epilepsy derived from the Greek word for “attack.” It was once thought that those with epilepsy were being visited by demons or gods. In 400 B.C., Hippocrates suggested that epilepsy was a brain disorder and we know now that he was right.

What is epilepsy?

A brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons usually generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions.

The normal pattern of neuronal activity becomes disturbed in someone with the disorder. This causes strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness.

Neurons may fire as many as 500 times a second during a seizure (much faster than normal). In certain people, this occurs occasionally. For others, it may occur up to hundreds of times a day.

In the united states alone, over 2 million people have experienced an unprovoked seizure or have been diagnosed with epilepsy.

About 80% of those diagnosed, their seizures can be controlled with modern medicines and surgical techniques. However, about 25 to 30% of people with the condition will continue to experience seizures even with the best available treatment. This situation is known as intractable epilepsy. Experiencing seizure attacks do not necessarily mean that a person has epilepsy. It’s only when a person has had 2 or more seizures, is he or she considered to have epilepsy.

This condition is not contagious and isn’t caused by mental illness or mental retardation. In some cases, some people with mental retardation may experience seizures but seizures don’t mean the person has or will develop mental impairment. Most people with the condition have normal or above-average intelligence. Some famous people who are known or rumored to have had the condition include Russian writer Dostoyevsky, philosopher Socrates, military general Napoleon, and the inventor of dynamite, Alfred Nobel (who established the Nobel Prize). Several Olympic medalists and other athletes also have had the condition.

Sometimes, seizures may cause brain damage, particularly if they are severe. Having said that, most seizures don’t to have a detrimental effect on the brain. If there are changes, they’re normally subtle and is often unclear whether these changes are caused by the seizures or by the underlying problem that caused the seizures in the first place.

Currently there is no cure for epilepsy. However, the good news is that for some people it does eventually go away on it’s own. In one study, it was found that children with idiopathic epilepsy or epilepsy with an unknown cause, had a 68 to 92% chance of becoming seizure-free by 20 years after diagnosis.

The odds of becoming free of seizures aren’t as good for adults or for children with severe epilepsy syndromes. Nonetheless, it’s possible that seizures may decrease or even stop with time.

SYMPTOMS OF EPILEPSY

The main symptom is having repeated seizures.There are certain symptoms that can indicate that a person may have epilepsy. If 1 or more of these symptoms are experienced, a medical exam is advised, especially if these symptoms recur:

• A convulsion with no temperature (no fever)
• Short spells of blackout or confused memory
• Intermittent fainting spells, during which bowel or bladder control is lost (This is frequently followed by extreme tiredness)
• For a short period the person is unresponsive to instructions or questions
• The person becomes stiff, suddenly
• The person suddenly falls
• Sudden bouts of blinking
• Sudden bouts of chewing
• For a short time the person seems dazed, and unable to communicate
• Repetitive movements that seem inappropriate
• The person becomes fearful for no apparent reason (they may even panic or become angry)
• Peculiar changes in senses (such as smell, touch and sound)

Arms, legs or body jerk in babies (these will appear as cluster of rapid jerking movements)

TREATMENT OPTIONS AVAILABLE FOR EPILEPSY

Treatment method used for epilepsy may involve surgery or medication. If your seizures are due to a tumor, abnormal blood vessels or bleeding in the brain, getting surgery to treat these disorders may stop the seizures.

A majority of epileptic seizures are controlled by medication. In particular, anticonvulsant drugs. Treatment type prescribed will depend on several factors. This includes the frequency and severity of the seizures and the person’s age, overall health, and medical history. Diagnosing the type of epilepsy accurately is critical to choosing the best treatment.

Drug Therapy

There are many drugs available to treat epilepsy. Even though generic drugs are safely used in most medications, anticonvulsants are 1 category of drugs where doctors proceed with caution. Brand-name anticonvulsants are preferred but realize that many insurance companies won’t cover the cost. This resulted in the acceptability to start taking  generic anticonvulsant medication. However, if the desired control is not achieved, the patient should be switched to the brand-name drug.

Choice of drug used is most often based on factors such as the patient’s tolerance of side effects, other illnesses they might have and the medication’s delivery method.

In general, medications are able control seizures in about 70% of patients even though the different types of epilepsy vary greatly.

