Epilepsy

Epilepsy is a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions. About one in 100 people in the United States will experience an unprovoked seizure in their lifetime. However, a solitary seizure doesn't mean you have epilepsy. At least two unprovoked seizures are required for an epilepsy diagnosis. Even mild seizures may require treatment, because they can be dangerous during activities like driving or swimming. Treatment — which generally includes medications and sometimes surgery — usually eliminates or reduces the frequency and intensity of seizures. Many children with epilepsy even outgrow the condition with age.

Symptoms

Because epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce:

·         Temporary confusion

·         A staring spell

·         Uncontrollable jerking movements of the arms and legs

·         Complete loss of consciousness

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

We can classify seizures as either partial or generalized, based on how the abnormal brain activity begins. In some cases, seizures can begin as partial and then become generalized.

Partial seizures
When seizures appear to result from abnormal activity in just one part of the brain, they're called partial or focal seizures. These seizures fall into two categories.

·         Simple partial seizures. These seizures don't result in loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of part of the body, such as an arm or leg, and spontaneous sensory symptoms such as tingling, vertigo and flashing lights.

·         Complex partial seizures. These seizures alter consciousness, causing you to lose awareness for a period of time. Complex partial seizures often result in staring and nonpurposeful movements — such as hand rubbing, twitching, chewing, swallowing or walking in circles.

Generalized seizures
Seizures that seem to involve all of the brain are called generalized seizures. Four types of generalized seizures exist.

·         Absence seizures (also called petit mal). These seizures are characterized by staring and subtle body movement, and can cause a brief loss of consciousness.

·         Myoclonic seizures. These seizures usually appear as sudden jerks or twitches of your arms and legs.

·         Atonic seizures. Also known as drop attacks, these seizures cause you to lose normal muscle tone and suddenly collapse or fal

Tonic-clonic seizures (also called grand mal). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and loss of bladder control.

Causes

Epilepsy has no identifiable cause in about half of those who have the condition. In the other half, the condition may be traced to various factors.

·         Genetic influence. Some types of epilepsy, which are categorized by your type of seizure, run in families, making it likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, though it's estimated that up to 500 genes could be tied to the condition. For some, genes are only part of the cause, perhaps by making a person more susceptible to environmental conditions that trigger seizures.

·         Head trauma sustained during a car accident or other traumatic injury can cause epilepsy.

·         Medical disorders. Events like strokes or heart attacks that result in damage to the brain also can cause epilepsy. Stroke is responsible for up to one half of epilepsy cases in those over age 65.

·         Dementia is a leading cause of epilepsy among older adults.

·         Diseases like meningitis, AIDS and viral encephalitis can cause epilepsy.

·         Prenatal injury. Fetuses are susceptible to brain damage caused by an infection in the mother, poor nutrition or oxygen deficiencies. This can lead to cerebral palsy in the child. About 20 percent of seizures in children are associated with cerebral palsy or other neurological abnormalities.

·         Developmental disorders. Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome.

Risk factors

Certain factors may increase your risk of epilepsy.

·         Your age. The onset of epilepsy is most common during early childhood and after age 65, but the condition can occur at any age.

·         Your sex. Men are slightly more at risk of developing epilepsy than are women.

·         A family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.

·         Head injuries. These injuries are responsible for many cases of epilepsy. You can reduce your risk by always 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. These can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of such diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet and exercising regularly.

·         Brain infections. Infections like meningitis, which causes an inflammation in the brain or spinal cord, can increase your risk of epilepsy.

·         Prolonged seizures in childhood. High fevers in childhood can sometimes be associated with prolonged seizures and subsequent epilepsy later in life, particularly for those with a family history of epilepsy.

Complications

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

·         Falling. If you fall during a seizure, you can injure your head or break a bone.

·         Drowning. If you have epilepsy, you're more than 15 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.

·          Accidents. A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Many states have driver's licensing restrictions related to your ability to control seizures and impose a minimum amount of time that you've been seizure-free — ranging from three months to two years — before you're allowed to drive.

·         Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you're considering becoming pregnant, talk to your doctor. Most women with epilepsy can become pregnant and have a healthy baby. You'll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It's very important that you work with your doctor to plan your pregnancy.

Other life-threatening complications from epilepsy are uncommon, but do occur.

·         Status epilepticus. This condition occurs if you're in a state of continuous seizure activity lasting more than five minutes or you have frequent recurrent seizures without regaining consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.

