Epilepsy

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at February 15, 2016
StartDiseasesEpilepsy

Epilepsy is a group of disorders involving seizures. It is the fourth most common neurological disease and can affect people of all ages with varying degrees of severity.

Contents

Definition & Facts

Epilepsy is a chronic disease in which patients experience recurrent seizures that are not provoked. About three million people in the United States and about 65 million people worldwide suffer from epilepsy. Each year, 150,000 new Americans are diagnosed with the disease.

Epileptic seizures may be generalized or partial. Generalized epilepsy involves seizures that begin over the brain's entire surface. Generalized seizures include absence seizures, tonic-clonic seizures, myoclonic seizures, atonic seizures, and tonic seizures.

Partial epilepsy involves seizures that begin in a specific part of the brain. These can be simple which involves a smaller part of the brain affected or complex which involves a larger part of the brain being affected. Partial epileptic seizures can also become a secondary generalized seizure meaning that it spreads to the rest of the brain.

Symptoms & Complaints

The only symptom of epilepsy that is visible is recurrent, unprovoked seizures. With varying types of seizures, symptoms vary. Seizures often happen without a warning. Some patients may be able to feel a seizure coming on, and experience its conclusion when the brain activity returns to normal and the abnormal electrical activity stops.

Seizures may last anywhere from a couple seconds to a few minutes. Patients may either be alert during this time or unconscious. Oftentimes, patients do not realize they are having a seizure and don't remember it occurring.

Some seizures, such as those that make a patient fall or twitch, are easily seen visually while others make a person lose consciousness and stare into space for an extended period of time. Others may be a short set of muscle twitches that only the patient will notice.

Causes

Epileptic seizures happen when normal brain function is disrupted by abnormal bursts of electricity. There is not always a clear trigger of this electric activity. However, there are some conditions that can cause seizures. These include stroke, head injury, atherosclerosis in the brain, brain tumor, Alzheimer's disease, brain infection, alcohol withdrawal or drug withdrawal.

When children develop epilepsy, it is often due to low oxygen during birth. Head injuries during birth or childhood can also cause the onset of epilepsy. While it may have a genetic factor, patients do not always have to have a family history to develop the disease. One genetic component that could cause epilepsy is tuberous sclerosis because it results in brain injury.

Diagnosis & Tests

Because of the varying types of seizures that occur in epilepsy, it must be determined what type of seizure each patient is experiencing. Doctors will need a patient's medical history, family history, and current medications. Some questions will also be asked about the particular seizure that has been experienced such as: How old were you? What were the circumstances around the seizure? How did you feel before, during, and after the seizure?

After a doctor's evaluation, tests will be performed. An epilepsy electroencephalogram (EEG) test tracks the electrical signals from the brain, picking up on abnormal activity. There are also several blood tests that can be done to diagnose epilepsy and rule out other conditions. In order to locate the part of the brain where the seizures are taking place, a PET scan may be performed. Another test for epilepsy is a lumbar puncture. This procedure extracts the cerebrospinal fluid that surrounds the spinal cord with a needle, which is then examined in a lab.

Treatment & Therapy

Patients have options when it comes to therapy and treatment for epilepsy from medication to surgery. The particular type of treatment that is prescribed depends on several factors such as the severity and frequency of the seizures, the age of the patient, their overall health, as well as their medical history. Alternative treatments and special diets are also available for those who will not respond well to medication. In the past decade, treatment options for epilepsy patients have doubled.

Many anticonvulsant drugs are available to epilepsy patients, such as diazepam, clonazepam, and lorazepam. Some lesser known drugs include levetiracetam and oxcarbazepin. Depending on how a patient tolerates side effects, medications may be altered. Medications are known to control the seizures in about 70% of epilepsy patients. Side effects of these drugs often include double vision or blurred vision, fatigue, unsteadiness, and upset stomach.

Additional therapies include vagus nerve stimulation wherein a device is inserted into the body and sends electrical signals that act to inhibit seizures. If surgery is required, there are several types available, depending on the location of the hub of the seizures and the type of epilepsy that is experienced. Surgery may be performed to remove the part of the brain where the seizure is originating (focal resection) or even the entire hemisphere of the brain where the seizure is originating (hemispherectomy).

If a seizure occurs, a caretaker can take several steps to alleviate the situation and prevent further damage from occurring. This includes making a cushion around the patient's head, as they are likely to hit it on something if they fall. Loosen any tight necklaces or shirts that are around the neck. Place the patient on their side, keeping the patient from being restrained in any way. Make sure the patient does not have anything in their mouth and take close notes of what happens during the seizure. These details can help doctors to further treat the epilepsy in the future.

Prevention & Prophylaxis

Because the cause of epilepsy is not always obvious, in general, it is not possible to be prevented. While common causes of epilepsy, such as head injury, may be prevented by wearing safety gear, it is also important to treat disorders that can have an effect on the brain, such as high blood pressure or meningitis.

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