Epilepsy

What is epilepsy?

What is epilepsy?

Epilepsy is a central nerve system (neurological) disorder in which brain activity becomes irregular, triggering seizures or periods of uncommon behavior, experiences, and sometimes loss of awareness. Anyone can establish epilepsy. Epilepsy affects both males and women of all races, ethnic backgrounds and ages.

Seizure symptoms can vary commonly. Some people with epilepsy merely stare blankly for a couple of seconds during a seizure, while others consistently jerk their arms or legs. Having a single seizure doesn’t indicate you have epilepsy. A minimum of two unprovoked seizures are normally required for an epilepsy medical diagnosis. Treatment with medications or sometimes surgery can control seizures for most of people with epilepsy. Some people need long-lasting treatment to manage seizures, however for others, the seizures ultimately go away. Some children with epilepsy might outgrow the condition with age.

Epilepsy Symptoms

Since epilepsy is brought on by unusual activity in the brain, seizures can impact any procedure your brain collaborates. Seizure signs and symptoms might include:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the limbs
  • Loss of awareness or awareness
  • Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending upon the kind of seizure. In most cases, a person with epilepsy will tend to have the very same kind of seizure each time, so the symptoms will be comparable from episode to episode. Physicians usually categorize seizures as either focal or generalized, based on how the irregular brain activity begins.

Focal seizures

When seizures appear to arise from unusual activity in simply one area of your brain, they’re called focal (partial) seizures. These seizures fall into two classifications:

  • Focal seizures without loss of consciousness. As soon as called easy partial seizures, these seizures do not cause a loss of awareness. They might change feelings or change the method things look, smell, feel, taste or sound. They may likewise lead to uncontrolled jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
  • Focal seizures with impaired awareness. As soon as called complex partial seizures, these seizures include a change or loss of awareness or awareness. During an intricate partial seizure, you might stare into area and not react typically to your environment or perform repeated motions, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures might be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. An extensive examination and testing are needed to distinguish epilepsy from other conditions.

Generalized seizures

Seizures that appear to include all areas of the brain are called generalized seizures. 6 types of generalized seizures exist.

  • Absence seizures. Lack seizures, previously called petit mal seizures, frequently occur in children and are identified by gazing into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a short loss of awareness.
  • Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures normally impact muscles in your back, limbs and might cause you to fall to the ground.
  • Atonic seizures. Atonic seizures, likewise referred to as drop seizures, cause a loss of muscle control, which might cause you to suddenly collapse or fall down.
  • Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures typically affect the neck, face and arms.
  • Myoclonic seizures. Myoclonic seizures typically appear as sudden brief jerks or twitches of your arms and legs.
    Tonic-clonic seizures. Tonic-clonic seizures, previously referred to as grand mal seizures, are the most remarkable type of epileptic seizure and can cause an abrupt loss of awareness, body stiffening and shaking, and in some cases loss of bladder control or biting your tongue.

When to see a doctor

Look for immediate medical assistance if any of the following occurs:

  • The seizure lasts more than 5 minutes.
  • Breathing or consciousness doesn’t return after the seizure stops.
  • A 2nd seizure follows instantly.
  • You have a high fever.
  • You’re experiencing heat fatigue.
  • You’re pregnant.
  • You have diabetes.
  • You’ve injured yourself during the seizure.

If you experience a seizure for the first time, seek medical guidance.

Causes of Epilepsy

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to numerous aspects, including:

  • Genetic influence. Some types of epilepsy, which are classified by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s most likely that there’s a hereditary influence. Scientists have connected some types of epilepsy to particular genes, however for the majority of people, genes are just part of the reason for epilepsy. Particular genes may make a person more sensitive to ecological conditions that set off seizures.
  • Head trauma. Head injury as an outcome of a vehicle accident or other traumatic injury can cause epilepsy.
  • Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
  • Infectious diseases. Transmittable diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
  • Prenatal injury. Before birth, babies are sensitive to brain damage that might be triggered by a number of elements, such as an infection in the mother, bad nutrition or oxygen deficiencies. This brain damage can lead to epilepsy or cerebral palsy.
  • Developmental conditions. Epilepsy can in some cases be connected with developmental conditions, such as autism and neurofibromatosis.

