Index
It is a condition in which people have seizures.
Many different seizures range from minor symptoms noticed only by the affected person to attacks, the most easily recognized type of seizure.
Essential 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 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 brain’s left half. 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 attacks are often called auras, especially when they progress to more severe attacks.
It is an advantage for the person 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 cannot communicate or remember what happened. A simple partial attack often precedes it.
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 challenging 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 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 vibration 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 essential 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.
It would help if you 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 arises 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.
Clinicians must be 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 attacks.
Absence attacks
In this type of attack, the person briefly loses consciousness and looks into space (usually for less than 10 seconds), making 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 severe problem.
For example, when a 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 diseases.
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 essential 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 focus site, for example, temporal lobe epilepsy.
If a lesion has been found on MRI / CT (e.g., 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.
Rolands epilepsy
This is called idiopathic partial epilepsy and can be largely genetically determined.
There are usually localized abnormal muscle movements (focal motor attacks) in this condition. 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 15. There may be some degree of reading difficulty, but intelligence is average.
Generalized epilepsy syndromes
Childhood and youth absence fever
These are two 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 seizures.
Some children will develop other types of generalized seizures. They generally have average 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 and 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, seizures are believed to be caused by a lack of a particular group of chemicals (neurotransmitters) 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 have epilepsy, it is a genetic mark.
New research has shown that some instances of idiopathic epilepsy are inherited and 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 occurs to the brain as it develops during the first three months of pregnancy.
This can be revealed by modern MRIs and causes many 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 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 incredibly slow-growing superficial tumors
Since these can be surgically removed, it is essential 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 chronic abuse of any 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.
Although stress-relieving treatments such as aromatherapy and yoga can be beneficial when stress triggers attacks, there are no proven complementary therapies.
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 adverse side effects.
multidrug therapy
If one type of drug doesn’t work, a second drug is added. The first drug is reduced if the patient’s attacks stop 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 remedies 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 to treat epilepsy are taken in one or two doses per day.
No matter how the patient feels, it is essential to take the medication regularly to achieve satisfactory results. Forgetting to assume it could trigger an attack.
What kind of medicine should be used?
Various medications are available for different types of epilepsy.
Some types are pretty specific; they only affect certain types of epilepsy, while in other cases, they have no effect or may even increase the risk of seizures.
