Epilepsy

Epilepsy

Overview

Epilepsy is a central nervous system disorder which causes periods of abnormal brain function called seizures. Typically, a patient experiences at least 2 unprovoked seizures before a definitive diagnosis can be made. Seizures that affect a defined zone in the brain are called focal seizures. Seizures that affect all areas of the brain are called generalised seizures. Epilepsy can occur at any age, and the symptoms can vary widely. Some children outgrow epilepsy with age.

Signs and symptoms

Epilepsy affects brain activity, so it could cause a range of symptoms that affect processes governed by your brain. Symptoms of the seizure may include temporary disorientation, staring blank into space, uncontrollable jerky spasms of the arms and legs, loss of consciousness and frothing from the mouth.

Causes

Epilepsy could be caused by traumatic injury to the head, lack of oxygen to the brain, a brain tumour, stroke, or infectious brain diseases such as meningitis, AIDS and viral encephalitis. High fever, low blood sugar and alcohol withdrawal could also cause seizures. However, in almost half of all cases of epilepsy, the cause is unidentifiable.

Risk factors

A family history of epilepsy could increase the patient’s chances of developing the condition. Traumatic brain injury, stroke, high fever, brain infections and dementia in geriatric adults, could increase the patient’s risk of epilepsy.

Complications

Having a seizure could be dangerous depending on what the patient is doing when the seizure occurs. patient may fall down and injure themselves. This could be even more dangerous if the patient is swimming or driving when the epilepsy attack happens. The unpredictability of the attack adds to danger. Patients with epilepsy are also more likely to develop mental health issues because of the condition.

Diagnosis

A seizure could be a symptom of a serious medical issue and must be medically investigated immediately. If you suspect that you or a loved one has had a seizure, please go to the emergency room immediately. The doctor usually starts with a medical history and a physical and neurological exam to test motor and cognitive abilities. In order to diagnose epilepsy, other conditions that could cause seizures need to be ruled out. For this reason, the doctor may prescribe a few blood tests to check the presence of infection, kidney function, liver function and blood glucose levels. An Electroencephalogram (EEG) is a non-invasive imaging test to record electrical activity in various parts of the brain. EEGs are the most commonly used diagnostic test for epilepsy. CT scans, PET scans and MRI scans may be taken to rule out both acquired brain abnormalities like tumours and also to detect some development abnormalities like dysplasia that could cause seizures. These are the group of patients who require careful selection of medications. Some of them can have seizure freedom if a meticulous surgical resection of the abnormality is done. A proportion of patients will have a genetic cause for epilepsy and respond well to medications alone.

Treatment

Epilepsy cannot be cured completely; however, it can be managed. The treatment plan is based on the severity of the symptoms, the patient’s general health and how well they respond to therapy. The treatment usually includes anti-epileptic drugs, which reduce the frequency and occurrence of the seizures. In order to be effective, the medication must be taken at the right times and frequency, as prescribed by the physician. Irregular consumption of the medication could trigger seizures. Possible side effects of the medication include skin rashes, fatigue and problems with coordination and memory. In rare cases, the patient may experience effects such as depression and liver inflammation.

If medication is ineffective, surgery may be considered in selected cases to stop the seizures from occurring. The surgical treatment for epilepsy involves resecting (removing) the part of the brain where the seizures originate. This is possible only for focal seizures, where the origin can be traced back to one specific part of the brain. This is done through extensive brain scans and studies. The surgical approach is planned carefully, to ensure that functional parts of the brain that deal with speech, memory, mobility etc. are not affected. For this reason, the surgeons may elect to perform the procedure while the patient is awake and responsive. If the portion of the brain where the seizures originate is too large or involves a functional area, the surgeons may choose to perform a multiple subpial transection. In this procedure, the surgeon interrupts some neural paths in the brain to prevent the seizures from spreading beyond where they originate. This does not stop seizures from occurring, but reduces their intensity.

A variety of alternative therapies have also been proven useful in managing the frequency and intensity of seizures, such as deep brain stimulation, vagus nerve stimulation and ketogenic diet.

Prevention

As the cause of epilepsy is unknown, the condition itself cannot be prevented. However, seizures can be prevented. Each patient has unique triggers, and identifying and staying away from those triggers can help prevent seizures to some extent

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