Surgery for Epilepsy

Surgery is not required in most people with epilepsy. Only when seizures are not controlled after a trial of 2 or 3 medications (normally accomplished within 2 years) then re-evaluation will be suggested. This information play a critical role in deciding if epilepsy surgery is an option. Out of the 30% of patients whose seizures cannot be controlled with drugs, approximately one third may be candidates for epilepsy surgery. With that said, only about 3,000 epilepsy surgeries are performed per year.

Surgery is commonly used when treating partial epilepsy as it’s only 1 area of the brain that is involved. The area of the brain that triggers the seizures (usually a portion of the anterior temporal lobe) is removed after surgery.

Some patients will be completely free of seizures after surgery while in others, the seizures will be better controlled. In certain cases, patients may need additional surgery.

Other surgical approaches are used for specific types of epilepsy and are often performed in young children. They are:

• Hemispherectomy: Remove a large part of one side of the brain
• Corpus callosotomy: The nerve fibers connecting the two sides of the brain are cut

Surgery may also be done to implant devices such as:

• Vagus nerve stimulation (VNS): A device that electronically stimulates the vagus nerve (controls activity between the brain and major internal organs) is implanted under the skin. This helps to reduce seizure activity in some patients with partial seizures.



• Responsive neurostimulation device (RNS): Consists of a small neurostimulator implanted within the skull under the scalp. The device is connected to 1 or 2 wires (called electrodes) placed where the seizures are suspected to originate within the brain or on the surface of the brain. Abnormal electrical activity is detected in the area and delivers electrical stimulation to normalize brain activity before symptoms start.

DIAGNOSING EPILEPSY

Evaluating patients with epilepsy is aimed at determining what type of seizures they are having and their cause. Various seizure types respond best to specific treatments.

• Consult with the doctor & physical examination: Your doctor will ask you questions about your medical history. This includes any family history of seizures, associated medical conditions and current medications. It’s also beneficial if the doctor has the input of people who have witnessed a patient’s seizures (especially if there is a loss of consciousness). A physical exam is performed. This will include a detailed look at the brain and nervous system.
• Electroencephalogram (EEG): A test that helps to diagnose epilepsy. Electrical signals of the brain are recorded. The electrical activity is detected by electrodes (sensors) placed on the patient’s scalp and the activity is transmitted to a machine where they produce separate graphs on moving paper that’s recorded in ink or on a computer screen. The recordings are examined for any abnormalities in the brain-wave pattern, which may reflect diseases of the nervous system.
• Blood tests: A number of blood tests may be recommended as part of your epilepsy diagnosis and treatment. Your doctor may order a complete blood count (CBC). This helps the doctor to establish a baseline and can identify infections, allergies, and other abnormalities that may affect the choice of appropriate anticonvulsant medications and help to monitor the possible drug-induced side effects in the future.Another blood test that’s important is known as a chemistry panel where sodium, potassium, and blood sugar levels are evaluated.

  Kidney and liver function tests are also normally included, in what’s known as a complete metabolic panel. This test helps to identify conditions such as electrolyte (such as sodium) imbalances, kidney or liver damage and diabetes (which may be causing your seizures or may affect the choice of the appropriate anticonvulsant medications prescribed for you including the doses needed).Other blood tests may be ordered including blood levels of medications you may be taking for seizure control. These tests are normally ordered when seizures continue or when drug-induced side effects are suspected.

• Brain Scans: This is one of the most important ways of diagnosing epilepsy. The most commonly used brain scans are CT, PET and MRI scans. CT and MRI scans can reveal the structure of the brain. This is useful for identifying brain tumors, cysts, and other structural abnormalities.PET and functional MRI (fMRI) are used to monitor the brain’s activity and detect abnormalities. SPECT (single photon emission computed tomography) is a relatively new kind of brain scan that may sometimes be used to locate seizure foci in the brain.

  Doctors may use an experimental type of brain scan called a magnetoencephalogram (MEG) in some cases. It has the ability to detect the magnetic signals generated by neurons. This allows doctors to monitor brain activity at different points in the brain over time (revealing different brain functions).While MEG is similar to EEG, it does not require electrodes and can detect signals from deeper in the brain than an EEG. Magnetic resonance spectroscopy (MRS) is also being experimented by doctors to detect abnormalities in the brain’s biochemical processes and with near-infrared spectroscopy (a technique that can detect oxygen levels in brain tissue).