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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.

Cerebral Palsy
  • palsy and severe intellectual disability as well as multifocal epilepsy.[ncbi.nlm.nih.gov]
  • Review: The prevalence of epilepsy in Ukraine amounts to 25 695 children (3.21%), higher than the prevalence of cerebral palsy or neuroinfections, the average value for 5 years is 24 667 children (3.144%).[ncbi.nlm.nih.gov]
  • 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.[mayoclinic.org]
  • palsy Mental disabilities Seizures occurring within days after head injury Family history of epilepsy or fever-related seizures Alzheimer's disease (late in the illness) Lengthy fever-related (febrile) seizures Alcohol or drug abuse A doctor makes his[aans.org]
  • "Epilepsy in patients with cerebral palsy". Developmental Medicine & Child Neurology . 39 : 659–63. doi : 10.1111/j.1469-8749.1997.tb07359.x . PMID 9352726 . a b Bromfield EB (2006). An Introduction to Epilepsy . American Epilepsy Society.[en.wikipedia.org]
Cyanosis
  • In addition to the typical features of PTHS, the girl also had paroxysms of tachypnea followed by cyanosis and recurrent seizures.[ncbi.nlm.nih.gov]
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]
Urinary Incontinence
  • At 14 years old, she experienced an aggravated seizure, manifesting as unconsciousness, hyperventilation, and urinary incontinence.[ncbi.nlm.nih.gov]
Visual Hallucination
  • The cortex is the outer layer of the brain, and seizure symptoms can vary from unusual sensations to visual hallucinations, emotional changes, or convulsions.[everydayhealth.com]
  • Types of auras include: Vision (visual): Visual auras can be simple, such as seeing bright flashes of light, dark spots, or tunnel vision, or they can be complex or experiential, such as blindness, visual hallucinations , illusions, and distorted scenery[verywell.com]
Anxiety Disorder
  • An estimated one out of every three people who have epilepsy will develop clinical depression at some point in their lives, which is often accompanied by an anxiety disorder. Treatment for these issues, however, can help.[verywell.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]
  • Exogenous estrogens might lead to seizure worsening in women with epilepsy (WWE) by lowering the seizure threshold and inducing glucuronidation in women taking lamotrigine.[ncbi.nlm.nih.gov]
  • 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]
  • The second patient initially had nonreflex seizures arising from the left temporal lobe and went on to develop reflex seizures upon exiting water.[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]
  • Our case showed rare manifestations and special EEG features of PME, which may be confused with occipital epilepsy or photosensitive epilepsy.[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]
  • 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]
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]
  • It may also result in involuntary jerking of a body part, such as an arm or leg, or spontaneous sensory symptoms, such as tingling, dizziness and flashing lights.[uchospitals.edu]
  • Before a seizure begins, some people experience dizziness or emotional changes. They also may experience changes in vision (such as hallucinations), smell (smelling an odor that isn’t there), and touch (such as numbness or tingling).[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]
Aura
  • Although an aura may signal a seizure only seconds before it occurs, an aura and a seizure may be separated by as much as an hour.[verywell.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]
  • She took estradiol valerate 4 mg for 10 days for endometrial preparation for embryo transfer and had the only seizure over six years, with the exception of auras during advanced pregnancy, related to marked decrease of lamotrigine blood levels.[ncbi.nlm.nih.gov]
  • Aura Stage For some types of seizures, an aura happens before a seizure and may alert a person that a seizure may occur. Auras typically begin seconds before the seizure.[uchospitals.edu]
  • 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]
Staring Spells
  • During the seizure, a person may have a staring spell, be unaware of his or her surroundings, suddenly stop talking or moving, or have small changes in muscle 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]
  • Childhood Absence Epilepsy (CAE) People with this epilepsy syndrome have staring spells that last 10 to 20 seconds and then end abruptly. This was previously called “petit mal” epilepsy and is most common in children.[everydayhealth.com]
  • 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]
  • 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 or deja vu Symptoms vary depending on the type[mayoclinic.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
  • Electroencephalography showed spike-slow waves and slow waves with mixed asynchronized spike waves originating from the frontal lobe during the sleep stage. Transient outbreaks of spike-slow complex waves (1-2 s) were also noted in all leads.[ncbi.nlm.nih.gov]
  • 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]
  • Electroencephalography (EEG) showed progressively slowed background activity and sporadic generalized spike-and-wave discharges.[ncbi.nlm.nih.gov]
  • Her EEG showed slow background with continuous occipital small spikes and photosensitivity. The following genetic testing with mutation in CLN6 confirmed the diagnosis and excluded the occipital epilepsy.[ncbi.nlm.nih.gov]
  • The presence of massive myoclonus, intellectual disability, or slowing of the EEG background are not typical features of the syndrome and may cause delay in making the correct diagnosis.[ncbi.nlm.nih.gov]
Suppression
  • (WM-suppressed), and gray-white matter tissue border enhancement (GW-TBE) MPRAGE sequences.[ncbi.nlm.nih.gov]
  • This surgery should focus initially on well circumscribed lesions that do not require sophisticated methods of investigation and can be removed relatively easily, with a high probability of seizure suppression.[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
  • Through an accurate Video-EEG polygraphic analysis, we demonstrated that seizures are related to an abnormal increase of epileptiform activity after eye-closure or loss of fixation as observed in the Fixation-Off Sensitivity (FOS) phenomenon.[ncbi.nlm.nih.gov]
  • 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]
3 Hz Spikes
  • Epilepsy Synonyms Seizure disorder Generalized 3 Hz spike-and-wave discharges on an electroencephalogram Specialty Neurology Symptoms Periods of vigorous shaking, nearly undetectable spells [1] Duration Long term [1] Causes Unknown, brain injury , stroke[en.wikipedia.org]
Multifocal Spikes
  • Electroencephalography showed multifocal spikes over the right frontal, temporal and parietal regions. The seizure frequency decreased dramatically after tumorectomy.[ncbi.nlm.nih.gov]

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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Last updated: 2017-08-09 18:13