Tests and diagnosis

Your doctor may use a number of tests to diagnose epilepsy, from neurological exams to imaging techniques like MRI scans.

·         Neurological and behavioral exam. Your doctor may want to test your motor abilities, behavior and intellectual capacity to see how the seizures are affecting you.

·         Blood tests. Your doctor may take a blood sample to check for signs of infections, lead poisoning, anemia or diabetes, which can cause seizures.

Your doctor may also suggest tests to detect abnormalities within the brain. These include:

·         Neuropsychological tests. This group of tests includes IQ, memory and speech assessments, which help doctors pinpoint where the seizures are originating. This type of testing is routinely done before epilepsy surgery.

·         Electroencephalogram (EEG). This is the most common test to diagnose epilepsy. An EEG records the electrical activity of your brain via electrodes affixed to your scalp. 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 want to monitor you on video while conducting an EEG of you awake or asleep in hopes of recording the seizure to see what kind of seizures you're having. Sometimes your doctor will have to do something to provoke a seizure while you're being tested, such as asking you to sleep very little the night before.

·         Computerized tomography (CT). You might be given a CT scan if you go to an emergency room for an initial seizure, because it's generally a readily available test. CT machines use a type of X-ray equipment to obtain cross-sectional images of your brain and skull. CT scans can reveal abnormalities in the brain that might be causing your seizures, including tumors, bleeding and cysts.

·         Magnetic resonance imaging (MRI). An MRI provides much the same type of information as a CT scan, but in far greater detail. MRIs use radio waves and a strong magnetic field to produce detailed images of your brain. MRIs can reveal brain abnormalities that could be causing your seizures.

Medication
Most people with epilepsy can become seizure-free by using a single anti-epileptic drug. Others can decrease the frequency and intensity of their seizures. More than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.

Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage, and may increase the dosage gradually until your seizures are well controlled. If you've tried two or more seizure medications without success, your doctor may recommend trying a combination of two drugs.

All anti-seizure medications have some side effects. Mild side effects include:

·         Fatigue

·         Dizziness

·         Weight gain

·         Loss of bone density

·         Skin rashes

·         Loss of coordination

·         Speech problems

More severe but rare side effects include:

·         Depression

·         Suicidal thoughts and behaviors

·         Severe rash

·         Inflammation of certain organs, such as your pancreas

To achieve the best seizure control possible with medication:

·         Take medications exactly as prescribed.

·         Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.

·         Never stop taking your medication without talking to your doctor.

·         Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts or unusual changes in your mood or behaviors.

Half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies.

Lifestyle and home remedies

Understanding your condition can help you control it.

·         Take your medication correctly. Don't take it upon yourself to adjust your dosage levels. Instead, talk to your doctor if you feel something should be changed.

·         Get enough sleep. Sleep deprivation is a powerful trigger of 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.

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

Coping and support

Uncontrolled seizures and their effect on your life may at times feel overwhelming or lead to depression. It's important not to let epilepsy constrain you. You can still live an active, social life. To help cope:

·         Educate yourself and your friends and family about epilepsy so they understand the condition.

·         Try to ignore negative reactions from people. It helps to learn about epilepsy so you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.

·         Live as independently as possible. This means continuing to work, if possible. If you can't drive because of your seizures, investigate public transportation options near you.

·         Find a doctor you like and with whom you feel comfortable.

·         Try not to constantly worry about having a seizure.

If your seizures are so severe that you can't work outside your home, there are still ways to feel productive and connected to people. These include:

·         Work from home by developing a special skill, like computer programming.

·         Develop or participate in hobbies, and connect over the Internet with other people who are interested in the same things.

·         Work to develop friends and have contact with other people.

Let people you work and live with know the correct way to handle a seizure in case they're with you when you have one. This includes:

·         Gently roll the person onto one side.

·         Put something soft under his or her head.

·         Loosen tight neckwear.

·         Don't try to put your fingers or anything else in the person's mouth. No one has ever "swallowed" his or her tongue during a seizure — it's physically impossible.

·         Don't try to restrain someone having a seizure.

·         Don't attempt to rouse the person by shouting at or shaking him or her.

·         If the person is moving, clear away dangerous objects.

·         Stay with the person until medical personnel arrive.

·         Observe the person closely so that you can provide details on what happened.

·         Time the seizures with your watch.

·         Keep calm and reassure others

                                                                                           Dr C P Sedain,Neuropsychiatrist,

                                                                   Chitwan med college

,                                                                Bharatpur,Nepal