Daily Medicos

EPILEPSY: A chronic CNS disorder

  • Epilepsy is the 4th most common CNS disorder, which affects people of all ages.
  • 65 million people around the world who have shown the symptoms of epilepsy.
  • Brain injury and family tendency can be the cause of epilepsy.
  • Epilepsy patients can show more than one type of seizure.
  • 1/3 people in the world live with uncontrollable seizures because no valid and available treatment is working for them.
  • 15 million people with epilepsy were found in South-East Asia.
  • Epilepsy is a chronic disease and it is more common in developing countries.

What is meant by Epilepsy:

The word epilepsy is a Greek word that means to be taken, seized, or attacked.

Epilepsy is a medical condition in which repeated seizures or attacks occur due to a disorder of the brain cells. The seizures may start at any age of your life, and some suffer from it their whole life or some only for a few years (approximately up to 13 years).

Symptomatic epilepsy also called secondary epilepsy that may develop after particular identification events like asphyxia, head injury, or meningitis.

Primary epilepsy also called idiopathic epilepsy that may develop without any identifiable causes.

Epilepsy has a lifelong tendency.

Seizure:

A seizure is a defined symptom of epilepsy, which is a result of excessive nerve-cell discharge in the brain. Seizures manifest by a sudden abnormal function of the body,  often loss of consciousness, an excess of muscular activity, and an abnormal sensation.

The excitation in nerve cell discharge in a small area of the brain giving rise to a partial seizure, and start spreading from small area to the whole brain and spinal cord named as a generalized seizure. 

the seizure is also said as convulsion, fit, or attack. Nerve cell discharge or excitation, site, severity, and extent are the wide variety of clinical forms.

Classification of Epileptic Seizures:

International League against Epilepsy (ILAE) approved the classification of epileptic seizures, which is based on the clinical expression of seizures and electroencephalographic pictures. The  main classification of epileptic seizure are;

Partial seizure:

The partial seizure is the abnormal excitation in nerve cell discharge, which starts in a localized area of the brain. The signs and symptoms depend on which part of the brain is affected. The excitation may remain localized or may spread to other parts of the body.

The partial seizure is further divided into two groups depending upon the consciousness of the patient;

Simple Partial Seizure:

In a simple partial seizure, the patient does not lose consciousness and therefore can speak what happened, but the experience is so strange that the patient may not able to express properly. Manifestation is depended on the location of the affected area.

  • In Motor seizure, It is a focus in the motor cortex, in which twitching starts from the distal part of the extremity or in the face for some time or spread up to the whole extremity and even become completely generalized. The spreading is known as the Jacksonian march.
  • The  Sensory seizure has a focus in the postcentral gyrus. There might be a feeling of tingling, pins, and needles, cold or heat, or numbness in extremities. Sometimes a strange feeling with visual signs, hearing, or smell sensation.
  • The Autonomic seizure is related to foci in the temporal lobe, which may feel sensation rising from epigastrium to the throat, palpitation, sweating, or flushing.

The Physical symptoms include;

  • changes in mood, memory, and thought.
  • distorted perception (time, space, and person).
  • problem with language
  • may be a structured hallucination.

Complex Partial seizures:

In complex partial seizure, the patient has impaired consciousness means no complete loss of consciousness. The symptoms that might the patients feel are;

  • The patient slightly aware of the situation but can’t respond to anything.  
  • A strange sensation of light, smell, sound, and taste.
  • change in perception of time (time running too fast or too slow), light, space.
  • The surrounding may seem completely strange and different, which causes the patient anxious.

Sometimes seizure with hallucination or with psychomotor show symptoms like automatisms, automatic movement e.g aimless movements, chewing, lip-smacking.  This automatism may become very complex and the patient can perform difficult tasks and go somewhere, but later not remember anything. After the attack patient becomes complete amnesiac.

Complex partial seizure previously called “psychomotor seizure”, but now called “Temporal lobe epilepsy” because the abnormal discharge occurs in the temporal lobe. 

