Epileptic Attack: Types, Epilepsy Syndromes, Symptoms, Causes and Treatment

It is a condition in which people have seizures.

There are many different types of seizures, ranging from minor symptoms noticed only by the affected person, to seizures , the most easily recognized type of seizure.

Important facts about the attacks are:

  • Where they start in the brain.
  • How they spread and how much of the brain is affected.

Is it possible to divide the attacks into groups?

Epileptic seizures are divided into two main groups.

Partial (focal) attacks

These attacks begin in a specific part of the brain’s white matter (cerebral cortex).

The starting point of abnormal electrical activity is called ‘focus’. During attacks, they can stay there, spread to surrounding areas, or eventually spread to involve the entire brain.

It is more important to determine the early symptoms of an attack, as this will indicate where the focus is.

If the person has spasms in the right hand, the focus should be on the left half of the brain. In general, the left side of the brain controls the right side of the body.

If the attack begins with a flash of light, the focus is on the area at the back of the brain (the occipital lobe) that deals with vision.

If there are hallucinatory experiences, which may be the awareness of a strange taste or smell or a feeling of déja vu, the attack comes from a temporal lobe located on the sides of the brain.

 Simple partial attacks

They are characterized by the fact that the patient is alert, awake and knows what is happening. These types of attacks are often called auras, especially when they progress to more severe attacks.

It is an advantage for the person to be able to communicate with those around him during the attack, for example, to be able to tell people that the attack is not dangerous and that it will stop itself.

 Complex partial attacks

In this type of attack, the person loses consciousness and therefore cannot communicate or remember what happened. It is often preceded by a simple partial attack.

Due to loss of consciousness, the person may stare into space or do automatic things, such as chewing or smacking the lips, picking at nearby clothing or objects, or getting up and wandering around in confusion.

The attacks usually last a few minutes. These attacks can be embarrassing and socially disabling. Most complex partial seizures begin in the temporal lobe.

They can be difficult to control with medicine and are sometimes cured with surgery.

 Symptoms of generalized attacks

When the attack spreads to affect the entire brain, the victim will have what is called a secondary generalized tonic clonic seizure. This is also known as a seizure or grand mal attack.

Doctors currently prefer to use the term tonic clonic seizure as it is descriptive of what happens during the attack:

  • First, the person stiffens (tonic) and then jerks off (clonic).
  • Breathing may stop during the attack, and the person’s skin may turn blue.
  • The shaking typically lasts one to two minutes, but can last longer. When the shaking stops, it may be impossible to wake the person for a few minutes.

During attacks, people can be injured by falling to the ground. They can bite their tongue or become incontinent.

During a tonic clonic attack, it is important to remove all sharp or heavy objects near the person and after the seizure is over, put them on their side in the recovery position.

You should never put anything in the mouth of someone who has a clonic tonic attack.

Widespread attacks

In this type of attack there is no focus. Generalized seizures occur due to abnormal electrical activity that occurs spontaneously on both sides of the brain.

Many of the epilepsies that cause generalized seizures are believed to have a genetic basis. There are several types of generalized attacks

Generalized tonic-clonic

In addition to occurring in people with focal epilepsy , those with generalized epilepsy may have clonic tonic seizures.

It is very important that clinicians are able to distinguish between generalized-onset and partial-onset clonic tonic seizures, as treatment and research are different.

Clonic tonic seizures with a generalized onset will occur without warning.

For clonic tonic seizures with a focal onset, the patient will usually receive a warning (aura) and may also experience simple partial or complex seizures.

Absence attacks

In this type of attack, the person briefly loses consciousness and looks into space (usually for less than 10 seconds) and makes an immediate recovery.

During the attack, the patient may blink. Sometimes absences can happen with great frequency, up to 100 times a day, and therefore can be a serious problem.

For example, when the person is in school and their condition is not recognized.

Other widespread types of attacks

 Myoclonic:

Short, symmetrical contraction is in the arms and legs, similar to what many people experience while falling asleep.

Myoclonic seizures usually occur in the morning within an hour or so of wakefulness.

Atonic seizures

In this type of attack, the muscles suddenly relax, causing the person to fall to the ground. Head or face injuries often occur.

What are epilepsy syndromes?

So far, we have focused on different types of seizures. It is important to remember that epilepsy is not a single condition but a group of conditions.

To better understand epilepsy, for example, the cause and prognosis, the different types of epilepsy have been categorized into syndromes.

Examples of partial epilepsy syndromes

It is important to be able to categorize, when possible, the epilepsy syndrome that the patient has, as this will influence the choice of treatment and the final result.

Temporal, frontal, parietal, or occipital lobe epilepsy

Most partial epilepsy syndromes are named based on the site of focus, for example, temporal lobe epilepsy.

If a lesion has been found on MRI / CT (eg, congenital abnormality or tumor), the epilepsy is called symptomatic.

If no lesion is found, the epilepsy is called cryptogenic.

For symptomatic epilepsies, the prognosis largely depends on the pathology that the epilepsy is symptomatic of.

Rolandian epilepsy

This is called idiopathic partial epilepsy and can be largely genetically determined.

In this condition, there are usually localized abnormal muscle movements (focal motor attacks). They affect one side of the face.

They generally occur at night, accompanied by guttural noises and excessive saliva production. The victim is awake during the attack, which could progress to a secondary generalized clonic tonic attack.