Risk Factors

Specific aspects might increase your risk of epilepsy:

  • Age. The onset of epilepsy is most common in children and older adults, however the condition can occur at any age.
  • Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
  • Head injuries. Head injuries are responsible for some cases of epilepsy. You can decrease your risk by wearing a safety belt while riding in a car and by using a helmet while cycling, snowboarding, riding a motorbike or engaging in other activities with a high risk of head injury.
  • Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to mental retardation that may trigger epilepsy. You can take a number of actions to minimize your risk of these diseases, including restricting your intake of alcohol and preventing cigarettes, eating a healthy diet, and exercising routinely.
  • Dementia. Dementia can increase the risk of epilepsy in older adults.
  • Brain infections. Infections such as meningitis, which causes inflammation in your brain or spine, can increase your risk.
  • Seizures in youth. High fevers in childhood can in some cases be related to seizures. Children who have seizures due to high fevers generally will not develop epilepsy. The risk of epilepsy boosts if a child has a long seizure, another nervous system condition or a family history of epilepsy.

Complications

Having a seizure at specific times can cause scenarios that are dangerous to yourself or others.

  • Falling. If you fall during a seizure, you can hurt your head or break a bone.
  • Drowning. If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the remainder of the population due to the fact that of the possibility of having a seizure while in the water.
  • Cars and truck accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other devices. Numerous states have driver’s license restrictions associated with a driver’s capability to manage seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being permitted to drive.
  • Pregnancy complications. Seizures during pregnancy position risks to both mother and baby, and particular anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re thinking about becoming pregnant, speak with your doctor as you plan your pregnancy. Many women with epilepsy can become pregnant and have healthy babies. You’ll have to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It’s very important that you work with your doctor to plan your pregnancy.
  • Emotional health concerns. People with epilepsy are more likely to have psychological problems, especially depression, stress and anxiety and self-destructive ideas and behaviors. Problems may be an outcome of troubles handling the condition itself as well as medication side effects.

Other deadly complications of epilepsy are uncommon, but might take place, such as:

  • Status epilepticus. This condition happens if you’re in a state of continuous seizure activity lasting more than 5 minutes or if you have regular recurrent seizures without gaining back complete awareness in between them. People with status epilepticus have actually an increased risk of long-term mental retardation and death.
  • Abrupt unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of abrupt unanticipated death. The cause is unidentified, but some research study reveals it might take place due to heart or breathing conditions.

People with regular tonic-clonic seizures or people whose seizures aren’t controlled by medications may be at higher risk of SUDEP. In general, about 1 percent of people with epilepsy die of SUDEP.

How Is Epilepsy Diagnosed?

To detect your condition, your doctor will examine your symptoms and case history. Your doctor may order numerous tests to detect epilepsy and identify the reason for seizures. Your assessment may consist of:

  • A neurological examination. Your doctor may test your habits, motor capabilities, mental function and other areas to identify your condition and identify the type of epilepsy you may have.
  • Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be related to seizures.

Your doctor may also suggest tests to find brain abnormalities, such as:

  • Electroencephalogram (EEG). This is the most typical test used to diagnose epilepsy. In this test, medical professionals attach electrodes to your scalp with a paste-like substance. The electrodes tape-record the electrical activity of your brain. If you have epilepsy, it’s typical to have modifications in your normal pattern of brain waves, even when you’re not having a seizure. Your doctor may monitor you on video while carrying out an EEG while you’re awake or asleep, to record any seizures you experience. Recording the seizures might help the doctor determine what type of seizures you’re having or dismiss other conditions. Your doctor may offer you directions to do something that will cause seizures, such as getting little sleep prior to the test.
  • High-density EEG. In a variation of an EEG test, your doctor might recommend high-density EEG, which areas electrodes more carefully than conventional EEG — about a half a centimeter apart. High-density EEG might assist your doctor more exactly determine which areas of your brain are impacted by seizures.
  • Computerized tomography (CT) scan. A CT scan uses X-rays to get cross-sectional images of your brain. CT scans can expose abnormalities in your brain that might be triggering your seizures, such as tumors, bleeding and cysts.
    Magnetic resonance imaging (MRI). An MRI uses effective magnets and radio waves to develop a comprehensive view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be triggering your seizures.
    Functional MRI (fMRI). A functional MRI measures the changes in blood circulation that happen when particular parts of your brain are working. Medical professionals may use an fMRI prior to surgery to identify the exact places of vital functions, such as speech and movement, so that surgeons can avoid injuring those locations while running.
    Positron emission tomography (PET). FAMILY PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help envision active areas of the brain and detect problems.
    Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you’ve had an MRI and EEG that didn’t pinpoint the location in your brain where the seizures are coming from. A SPECT test uses a small amount of low-dose radioactive product that’s injected into a vein to develop a detailed, 3-D map of the blood flow activity in your brain during seizures. Doctors also may carry out a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may supply even more-detailed results.
  • Neuropsychological tests. In these tests, medical professionals assess your thinking, memory and speech abilities. The test results help doctors identify which areas of your brain are affected. Along with your test results, your doctor might use a combination of analysis strategies to help pinpoint where in the brain seizures begin:
  • Statistical parametric mapping (SPM). SPM is a technique of comparing areas of the brain that have increased metabolic process during seizures to normal brains, which can provide medical professionals a concept of where seizures start.
  • Curry analysis. Curry analysis is a technique that takes EEG information and tasks it onto an MRI of the brain to show physicians where seizures are taking place.
  • Magnetoencephalography (MEG). MEG measures the electromagnetic fields produced by brain activity to determine prospective areas of seizure beginning.

Precise diagnosis of your seizure type and where seizures start offers you the best possibility for discovering an effective treatment.

Epilepsy Treatment

Physicians generally start by dealing with epilepsy with medication. If medications don’t treat the condition, medical professionals might propose surgery or another kind of treatment.

Medication

The majority of people with epilepsy can end up being seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others might have the ability to reduce the frequency and strength of their seizures by taking a mix of medications.

Most popular drugs for epilepsy are:

  • Acetazolamide.
  • Carbamazepine.
  • Clobazam.
  • Clonazepam.
  • Eslicarbazepine acetate.
  • Ethosuximide.
  • Gabapentin.
  • Lacosamide.

Numerous children with epilepsy who aren’t experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Numerous adults can terminate medications after two or more years without seizures. Your doctor will encourage you about the proper time to stop taking medications.

Finding the right medication and dosage can be intricate. Your doctor will consider your condition, frequency of seizures, your age and other factors when selecting which medication to prescribe. Your doctor will likewise evaluate any other medications you may be taking, to guarantee the anti-epileptic medications will not communicate with them.

Your doctor likely will first prescribe a single medication at a fairly low dosage and may increase the dosage gradually until your seizures are well-controlled.

Anti-seizure medications may have some side effects. Moderate side effects consist of tiredness, dizziness, skin rashes, loss of coordination, weight gain, loss of bone density, speech problems and memory and thinking problems.

More-severe however uncommon side effects consist of depression, suicidal ideas and behaviors, severe rash, inflammation of particular organs, such as your liver.

To attain the best seizure control possible with medication, follow these steps:

  1. Take medications exactly as prescribed.
  2. Constantly call your doctor prior to switching to a generic variation of your medication or taking other prescription medications, over-the-counter drugs or organic treatments.
  3. Never stop taking your medication without speaking with your doctor.
  4. Inform your doctor instantly if you see new or increased sensations of depression, self-destructive ideas, or unusual modifications in your state of mind or habits.
  5. Inform your doctor if you have migraines. Doctors might prescribe among the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half the people freshly detected with epilepsy will end up being seizure-free with their first medication. If anti-epileptic medications don’t provide acceptable outcomes, your doctor may suggest surgery or other treatments. You’ll have regular follow-up appointments with your doctor to examine your condition and medications.

