Author: Dr. Gbenga Ogunfowokan | Source: Admin | Date Published: 06 Mar 2019

Source: West Texas ADRC


Background and definition

Hippocrates wrote the first book about epilepsy almost 2500 years ago. He rejected ideas regarding the divine etiology of epilepsy and concluded that the cause was excessive phlegm leading to abnormal brain consistency. Hippocratic teachings were forgotten, and divine etiologies again dominated beliefs about epileptic seizures during medieval times

Epilepsy is due to brain disorder resulting in abnormal brain activity. Anyone can develop epilepsy. Epilepsy affect all gender, all races, ethnic backgrounds and ages. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.


What are the causes?

Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

  • Genetic influence: Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it's likely that there's a genetic influence.

Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.

  • Head trauma: Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.

  • Brain conditions: Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.

  • Infectious diseases: Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.

  • Prenatal injury: Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.

  • Developmental disorders: Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.


What are the risk factors?

Certain factors may increase your risk of epilepsy:

  • Age: The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.

  • Family history: If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.

  • Head injuries: Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.

  • Stroke and other vascular diseases: Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.

  • Dementia: Dementia can increase the risk of epilepsy in older adults.

  • Brain infections: Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.

  • Seizures in childhood: High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.

Those who have the risk of these factors stated above may develop epilepsy.


How does it manifest in patients?

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

  • Temporary confusion

  • A staring spell

  • Uncontrollable jerking movements of the arms and legs

  • Loss of consciousness or awareness

  • Psychic symptoms such as fear, anxiety


What could be done at home by those having epilepsy?

  • Take your medication correctly: Don't adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.

  • Get enough sleep: Lack of sleep can trigger seizures. Be sure to get adequate rest every night.

  • Wear a medical alert bracelet: This will help emergency personnel know how to treat you correctly.

  • Exercise: Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water, and rest if you get tired during exercise.

In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.


When should medical care be sought?

Seek immediate medical help if any of the following occurs:

  • The seizure lasts more than five minutes.

  • Breathing or consciousness doesn't return after the seizure stops.

  • A second seizure follows immediately.

  • You have a high fever.

  • You're experiencing heat exhaustion.

  • You're pregnant.

  • You have diabetes.

  • You've injured yourself during the seizure.

If you experience a seizure for the first time, seek medical advice.

What will a medical doctor do to manage epilepsy?

Your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include:

  • A neurological exam: Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.

  • Blood tests: Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

  • Electroencephalogram (EEG): This is the most common test used to diagnose epilepsy. In this test, electrodes are attached to your scalp with a paste-like substance or cap. The electrodes record the electrical activity of your brain.

If you have epilepsy, it's common to have changes in your normal pattern of brain waves, even when you're not having a seizure. Your doctor may monitor you on video when conducting an EEG while you're awake or asleep, to record any seizures you experience. Recording the seizures may help the doctor determine what kind of seizures you're having or rule out other conditions.

The test may be done in a doctor's office or the hospital. If appropriate, you also may have an ambulatory EEG, which you wear at home while the EEG records seizure activity over the course of a few days.

Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test.

  • High-density EEG: In a variation of an EEG test, your doctor may recommend high-density EEG, which spaces electrodes more closely than conventional EEG — about a half a centimeter apart. High-density EEG may help your doctor more precisely determine which areas of your brain are affected by seizures.

  • Computerized tomography (CT) scan: A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.

  • Magnetic resonance imaging (MRI): An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.

  • Functional MRI (fMRI): A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.

  • Positron emission tomography (PET): PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.

  • Single-photon emission computerized tomography (SPECT): This type of test is used primarily if you've had an MRI and EEG that didn't pinpoint the location in your brain where the seizures are originating.

A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.

Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM), which may provide even more-detailed results.

  • Neuropsychological tests: In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.

Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:

  • Statistical parametric mapping (SPM): SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin.

  • Curry analysis: Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.

  • Magnetoencephalography (MEG): MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset.

Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.

Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.


How can injury be prevented during epileptic attack?

Injuries during epileptic attack can be prevented by taking the following precautions for people who have epileptic seizures and other spells of sudden-onset seizures:

  • Restrictions on driving

  • Restrictions on swimming

  • Restrictions on taking unsupervised baths

  • Restrictions on working at significant heights

  • Restrictions on the use of fire and power tools

What are other similar conditions?

  • Syncope (e.g. cardiac arrhythmia, vasovagal syncope, dysautonomia)

  • Metabolic conditions (e.g. hypoglycemia, hyponatremia)

  • Migraine (e.g. migrainous aura, migraine equivalent)

  • Vascular conditions (e.g. transient ischemic attacks)

  • Sleep disorders (e.g. cataplexy, narcolepsy, night terror)

  • Movement disorders (e.g. paroxysmal dyskinesia)

  • Gastrointestinal conditions (eg, esophageal reflux in neonates and infants)

  • Psychiatric conditions (eg, conversion, panic attacks, breath-holding spells, malingering, secondary gain)


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