Partial seizure of secondary generalized:

Both simple and complex partial seizure combined become generalized tonic-clonic seizures. The beginning is the same as partial seizure but ends alike the primary generalized tonic-clonic seizures.

Generalized Seizures:

The Generalized seizures are characterized by the complete loss of consciousness with the absence of an aura. It occurs suddenly and unexpectedly, and it the patient fall they may injure themselves.

The generalized seizure divided into six different types of seizures;

Absence seizure:

These are short periods of loss of consciousness lasting only a few seconds to a half minute.  An absence seizure is an onset, a blank stare, and a brief upward rotation of the eyes. The patient is unresponsive, but suddenly over and the patient continues what he was doing before a seizure.

Typical absence seizures mostly occur in school-going age or during childhood, that’s because it is also known as childhood absence epilepsy.

Myoclonic seizures:

Myoclonic seizure consists of sudden, brief, shock-like muscle contraction, which is either occurring in one limb or whole bilateral limbs.their may be single jerks or a repeated jerk for a long time. 

Clonic seizures:

These are generalized seizures, where the tonic component is not present only repetitive clinic jerks occur.  

Tonic seizures:

These jerks are sudden sustained muscle contractions, fixing the limbs in some strained position.  There is an immediate loss of consciousness, with a deviation of eyes and head towards one side, or sometimes rotation of the whole body.

Tonic-clonic seizures (GTCS):

In Tonic-clonic seizures, the patient loses consciousness, falls, develops generalized stiffness, breathing stops because all the muscles of the trunk are in spasm, and the patient becomes cyanotic. With these jerks, the patient might bite his tongue, pass urine, or sometimes stool. When a patient regains consciousness, the patient may feel tired, headache, confusion, sleepy, and no memory of what happened.  GTCS also called a “grand mal seizure.”

Atonic seizures or Astatic seizures:

In Atonic seizure, there is a sudden loss of muscle tone causing the head or a limb drop, and the patient falls suddenly to the floor. That’s why it also called “drop attacks”. The atonic seizure is a very short period (only for seconds) but may occur several times a day. These patients often present with a scar or fresh wound on the face. 

Symptoms of Epilepsy:

Recurrent seizures are the main symptoms of epilepsy. However, if the patient faced more then one symptom then he must seek medical attention. Associated symptoms include;

  • Fits with no fever.
  • confused and anxiety
  • temporary unresponsive
  • sudden stiffness of the body
  • sudden falling with no reason
  • fear and panic or anger
  • changes in perception of time, touch, and smell

Causes:

There are no specific causes found of epilepsy, but some conditions can be associated with epilepsy include;

  • genetic factor
  • Head trauma (car accidents or traumatic injury)
  • brain conditions (tumor or stroke)
  • Infectious disease (meningitis, AIDs, viral encephalitis)
  • Prenatal injury (get an infection or any trauma in mother’s womb)
  • Developmental disorder (autism or neurofibromatosis)

Treatment:

There is no valid treatment is available, but doctors may prescribe antiepileptic drugs to prevent symptoms. If these drugs don’t work then a doctor refers to other options like surgery, vagus nerve stimulation, and a healthy diet. Common AEDs for epilepsy is;

  • valproic acid
  • carbamazepine
  • lamotrigine
  • levetiracetam

Surgeries include lobectomy, multiple subpial transection, corpus callosotomy, and hemispherectomy. 62% of adults show a significant reduction or no seizure for around 7 years after surgery.

Healthy diet:

In 2014, research present that a low carbohydrate diet could help with epilepsy in adults and children.

Prevention:

  • Get enough sleep
  • learn stress management techniques
  • avoid drugs and alcohols
  • take your medication on time
  • try to avoid bright light 
  • minimize or skip a TV or computer 
  • Eat healthily.

Takeaway:

Epilepsy is a chronic CNS disorder in which excessive discharge of nerve cells stimulates the different types of seizures. Epilepsy can be overcome by AEDs, and surgeries and can prevent it with a healthy diet.

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