The epilepsies are a group of disorders of cerebral functions characterized by chronic recurrent, paroxysmal, nonsynchronous discharge of cerebral neurons. Epilepsy is a most common neurological disorder affecting 0.5 – 2% of the population.They can occur in any stage.
Seizure is defined as an episode of neurological dysfunction. Convulsions are seizures accompanied by motor manifestations such as limb jerking, incontinence etc. Seizures need not be always convulsive, it may be manifested by other changes in the neurological functions like sensory, cognitive, emotional events etc.
Causes Of Epilepsy
The likely cause of a given seizure depends on the age of the patient and its type. Primary generalised epilepsy is usually idiopathic. In 40% of patients there may be a positive family history of epilepsy. Causes of epilepsy can be determined on the basis of age group.
- 0 – 2 years
- Birth injury
- Genetic Disorders
- Acute infections like meningitis and encephalitis
- 2 – 12 years ( children )
- Acute infections
- Head injury or trauma
- Febrile convulsions
- 12 – 18 years ( adolescent )
- Head trauma
- Drugs such as amphetamines, phenothiazines etc.
- Alcohol withdrawal
- Infections like meningitis, cerebral abscess etc.
- 18 – 35 years
- Head injury or trauma
- Brain tumors, cysts, hydrocephalus
- Inflammatory disorders like sarcoidosis, multiple sclerosis etc.
- More than 35 years
- Brain tumors
- Hepatic encephalopathy
- Electrolyte disturbances
Generalised epilepsy is occasionally secondary to a definable cause but it is partial seizure which has detectable cortical lesion in the majority of patients.
Decoding Epilepsy Classification
The proper classification of epileptic seizures is important for an appropriate diagnostic work up, prognostic evaluation and selection of therapy. Epilepsies are classified in to three categories, which are Primary partial seizures, primary generalised and unclassified seizures called epileptic syndrome
Primary partial seizures – It is further divides into three types
Simple partial seizures – Depending on the concomitant signs, they are :
- With motor symptoms
- With sensory symptoms
- With visual symptoms
- With versive signs
- Complex partial seizures – Depending on the area involved due to spread, they are :
- Temporal lobe
- Frontal lobe
- Secondary generalised partial seizures
- Primary generalised seizures
- Tonic – clonic
- Infantile spasm
- Unclassified seizures called epileptic syndrome
Seizures which do not fit into above categories :
- Neonatal seizures
- Infantile spasms
Diagnosis can be done on the basis of review on symptoms and medical history. Evaluation may include :
- Blood Tests
- A neurological exam
- Genetic testing
Brain imaging tests should be done to to detect the changes in brain
- High density ECG
- CT scan
- Functional MRI
- Positron Emission tomography
- Neurophysiological tests
Treatment of epilepsy is directed at the elimination of the cause of seizures, suppressing the expression of seizure and dealing with psychosocial consequences. The major goal of management includes :
- Proper identification of the type of seizure
- Taking medicines according to instructions.
- Maintaining a good medicating level.
Epilepsy may be treated with anti-epileptic medications (AEDs), diet therapy and surgery. There are many anti-epileptic drugs currently available, choosing the right medication for an individual patient has become complicated
First Aid Treatment Of A Seizure
This type of treatment is needed if one happens to witness a patient with epilepsy on the road. Following steps are to be taken during a seizure :
- Move the patient to safer place
- Loosen the clothes around the neck
- Move the public away from the scene so that the patient may breathe fresh air.
- Try to prevent tongue biting.
- Do not put fingers inside the mouth
- After a convulsion ceases, turn the patient into a semiplane position and make the air passage clear.
- Advice the patient to consult some doctor as soon as possible.
Precautions For Epileptics
The following precautions have to be observed by epileptics before a good control of seizures is achieved with drug therapy.
- Operation of dangerous machinery should be avoided.
- Patient should not lock the bathroom doors
- Cycling, Driving, swimming, mountaineering should be avoided until 6 months of seizure-free period has been achieved with treatment.
The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. It is very high in fat. Diet Should consist of proteins to help promote growth, carbohydrates cause the body to make ketones. Ketones are created from the breakdown of fat. They are made for energy when the body does not get enough carbohydrates for energy. Despite its success treating seizures, the keto diet is not risk free. Side effects with long term diet includes :
- High cholesterol
- Kidney stones
- Low bone density
Epilepsy is common. It is estimated that 1 in 26 people deals with this disorder. Having a single seizure does not mean you have epilepsy.It is diagnosed when there are at least 2 unprovoked seizures at least 24 hours apart. By integrating the web of causes, its classifications, management and treatment strategies , we can work towards reducing it.