Epilepsy is a neurological disorder in which patients experience recurrent seizures. At least two seizures must occur before epilepsy is diagnosed.
An epileptic seizure occurs when the nerve cells in the brain suddenly increase their activity, causing an electrical storm that can overwhelm the brain. This can result in various symptoms ranging from slight changes in taste or smell to loss of consciousness and involuntary muscle contractions that affect the whole body. The symptoms experienced depend on the area of the brain affected.
Anything that disrupts the normal function of the brain can cause seizures and epilepsy. Although roughly half of all seizures have no known cause, there are certain factors that can trigger seizures, such as brain trauma, genetic abnormalities, infections and tumors.
Depending on the severity and frequency of seizures, epilepsy can cause significant disruption to a person’s life. People with epilepsy may be unable to keep a job or live independently. They may live in fear of their next seizure. Even people who can control their seizures may experience frustration or the ill effects of others’ perception of epilepsy.
People may have seizures that are unrelated to epilepsy. For example, young children with high fevers may develop febrile seizures. Pregnant women may develop a serious condition called eclampsia that involves seizures. Some people appear to have seizures, but there is no evidence of abnormal electrical activity in the brain. These are called pseudoseizures and they may be psychological in nature, resulting from stress or other medical conditions. Some people with epilepsy may experience pseudoseizures in addition to actual seizures.
Signs and symptoms of epilepsy
The signs and symptoms of epilepsy vary depending on the part of the brain affected and the type of seizure (whether partial or generalized). Some seizures may barely be noticeable to the patient or witnesses.
Signs and symptoms of partial and generalized seizures may include:
- Involuntary movements affecting half the body (e.g., one leg or side of the face)
- Purposeless movements (e.g., lip-smacking, picking at clothes, swallowing)
- Strange physical sensations (e.g., crawling, tickling, numbness)
- Abdominal pain
- Impaired consciousness
- Dilated pupils
- Generalized Seizures
- Blank stare with only eye blinking
- Sudden loss of awareness
- Involuntary muscle contractions that affect the whole body
- Loss of consciousness
- Sudden muscle tension and rigidity
- Biting tongue or cheek
People who witness an epileptic seizure should not attempt to move or disturb the person while the seizure is taking place. Instead, they should move any objects that may cause harm to the person. Nothing should be placed in the person's mouth (including fingers). Contrary to popular belief, it is physically impossible for a person to swallow their own tongue during a seizure. If this is the first time a person has had a seizure or if the seizure lasts five minutes or more, emergency services should be called.
Diagnosis methods for epilepsy
Diagnosis of epilepsy usually begins with a medical history and physical examination. Because there are many different types of seizures, some of which are not related to abnormal brain activity, it is important that a physician identify the type of seizure a patient has had. The physician may ask questions that relate to:
- What sensations the patient feels before, during or after a seizure
- How long the seizure normally lasts
- Which side of the body is most affected during a seizure
- To what extent the patient experiences a change in or loss of consciousness
- Whether the patient feels any pain before, during or after the seizure
If patients do not remember the nature of their seizures, a physician may ask questions of the patient’s caregiver, parents or others who have witnessed the seizures. The physician may also ask about any other conditions or symptoms the patient has, any medications the patient may be taking, and whether the patient uses alcohol or drugs.
In addition to the medical history and physical examination, a physician may conduct tests to assess which areas of the brain may be involved in the seizures. These tests may include:
- Electroencephalogram (EEG). An EEG is one of the most common tests that a physician may conduct following a seizure. During an EEG, electrical activity in the brain is monitored through electrodes placed on the scalp. People with epilepsy may show abnormally slow frequencies or spikes and other disruptions, even when they are not having a seizure. A physician may request that the EEG be performed while the patient is sleeping to get an accurate picture of normal brain activity.
- Computed axial tomography (CAT) scan. A CAT scan is a noninvasive or minimally invasive test that uses a rotating x-ray device to create detailed cross-sectional images of different body parts, including the brain. It can be used to identify tumors or other abnormalities in the brain that may be causing a patient’s recurring seizures.
- MRI (magnetic resonance imaging). An MRI is a noninvasive procedure that uses powerful magnets and radio waves to produce clear, cross-sectional and three-dimensional images of the body’s tissues. Like the CT scan, it can be used to view the brain and identify abnormalities. A special kind of MRI, called a functional MRI (fMRI), can be used to allow physicians to see how the brain functions. During an fMRI, the patient may be asked to perform a task while the machine scans the brain and records its activity. This can then be used to gauge which parts of the brain are functioning abnormally.
- Blood tests. Blood samples may be taken to screen for conditions such as diabetes, infection or anemia, which may be the causing a patient's recurrent seizures. Blood tests may also be used to identify metabolic or genetic disorders that may be related to the seizures.
Treatment options for epilepsy
There is no cure for epilepsy. However, 80 percent of people with epilepsy are able to effectively control their seizures through various treatment methods, according to the National Institute of Neurological Disorders and Stroke (NINDS). Treatment should begin as soon as possible after diagnosis. Studies have shown that patients are more likely to be able to control their seizures effectively if treatment is started early.
The most common treatment method for epilepsy is the use of anticonvulsant (anticonvulsants). These medications attempt to control the area of the brain that triggers the seizures. For this reason, it is important that a patient’s seizures be accurately classified before treatment is started. Patients are usually prescribed a low initial dose of one type of anticonvulsant. Their progress will then be monitored by a physician to assess if the anticonvulsant is effective or if the dosage level needs to be adjusted. Patients should understand what side effects are possible so they can report them to their physician. In some cases, a patient may require two types of anticonvulsants to control the seizures.
For some people with epilepsy, medications fail to control their seizures. In these cases, a physician may recommend additional treatment methods that may be used with medications. These treatment methods include:
- Surgery. Surgery may be considered if a physician thinks that the patient is unlikely to respond to medication. It usually involves removing a small area of the brain. Tests such as electroencephalograms (EEGs) and magnetic resonance imaging (magnetic resonance imaging) may be used to identify the area of the brain triggering the seizures. A surgical team will assess whether the portion of the brain to be removed is close to areas that control motor function, sensations or language. Complications from brain surgery are rare. Studies have shown that most people with epilepsy who have surgery either stop having seizures or the frequency of their seizures is drastically reduced.
- Vagus nerve stimulation. The vagus nerve is a cranial nerve that originates in the brain stem and controls numerous organs in the body. People with epilepsy that cannot be controlled through medication may have an electronic device surgically implanted under the skin of the chest and attached to the vagus nerve in the lower neck. This device stimulates the vagus nerve through a series of small shocks. These shocks can reduce seizures in people with epilepsy by 20 to 40 percent, according to the NINDS.
- Diet. There is evidence that a diet that is low in carbohydrates and high in fat can help control seizures in some patients, especially children. This type of diet is called a ketogenic diet because it forces the body to enter a state called ketosis where it burns fat instead of carbohydrates to function. Although there is evidence to support the ketogenic diet as a treatment method, the diet is difficult to maintain and may result in nutritional deficiencies, which can be especially damaging for children.
- Some people stop having seizures after a period of time. This is more likely in people (especially children) who have epilepsy with no known cause. People who stop experiencing seizures for a period of two to five years are considered seizure-free and they may be able to stop taking their medications. However, this should be done under the guidance and supervision of a physician.
Source: Jagran Cityplus Jan 10, 2011
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