Surgery

When medications fail to offer adequate control over seizures, surgery might be a choice. With epilepsy surgery, a surgeon gets rid of the area of your brain that’s causing seizures.

Doctors typically perform surgery when tests reveal that:

  • Your seizures originate in a little, well-defined area of your brain
  • The area in your brain to be run on doesn’t hinder vital functions such as speech, language, motor function, vision or hearing

Although many individuals continue to require some medication to assist prevent seizures after effective surgery, you may have the ability to take fewer drugs and minimize your dosages.

In a small number of cases, surgery for epilepsy can cause complications such as completely altering your thinking (cognitive) abilities. Talk with your surgeon about his or her experience, success rates, and issue rates with the procedure you’re considering.

Therapies

Apart from medications and surgery, these potential therapies offer an option for treating epilepsy:

Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator beneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.

The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It’s unclear how this inhibits seizures, but the device can generally lower seizures by 20 to 40 percent.

The majority of people still have to take anti-epileptic medication, although some people may be able to decrease their medication dosage. You might experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.

Ketogenic diet. Some children with epilepsy have had the ability to lower their seizures by following a stringent diet that’s high in fats and low in carbs.

In this diet, called a ketogenic diet, the body breaks down fats rather of carbohydrates for energy. After a couple of years, some children might have the ability to stop the ketogenic diet– under close guidance of their medical professionals– and remain seizure-free.

Seek advice from a doctor if you or your child is considering a ketogenic diet. It’s crucial to make sure that your child doesn’t become malnourished when following the diet.

Side effects of a ketogenic diet may include dehydration, constipation, slowed growth since of dietary deficiencies and an accumulation of uric acid in the blood, which can cause kidney stones. These side effects are unusual if the diet is appropriately and clinically supervised.

Following a ketogenic diet can be a challenge. Low-glycemic index and customized Atkins diets provide less restrictive alternatives that may still offer some benefit for seizure control.

Prospective Future Treatments

Researchers are studying lots of prospective new treatments for epilepsy, consisting of:

  • Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a particular part of your brain, normally your thalamus. The electrodes are linked to a generator implanted in your chest or the skull that sends out electrical pulses to your brain and might lower your seizures.
  • Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are likewise under examination. These responsive stimulation or closed loop devices evaluate brain activity patterns to discover seizures prior to they take place and provide an electrical charge or drug to stop the seizure.
  • Constant stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation– constant stimulation to an area of your brain below a level that’s physically noticeable– appears to enhance seizure results and lifestyle for some people with seizures. This treatment method may operate in people who have seizures that start in an area of the brain that can’t be removed since it would affect speech and motor functions (significant area). Or it might benefit people whose seizure characteristics indicate their opportunities of successful treatment with responsive neurostimulation are low.
  • Minimally invasive surgery. New minimally intrusive surgical techniques, such as MRI-guided laser ablation, show pledge at minimizing seizures with fewer risks than standard open brain surgery for epilepsy.
  • Stereotactic laser ablation or radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery might offer effective treatment for people where an open procedure may be too risky. In these procedures, medical professionals direct radiation at the particular area in the brain causing seizures, to destroy that tissue in an effort to much better control the seizures.
  • External nerve stimulation device. Just like vagus nerve stimulation, this device would promote particular nerves to lower frequency of seizures. But unlike vagus nerve stimulation, this device would be used externally so that no surgery to implant the device is needed.

Newest Medications for Epilepsy

Here are the list of new drugs for last years: Neurontin (which is now the generic gabapentin), Lamictal, Topamax, Zonegran, Keppra, Trileptal, and Gabitril, a number of which are now generic. These medications are fairly new (according to 2018 year), effective and approved.

All of these drugs have been shown to be effective in regulated trials. One of the nice things about these more recent drugs is they have the tendency to have fewer side effects. They’re simpler to use and more “predictable”. That’s handy, considering that we understand that drug interactions are the bane of many patients.


Last modified: February 20, 2018

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