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Epilepsy

Seizure Disorder

Epilepsy is a brain disorder characterized by an enduring predisposition to generate epileptic seizures, the consequences of this condition and the occurrence of at least one seizure. Seizures can be classified as being partial-onset seizures and generalized-onset seizures.

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Presentation

The symptoms of epilepsy usually vary on the basis of underlying pathology. Seizure is the only symptom which is present in all types of epilepsy. However, the associated symptoms may differ on the type of seizures.

Impairment or loss of consciousness is usually a feature of complex partial seizures. The level of consciousness is not affected in simple partial seizures. Atonic and tonic seizures often make the patient fall down.

Muscle Twitch
  • These seizures produce muscle twitches, convulsions and loss of consciousness. People with this type of epilepsy do not remember having a seizure.[faculty.washington.edu]
  • Convulsions, during which the muscles twitch or jerk, are just one characteristic of seizures. Some seizures cause convulsions, but many do not.[northshore.org]
  • Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.[healthline.com]
Seizure
  • Increased seizure frequency was defined as a 50% increase in seizure frequency after conversion date compared with seizure frequency before the conversion date.[ncbi.nlm.nih.gov]
  • Seizures can be classified as being partial-onset seizures and generalized-onset seizures. The symptoms of epilepsy usually vary on the basis of underlying pathology. Seizure is the only symptom which is present in all types of epilepsy.[symptoma.com]
  • Up to four consecutive focal seizures were evaluated in 277 patients with lesional focal epilepsy, excluding isolated auras and subclinical EEG seizure patterns.[ncbi.nlm.nih.gov]
  • Our study showed that being female, comorbid autism with febrile seizure and recurrent febrile seizure had an increased association with development of epilepsy.[ncbi.nlm.nih.gov]
  • This study aims to explore the predictive role of irisin and chemerin for seizure control in children with idiopathic epilepsy.[ncbi.nlm.nih.gov]
Confusion
  • On 1-year follow-up, patient and family members did not report episodic confusion or any seizure-like activity. RAS constitute a particular entity of seizures and need careful interpretation and management.[ncbi.nlm.nih.gov]
  • Often people will be confused briefly after a generalized seizure. Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected.[emedicinehealth.com]
  • Unfortunately, a great deal of misunderstanding and confusion about seizures still exists, so it is important that your child's friends and teachers become educated about her condition.[healthychildren.org]
  • Partial-onset seizure symptoms can include: Shaking/stiffening of one side of the body Confusion, inability to speak Staring spells Sensory disturbances Tongue biting, drooling or foaming at the mouth Uncontrollable screaming[aurorahealthcare.org]
  • This can be even more confusing, because strokes can sometimes cause seizures . Anxiety Anxiety is commonly experienced before a seizure with most seizure types and can signal a seizure is about to occur.[verywell.com]
Dizziness
  • Nervous system problems : APTIOM may cause problems that can affect your nervous system, including dizziness, sleepiness, vision problems, trouble concentrating, and difficulties with coordination and balance.[aptiom.com]
  • In some cases, people know they are about to have a seizure because they see or hear something, or feel dizzy, nauseous, or "strange." This is called an aura .[faculty.washington.edu]
  • These medicines may cause side effects, including fatigue, dizziness, skin rash, or problems with your memory, coordination, or speech.[familydoctor.org]
  • Many people experience a sensory change or sensation, such as a tingling or dizziness, immediately before a grand mal seizure. During a focal seizure, symptoms typically affect one area of the body such as a jerking arm or leg.[radiologyinfo.org]
  • Some people also experience nausea, blurry vision, a headache, or dizziness before a seizure.[verywell.com]
Aura
  • Up to four consecutive focal seizures were evaluated in 277 patients with lesional focal epilepsy, excluding isolated auras and subclinical EEG seizure patterns.[ncbi.nlm.nih.gov]
  • This is called an aura . An aura can act as an "early warning system" telling a person that a seizure is about to happen. The person can therefore minimize a possible injury by taking precautions such as sitting down.[faculty.washington.edu]
  • There are many different types of auras which people may experience, yet while there is a great variety, aura's tend to be the same for an individual person from seizure to seizure.[verywell.com]
  • This is called an aura . Others find that certain things may bring on a seizure, like not getting enough sleep or playing video games. During a seizure, the person may fall down, shake, stiffen, throw up, drool, urinate (pee), or lose bowel control.[kidshealth.org]
Staring Spells
  • Partial-onset seizure symptoms can include: Shaking/stiffening of one side of the body Confusion, inability to speak Staring spells Sensory disturbances Tongue biting, drooling or foaming at the mouth Uncontrollable screaming[aurorahealthcare.org]
  • Or, the seizure may cause staring spells, sometimes with unusual repetitive movements, such as moving the mouth or the lips, chewing or swallowing, or hand movements.[familydoctor.org]
  • Others cause confusion and staring spells. More people are dealing with a seizure-causing brain disorder , according to a new study from the Centers for Disease Control and Prevention (CDC).[aarp.org]
  • Spontaneous, temporary symptoms such as confusion, muscle jerks, staring spells, loss of awareness and disturbances in mood and mental functions can occur during seizures.[livescience.com]
  • Characteristic symptoms include: Unexplained staring spells Stiffening of muscles Involuntary jerking of limbs Other less-specific symptoms can include: Sleepiness or sleep disturbances Marked and unexplained irritability or aggressiveness Regression[autismspeaks.org]