The electroencephalogram (EEG) shows characteristic focal peaks in the motor area. The prognosis is always good.

Most people have few attacks and they stop before the age of 15. There may be some degree of reading difficulty, but intelligence is normal.

 Generalized epilepsy syndromes

Childhood and youth absence fever

These are two of the generalized epilepsies and are believed to be genetic in origin.

In these two syndromes, absence seizures are experienced. Not surprisingly, childhood absence epilepsy has its onset in childhood and juvenile absence epilepsy in adolescence.

Both are accompanied by characteristic EEG changes, ‘spike waves’ in the tracing that occur approximately three times per second.

Approximately 70 to 80 percent control attacks to treatment, which can generally be discontinued in later adolescence without recurrence of attacks.

Some children will develop other types of generalized seizures. They generally have normal intelligence.

 Juvenile myoclonic epilepsy

This is another idiopathic generalized epilepsy that usually begins in adolescence.

It is believed to account for 5 to 10 percent of all cases among youth and adults.

Patients experience myoclonic seizures, particularly within an hour or so of wakefulness, most will also experience clonic tonic seizures. About a third will also experience absence seizures.

The EEG will usually show photosensitivity, that is, extra activity when looking at the light. Seizures are often precipitated by lack of sleep or alcohol.

Causes

Epilepsy is caused by abnormal electrical impulses in groups of nerve cells (neurons) found in the brain.

For diagnostic purposes, epilepsy is divided into two main groups.

Idiopathic epilepsy (primary epilepsy)

In cases of this type, the cause is unknown.

However, the seizures are believed to be caused by a lack of a particular group of chemicals (neurotransmitters) that are used to regulate electrical impulses in the brain.

There may be a hereditary (genetic) background, since epilepsy of the same type is often seen among relatives.

Also, EEG irregularities similar to that of the patient are often seen among family members, even if they do not suffer from epilepsy, it is a kind of genetic mark.

New research has shown that certain cases of idiopathic epilepsy are clearly inherited, caused by chromosomal abnormalities.

The patient has no other signs of neurological disease or mental defects.

Symptomatic epilepsy (secondary epilepsy)

There is a known cause for epilepsy in these patients. Triggers for epilepsy can be numerous diseases or types of brain damage.

The following are the most common:

Developmental abnormalities

Damage that occurs to the brain as it develops during the first three months of pregnancy.

This can be revealed by modern MRIs and causes many of the difficult-to-control cases in children.

Trauma to the skull

Unlike an ordinary concussion, accidental trauma or injury can be so severe that the patient is admitted to a neurosurgical room.

The chance of epilepsy after trauma ranges from 5 to 50 percent, with the highest risk after a depressed skull fracture where brain tissue has been partially damaged or a gunshot wound to the head.

Blood clots (heart attacks) and bleeding in the brain

About 10 percent of all strokes cause epilepsy. It can also continue as after cranial surgery.

Metabolic medical disorders

These include problems such as hyponatremia or hypercalcemia .

 Problems at birth

Epilepsy can result in the baby suffering from a lack of oxygen to the brain during delivery, such as tightening or twisting of the umbilical cord.

Brain tumors or especially slow-growing superficial tumors

Since these can be surgically removed, it is important to check them if a patient develops epilepsy, especially if the seizures start in a limited part of the brain (focal seizures).

The most important techniques are CT scans and magnetic resonance imaging.

 Encephalitis / meningitis

Prolonged seizures and febrile seizures can induce brain damage.

Alcohol / drug abuse

Epilepsy can occur due to withdrawal from alcohol or drugs or due to chronic abuse of any of the substances.

Treatment

Epilepsy is usually treated with medicine. In this way, 60 to 70 percent of newly diagnosed epilepsy patients may avoid seizures, with no or minimal side effects.

Other ways to treat epilepsy include vagus nerve stimulation (VNS), the ketogenic diet (now only recommended for children with difficult-to-treat epilepsy), and surgery.

There are no proven complementary therapies, although stress relieving treatments such as aromatherapy and yoga can be beneficial when stress triggers attacks.

Monotherapy (single drug therapy)

The most appropriate drug is administered in the lowest possible dose.

If it reappears, the dose is gradually increased until it is stopped or the drug causes negative side effects.

multidrug therapy

If one type of drug doesn’t work, a second drug is added. If the patient’s attacks stop, the first drug is reduced, since most people can be treated with only one type (monotherapy).

If epilepsy is difficult to treat, you may need to try other medications. However, if additional medications are ineffective, the possibility of controlling the attacks is reduced.

 How does the doctor determine the dose?

The level of the drug in the blood is often measured to determine its effect on attacks.

It is important to remember that therapeutic levels (and their side effects) for epileptic patients are only guidelines and that each patient must be treated individually.

How often should the medicine be taken?

Most medications given to treat epilepsy are taken in one or two doses per day.

No matter how the patient feels, it is important to take the medication regularly to achieve satisfactory results. Forgetting to take it could trigger an attack.

What kind of medicine should be used?

Various medications are available for different types of epilepsy.

Some types are quite specific, they only have an effect on certain types of epilepsy, while in other cases, they have no effect or may even increase the risk of seizures.

In complicated cases of epilepsy, it is often a difficult task for the doctor to find the right treatment.