Epilepsy

Epilepsy is a chronic neurological disorder of the brain that can cause seizures and is commonly called as Fits. Epilepsy is caused by abnormal neurological signaling activity that results in convulsions and muscle spasms with strange behaviors, and most of the time the patient will lose consciousness. Usually, epilepsy is recurrent, and episodic attacks are common. Clinically, epilepsy is classified into many types that are: Temporal lobe epilepsy, neocortical epilepsy, Juvenile myoclonic epilepsy, etc. In epilepsy, there are different types of seizures that include Petit mal seizure, Grand mal seizure, atonic seizure, tonic seizures, myotonic seizure and clonic seizures. According to a medical survey report, in the United States more than 2 million people are affected by epilepsy. In the developed countries, the incidence of epilepsy is approximately 100-200 per 100,000 people and there is a constant increase of 7% every year.

Causes

The exact cause for the neuropathology of epilepsy is still unknown, but some of the common illnesses, severe traumatic injuries of the head that result in brain damage, brain abnormalities, central nervous system infections such as meningitis and cysticercosis, genetic factors, strokes, heart problems, AIDS, hydrocephalus, loss of blood supply to the brain and some of the common biochemical diseases including GABA disorders (Gamma-amino Butyric Disorders), autism, cerebral palsy, carbon mono oxide poisoning, idiopathic or unknown reasons, tumors and rarely dementia can cause epilepsy. In some adults, alcohol withdrawal syndrome can result in this disorder, and it is usually drug-responsive.

Symptoms

The symptoms differ with the types of epilepsy

In grand mal seizure:

• Unconsciousness with marked muscular tingling

• Difficulty in respiration

In petit mal seizure:

• Patient will be in unconscious state with constant mouth chewing

In simple partial seizures:

• Patient will be in good conscious and involuntary body jerks

• Nausea

• Emotional changes

In the complex partial seizures:

• Patient will remain conscious but still unresponsive to the external stimuli

• Shaking of hands

• Blank staring.

The status epilepticus is a life-threatening disease and the attack may last for more than ten minutes and it should be treated immediately in a hospital environment. Apart from the clinical symptoms, the epileptic patient can experience some abnormal symptoms before the epileptic attack such as sudden mood swings, different odor and abnormal muscle tingling. But many of the symptoms of epilepsy may vary from one person to another.

Diagnosis

• Laboratory tests such as Infection panel tests for encephalitis, HIV, TB and syphilis

• Biochemical tests of CSF

• Liver and kidney function tests with electrolytes including lithium levels

• Blood glucose

• Complete blood counts

• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) and Electroencephalogram (EEG)

Treatment Options

The primary treatment of epilepsy is the anticonvulsant drugs such as carbamazepine, valproic acid, pregabalin, clonazepam, gabapentin, valproate, phenytoin and phenobarbital. But all of these medicines have their own side effects, and they should be avoided in pregnancy. Some of the epileptic patients may need surgical intervention in case of lesions or tumors that can cause epilepsy. Some of the other therapies such as deep brain stimulation, vagus nerve stimulation and surgery with gamma knife are reported to be useful in epilepsy.

Prognosis

The prognosis of epilepsy depends on the type and cause of the epilepsy. Some of the types of epilepsy such as childhood absence epilepsy can be treated easily and the recurrence is rare. But some other type such as Dravet’s syndrome is unresponsive to medications and the prognosis is usually poor.

Prevention Strategies

As of now, there are no preventive measures identified for epilepsy but we can prevent the accidental traumas, injuries and complications of epilepsy. Some of them are: If you are a known epileptic, it is better to wear the seat belt while driving a vehicle, try to wear a medical ID that are you are epileptic with your emergency contact number and try to avoid handling hazardous machinery in the work place.

When to see a doctor

If you experience abnormal muscular movements, repeated attacks of seizure or any fits-like body reactions that are complained by your friends or family members or if you experience seizure attacks even after you took the prescribed medicine, you need to see a medical doctor immediately.