Workup

Before the diagnosis of epilepsy is made, the following investigations are used to rule out infections or metabolic causes of seizures.

  • Blood Chemistry Panel
  • Serum urea, creatinine and electrolytes
  • Random blood sugar
  • Serum calcium and magnesium
  • Liver function tests
  • Lumbar puncture

Other investigations that will help diagnose epilepsy include the following.

  • Electroencephalography: Electroencephalography may help establish and characterize the type of epilepsy by demonstrating abnormal electrical activity in the brain.
  • Compuerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan: CT or MRI brain scanning is often useful in defining or excluding structural causes for seizures e.g. tumors and infections.
  • Position Emission Tomography (PET) and Single Photon Emission Computed Tomography (SPECT): PET and SPECT are also used to evaluate certain patients of seizures who do not respond to medical therapy.
Slowing
  • EEG findings showed that slow background activity was significantly common among patients with EP (P 0.009). Although only 5 of 15 patients with EP had been operated, 43 of 67 patients had undergone epilepsy surgery (P 0.04) in the control group.[ncbi.nlm.nih.gov]
  • APTIOM may slow your thinking or motor skills. Do not drive or operate heavy machinery until you know how APTIOM affects you. Liver problems : APTIOM may cause problems that can affect your liver.[aptiom.com]
  • Often the rhythmic movements slow before stopping. Eyes are generally open. The person may not appear to be breathing. The person is often breathing deeply after an episode.[emedicinehealth.com]
  • […] not lesions, is around 45 percent across centers in the United States. back to top Catastrophic epilepsy in infants and small children: Seizures quickly spread over the whole brain to cause massive seizures, often severely weakening an arm or leg and slowing[neurosurgery.ucla.edu]
  • Papers published in the past two years suggest that keto may slow the growth of a brain tumor in mice.[nytimes.com]
Suppression
  • (WM-suppressed), and gray-white matter tissue border enhancement (GW-TBE) MPRAGE sequences.[ncbi.nlm.nih.gov]
  • Lennox-Gastaut syndrome) Symptomatic (e.g. early infantile epileptic encephalopathy with burst suppression) Epilepsies and syndromes undetermined whether focal or generalized With both generalized and focal seizures (e.g. epilepsy with continuous spike-waves[en.wikipedia.org]
Epileptiform Activity
  • activity. [124] In the developing world, 75% of people are either untreated or not appropriately treated. [29] In Africa, 90% do not get treatment. [29] This is partly related to appropriate medications not being available or being too expensive. [29[en.wikipedia.org]

Treatment

Immediate care of seizures:

Little can be done for a person having a major seizure. Supportive treatment includes first aid, maintenance of airway, provision of oxygen and administration of intravenous anticonvulsants.

Anti-convulsant drug therapy:

If the cause of epilepsy is treatable promptly, drug therapy is not necessary. Drug therapy is required when the cause is not immediately treatable and and the patient is at a risk of having further seizures. There are various anticonvulsant drugs with different mechanism of actions. They can be divided into the following large groups [6]. 

  • Sodium channels e.g. phenytoin, carbamazepine etc
  • GABA-A receptor enhancers e.g. phenobarbital
  • T-calcium channel blockers e.g. valproate
  • Carbonic anhydrase inhibitors e.g. zonisamide
  • Blockers of unique binding sites e.g. gabapentin

Surgical choices

The type of epilepsy surgery depends on the location in the brain causing the seizures. Anterior temporal lobectomy is the most common surgical choice in adults [7]. In children, the surgical choices include corpus callosotomy and hemispherectomy [8] [9].

Prognosis

If epilepsy is properly controlled via medications, the lifespan of the patients is completely normal.

Even without treatment, sudden death in the patients suffering from epilepsy is very uncommon. Those suffering from tonic-clonic seizures may suffer from accidents and traumas. Mortality is also higher in the patients whose seizures are associated with loss of consciousness.

