Epilepsy - Causes, Symptoms, Diagnosis, Prevention & Treatment

Epilepsy: A Neurological Disorder

Authored by Dr.Mohan Rao on 25 Jun 2015 - 13:45

Epilepsy

Epilepsy is a neurological disorder characterized by excessive and abnormal activity of cortical nerve cells in the brain leading to seizure. It is neither contagious nor caused due to mental retardation. It can be experienced at any time affecting an individual’s daily life. It may also be responsible for causing unfortunate events such as drowning, falling, road accidents and emotional health issues.

Epilepsy can be caused by illness to the brain, abnormal development of brain or genetics may also have a role. Diseases like stroke, Alzheimer’s and heart failure can also lead to Epilepsy. Other causes include injury and poisoning.

Mechanism of Seizure:

For a normal human, neurons in the brain conduct impulse in a non-synchronous way. In contrast, neurons in epileptic patients conduct excessive, abnormal impulses in a synchronous manner due to functional or structural defects in the brain.

Usually an excessive impulse is resisted by brain pathways, but due to modification of inhibitory neurons in epileptic patients, resistance is lowered which finally leads to seizures.

Seizure is the hallmark symptom of Epilepsy, which may be experienced occasionally in some patients and multiple times in others. Symptoms vary in patients based on the type of seizure experienced:

Partial seizure:

Smaller area of one side of brain is involved in partial seizures. 60% of all epileptic patients experience this type of seizure. These are further divided into two types:

  • Simple focal seizure: Patient remains conscious but experiences sudden unexplainable unusual feelings. He may also smell, taste, hear or see the things which are not real.
  • Complex focal seizure: In this type of seizure, consciousness is either lost or altered and patient experiences automatisms (strange repetitive behaviors like blinks, twitches, mouth movements), and auras (sensations that warn of a seizure).

Generalized seizure:

These are due to abnormal activity in both sides of the brain causing loss of consciousness, muscle spasms and falls. These are further divided into several types:

  • Absence (or petit mal) seizure: person may stare into space or have jerking or twitching muscles.
  • Tonic seizure: stiffening of muscles of the back, arms and leg takes place.
  • Clonic seizure: repeated jerking movements of muscles on both sides of the body.
  • Myoclonic seizure: jerking or twitching of the upper body, arms or legs.
  • Atonic seizure: loss of normal tone of muscles causing fall downs.
  • Tonic-clonic (or grand mal) seizure: causes a mixture of symptoms ranging from stiffening to jerking with loss of consciousness.

 

 

 

Diagnosis is primarily based on the clinical history taken from a person who has witnessed the events experienced by the patient. There are many tests to assist in the diagnosis:

Neurological examination: Behavior, motor abilities and other aspects of the patient are examined to diagnose the condition and to determine the type.

Blood tests: Sodium, potassium and blood sugar levels are determined to know the cause of seizure. These tests may also help in selection of appropriate drug based on the laboratory data.

Electroencephalogram (EEG): this is most commonly used test in the diagnosis of Epilepsy. Electrodes are attached to the scalp of the patient and electrical activity of the brain is monitored on a screen.

CT-scan: an X-ray image is obtained through computed tomography for finding any physical abnormalities in the brain.

Magnetic resonance Imaging (MRI): abnormalities or lesions if present in brain are determined with the help of this test.

Positron Emission Tomography (PET): radio-active material is injected into vein in small quantity to help visualize active areas of the brain and detect abnormalities.

Single-Photon Emission Computed Tomography (SPECT): this is similar to PET but gives more detailed information. Pinpoint location of seizure origination and 3D view of blood flow during seizure can be obtained by this test.

 

It is most commonly associated with:

  • Age:Early childhood or after 60 years of age
  • Family history of seizure
  • Head injury
  • Stroke and vascular diseases
  • Brain infection
  • Dementia
  • Childhood seizure

Medications which are used in the treatment of Epilepsy are known as anti-epileptic drugs. These drugs can either completely treat the condition or decrease the frequency of seizure episodes. Treatment usually consists of long duration which may last for years. Treatment starts with a single drug on a low dose, to avoid adverse effects. Treatment progress in patient is closely monitored to decide whether the drug needs to be changed or an additional drug is needed to treat the condition.

Anti-epileptic medications are divided into several categories based on their mechanism of action:

  • Sodium channel blockers: Carbamazepine, Phenytoin, Oxcarbazepine
  • GABA receptor agonists: Clonazepam, Phenobarbital
  • GABA re-uptake inhibitors: Tiagabine
  • GABA transaminase inhibitors: Vigabatrin
  • Glutamate blockers: Topiramate, Perampanel
  • Neuronal potassium channel openers: Ezogabine
  • T-calcium channel blockers: Valproate
  • Enhancers of sodium channel inactivation: Lacosamide, Rufinamide
  • N-methyl D-aspartic acid inhibitors: Felbamate

Surgery: It can give a permanent relief or may decrease the number of medications required to control the disease. It is recommended only when the seizure origination point in the brain is away from vital areas related to speech, language and motor functions.

Vagus nerve stimulation: A device known as vagus nerve stimulator is implanted underneath the skin of the patient’s chest which is connected to a battery. It sends bursts of electrical energy through the vagus nerve.

Ketogenic diet: Food high in fats and low in carbohydrates is effective in the treatment of seizure, but it may lead to dehydration, constipation, slowed growth because of nutritional deficiencies and buildup of uric acid in the blood, which can cause kidney stones. 

Lifestyle modifications:

  • Get enough sleep as seizure can be triggered by lack of sleep.
  • Regular exercises may keep you fit and reduce your depression.
  • Avoid driving your vehicle.
  • Avoid alcohol consumption as it may increase episodes of seizure.

 

 

 

Epilepsy can sometimes be prevented by considering the following:

  • Proper prenatal care should be given to avoid epilepsy in the new-born.
  • Complete immunization in childhood may help reduce the risk.
  • Avoid traumatic head injuries
  • Treat risk factors such as physical inactivity, high blood pressure, diabetes, obesity, high cholesterol, and smoking to lessen the likelihood of stroke and heart disease, which may help to decrease the probability of developing epilepsy later in life.
*Disclaimer This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.