What is Epilepsy?

What is Epilepsy?
Epilepsy is a disorder of the brain. Epilepsy can affect anyone regardless of ethnicity and age. Children make up 30% of all new epileptic diagnoses each year, but people over age 65 also are commonly diagnosed. But what happens during an epileptic attack?

During an epileptic attack, the normal transmission of electrical signals sent out from nerve cells (neurons) is disrupted. Disruptions may occur in one part of the brain, or in the entire brain. Disruption of nerve cell transmission in only one part of the brain is called a partial, or focal, seizure. A seizure that occurs in the entire brain is called a generalized seizure.

Partial or focal seizures include:

● Complex partial seizures

● Simple partial seizures

Generalized seizures include:

● Absence seizures (petit mal)

● Atonic seizures

● Myoclonic seizures.

● Tonic-clonic seizures (grand mal)

For most people diagnosed with epilepsy, the exact cause remains unknown. However, scientists have linked epilepsy with injury to the brain (for example, brain trauma from a sport-related accident), illness (brain tumors, lead poisoning, meningitis and encephalitis), abnormal brain development, and family history.

Physical changes may occur during a seizure, or a disruption of neuron transmission in the brain. Some physical symptoms of a seizure include convulsions (an involuntary repetitive contraction of a muscle that lasts for a very short time and results in visible shaking of the body), changes in behaviour, emotions, or sensations. Different seizure occurrences can result in different symptoms, because many symptoms accompany each category of seizure.

Earlier, we discussed different types epileptic seizures. These different types of seizures result in different physical changes in the brain.

Let's take a look at these different types of seizures to understand common symptoms.

Partial or focal seizures

1. Complex partial seizures exhibit the following symptoms:

• • Different facial expressions of emotions that are not triggered by a present or recent event
  • Difference in awareness
  • Moving the arms or rubbing hands without intending to
  • Swallowing without intending to
  • Staring
  • Wandering

2. Simple partial seizures exhibit the following symptoms:

• • Altered emotions
  • Changes in the way things look, smell, feel, taste or sound
  • Dreamy state
  • Involuntary muscle contraction that might imitate normal muscle movement
  • Unprovoked emotion

Focal or partial seizures generally do not result in a loss of consciousness. However, it is important to note that during partial or focal seizures, any specific change in perception greatly differs from one person to the next. That said, specific types of symptoms remain similar from one seizure to the next. For example, a person who experiences arm twitches during one episode is likely to experience twitching during a subsequent episode. It's also important to understand that these types of seizures generally do not result in a loss of consciousness.

Generalized seizures
Each type of generalized seizure is accompanied by a group of symptoms. We'll discuss about each type of generalized seizure, in turn.

1. Absence seizures (petit mal): Children are mostly affected by this type of generalized epilepsy, and often stare while making movements different than what they would normally do. This can include changing the positions of their hands, smacking their lips, and other types of behaviour. Awareness is affected.

2. Atonic seizures: A atonic seizure results in a loss of muscle control, causing the person to fall to the ground which may result in injuring his/her body. No loss of consciousness occurs, bit an atonic seizure generally occurs without notice.

3. Myoclonic seizures: These seizures are characterized a sudden, incontrollable jerking of limbs, the mouth, and other parts of the body. They happen only for a short period of time, but many cause a person to drop something, or to have their arms or legs to move up or down suddenly.

4. Tonic-clonic seizures (grand mal): This type of seizure often comes to mind when people think of seizures. People experiencing grand mal seizures will exhibit sudden, violent movement of the body and limbs, unconsciousness, headaches after the seizure, and loss of bladder control (involuntary urination) and bowel control (involuntary defecation) during or after the seizure.

Epilepsy Treatment

Epilepsy treatment
There a variety of techniques that can be used to control epileptic seizures, but it is important to remember that there is no cure for epilepsy. However, effective treatment can decrease seizure frequency and strength, or may leave you free of seizures. As with any medical decision, your doctor's advice, medical history, and tests are important to determine the best course of treatment.

Avoid triggers
It is very important that epileptic triggers be avoided. Aside from lack of sleep, stress and alcohol consumption, unexpected or repetitive or uncomfortable stimuli might trigger seizures. Repetitive flashing light (stroboscope) or inadequate screen frequency, sudden auditive stimulus (siren, or sudden yelling after silence), inadequate environmental temperature for longer period might trigger seizures are all environmental factors that should be avoided.

Diet
Approximately 66% of children are responsive to a ketogenic diet, which is a high fat and low carbohydrate diet, which may even go as far as preventing seizures. However, because the diet requires strict adherence, it does require a high amount of discipline to maintain.

Lifestyle
Excessive alcohol consumption, stress, and lack of sleep have all been linked to an increase in seizures. Talk with your doctor to determine your susceptibility.

Medications
Pharmaceutical drugs are widely prescribed for epilepsy, and have shown results for most people. In fact, many children and adults can eventually stop taking medications and live a life without seizures. One or more types of drugs may be prescribed, depending on the types of epilepsy diagnosed.

Currently, more than 20 different drugs for epilepsy are now available and prescribed by doctors. Your doctor may prescribe one or several of the drugs listed below, which are grouped together according to need. Newer drugs for epilepsy include:

• Diazepam (used for severe seizures that occur repeatedly)
• Ethosuximide (used for absence seizures)
• Felbamate
• Fosphenytoi (used only in a hospital setting)
• Gabapentin
• Levetiracetam
• Tiagabine
• Topiramate

Unless the type of epilepsy is known and requiring a different type of medication, patients who have recently been diagnosed with epilepsy may take:

• Carbamazepine
• Lamotrigine
• Oxcarbazepine
• Phenytoin
• Valproate

Do not alter your medication without consulting your doctor. Your doctor may start with a low dosage, which is increased until symptoms decrease. Some drugs may have serious side affects for the developing child during pregnancy, so work closely with your doctor if you are pregnant or are intending to become pregnant. If medicines do not work effectively, your doctor may recommend surgery (including implanted devices).

Surgery
If doctors determine that seizures are triggered by a specific part of the brain (diagnosed via SPECT test), surgery is performed to possibly remove that part of the brain. However, this is less likely if doctors cannot determine a specific part of the brain that causes the seizures or if the part of the brain is essential for normal life functions. Even with surgery, medication may be prescribed, though in a lower dosage.

Vagus nerve stimulation
This procedure involves a device, implanted into the chest, with wires that attach to the vagus nerve in the neck. The vagus nerve stimulator sends electrical impulses to the vagus nerve every several minutes, leading to an average reduction in seizures of 20-40%. Medication may still be prescribed, although it may be in lower dosage.