Etiology

The etiology of epilepsy varies with age group.

In neonates, developmental insufficiency or brain injury are the most common causes for the development of epilepsy.

In the infantile age group, the principal congenital malformations, perinatal injury and metabolic disorders are the principal causes of epilepsy.

In children and adolescents, epilepsy usually results from genetic causes.

In adults, in addition to genetic causes, cerebral neoplasms, drugs, alcohol withdrawal, brain trauma, stroke, infection and surgery are the predisposing conditions that lead to the development of epilepsy.

The genetic syndromes that cause seizures include Angelman syndrome, Rett syndrome, Pitt Hopkin’s syndrome, tuberous sclerosis, Prader Willi syndrome and Struge Weber syndrome [1][2].

Epidemiology

The annual incidence of epilepsy in Minnesota was demonstrated by a study to be around a 100 cases per 100,000 persons aged between 0 to 1 years; 40 cases per 100,000 persons aged 38 to 40 years and 140 cases per 100,000 persons aged 79-80 years.

Overall, the total incidence of epilepsy is 3400 per 100,000 men (3.4%) and 2800 per 100,000 women (2.8%) by the age of 75 years [3].

Sex distribution
Age distribution

Pathophysiology

Seizures result from a sudden imbalance between the excitatory and inhibitory mechanisms in the brain [4].

Partial seizures are those in which the seizure activity is restricted to one part of the cerebrum; i.e. the focus of increased electrical activity is in one hemisphere.

On the other hand, in generalized seizures, diffuse regions of both the hemispheres are involved simultaneously and sunchronously.

If any seizure remains for 60 minutes, irreversible brain damage occurs. Cell death occurs from excessively increased metabolic demands of the continuously discharging neurons.

Prevention

Since the cause of epilepsy is not exactly known, it is not possible to prevent it. However, head injury being the most important cause, if avoided can prevent the development of epilepsy [10]. Wearing seat belts, following traffic rules and avoiding accidents is helpful in reducing the risk of head trauma.
Epileptics sensitive to alcohol must prevent alcohol intake.

Summary

A seizure or convulsion is a paroxysmal involuntary disturbance of brain function that may be manifested as an impairment or loss of consciousness, abnormal motor activity, behavioral abnormalities, sensory disturbances or autonomic dysfunction.
Epilepsy is defined as a brain disorder that is characterized by recurrent seizures unrelated to fever or to an acute cerebral etiology.

Patient Information

Epilepsy is a group of disorders characterized by seizures in association with loss of consciousness and psychic abnormalities. The patients of epilepsy may belong to any age group. Early diagnosis and proper management of the disease improves the outcome. Treatment may be done through anti-seizure drugs or brain surgery.

References

Article

  1. Steffenburg U, Hagberg G, Hagberg B. Epilepsy in a representative series of Rett syndrome. Acta paediatrica. Jan 2001;90(1):34-39.
  2. Whalen S, Heron D, Gaillon T, et al. Novel comprehensive diagnostic strategy in Pitt-Hopkins syndrome: clinical score and further delineation of the TCF4 mutational spectrum. Human mutation. Jan 2012;33(1):64-72.
  3. Hauser WA, Annegers JF, Rocca WA. Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clinic proceedings. Jun 1996;71(6):576-586.
  4. Engelborghs S, D'Hooge R, De Deyn PP. Pathophysiology of epilepsy. Acta neurologica Belgica. Dec 2000;100(4):201-213.
  5. Tharyan P. Prolactin levels in epilepsy. The Journal of the Association of Physicians of India. Jun 1991;39(6):505-506.
  6. Goldenberg MM. Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment. P & T : a peer-reviewed journal for formulary management. Jul 2010;35(7):392-415.
  7. Matsuura M. Indication for anterior temporal lobectomy in patients with temporal lobe epilepsy and psychopathology. Epilepsia. 2000;41 Suppl 9:39-42.
  8. Gonzalez-Martinez JA, Gupta A, Kotagal P, et al. Hemispherectomy for catastrophic epilepsy in infants. Epilepsia. Sep 2005;46(9):1518-1525.
  9. Rahimi SY, Park YD, Witcher MR, Lee KH, Marrufo M, Lee MR. Corpus callosotomy for treatment of pediatric epilepsy in the modern era. Pediatric neurosurgery. 2007;43(3):202-208.
  10. Pitkanen A, Bolkvadze T. Head Trauma and Epilepsy. In: Noebels JL, Avoli M, Rogawski MA, Olsen RW, Delgado-Escueta AV, eds. Jasper's Basic Mechanisms of the Epilepsies. 4th ed. Bethesda (MD)2012.

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