What is epilepsy?
The name epilepsy comes from the Greek for "to be seized." Sudden seizure is the hallmark of this illness. It may involve falling to the ground and twitching spasmodically, but not always.
Epilepsy is a neurological condition, which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition like alcohol withdrawal or extremely low blood sugar. Sometimes, according to the International League Against Epilepsy, epilepsy can be diagnosed after one seizure, if a person has a condition that places them at high risk for having another.
The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures, what type they are, or how severe they are
What are Causes of Epilepsy?
Epilepsy is not a disease but rather a symptom of disturbed brain function, which can be caused by many different disease processes. Epilepsy that first appears in adulthood is often due to some localized damage such as poor blood flow to the brain, a brain tumour, or a previous head injury. Epilepsy in children can be brought on by meningitis during infancy or by abnormalities of brain development, but it is often inherited.
We know epilepsy can be passed on genetically, but we don't really understand what's different in the brain of a person with an inherited form of epilepsy. We also don't fully understand what happens to the brain during a seizure. Many people find that particular events tend to trigger seizures. These include:
•alcohol, cocaine and some other drugs
•exposure to flashing or strobe lights
•hormonal changes
•hyperventilation
•insufficient sleep
Different types of seizures
Epileptic seizures are classified according to their particular characteristics:
Partial or focal seizures affect a small area of the brain; the symptoms experienced by the person depend on the area of the brain that is involved:
•In a complex partial seizure, there is some alteration or loss of consciousness. The person can lose track of where they are for a minute or two. A person in such a state may stare, make meaningless sounds, or jerk one or two limbs around automatically. They cannot respond appropriately to questions. For a few minutes afterwards, they're likely to be confused. People experiencing a complex partial seizure may lash out unconsciously at anyone who tries to restrain them.
Generalized seizures affect a larger area of the brain than partial ones:
•Tonic-clonic ("grand mal") seizures involve falling, loss of consciousness, and muscle spasms throughout the body, lasting 1 to 2 minutes. Bladder control is sometimes lost. On regaining consciousness, the person may be very tired and confused. A partial seizure can develop into a tonic-clonic seizure.
•Absence ("petit mal") seizures occur primarily in children and involve a loss of consciousness lasting 10 to 30 seconds. The eyelids flutter. Children don't fall over but aren't aware of their surroundings and will have no memory of what happened during the seizure.
•Myoclonic seizures are brief body jerks that last less than a second. There is no loss of consciousness, but individuals may drop whatever they are holding.
•Atonic or akinetic seizures are sometimes called "drop attacks" because there is a momentary loss of muscle tone causing the person to fall to the ground without losing consciousness. Injuries are common because there is no warning.
•Infantile spasms, which affects only babies, will cause the baby to suddenly bend forward at the neck or waist. Each seizure lasts just a few seconds, but they may occur in clusters. The baby often cries afterwards. A child with infantile spasms tends to have other types of seizures later in life.
•Febrile seizures are quite common in children, affecting 1 in 25 before the age of 5. The child has a fever and a tonic-clonic seizure (there's usually just one brief seizure). You should take the child to the doctor immediately to diagnose the cause of the fever and make sure it is not due to rare but serious conditions such as meningitis.
Diagnosing Epilepsy
If you think you or your child may have had a seizure, see your doctor. You may be asked about your history of seizures, how long they last, when they occur, and how you feel afterwards. Family history may be relevant.
The primary test for epilepsy is the electroencephalogram (EEG). Wires are taped to the head and electrical activity is measured. It's completely painless and can even be performed while the person is asleep.
Computed tomography (CT) scans, positron emission tomography (PET), and magnetic resonance imaging (MRI) create detailed images of the brain. These are essential to check for trauma, tumours, abscesses, and infections such as meningitis that can cause epilepsy.
Treating and Preventing Epilepsy
Anticonvulsant medications will eliminate or reduce seizures in most people. There are several types, and not all of them work in every case. Examples of anticonvulsants include carbamazepine, lamotrigine, phenytoin, topiramate, and valproic acid. A doctor may need to try a few before finding the right one for a given person.
If a person hasn't had a seizure for more than a year, their doctor may want them to slowly stop the medication. Two-thirds of the time, the seizures never return.
Epilepsy originating from a damaged part of the brain may require surgery when medications are not enough. This can sometimes cure the problem.
All women who are sexually active, including those who have epilepsy, should talk to their doctor about folic acid supplements that reduce the risk of birth defects. There are also treatments for the various sexual problems that may accompany epilepsy.
Exercise is generally beneficial to those with epilepsy, and people rarely have seizures during exercise. People with epilepsy should take some common-sense precautions to avoid injury, such as avoiding swimming or bathing unsupervised, operating heavy machinery, or climbing ladders. Although some precautions are necessary, parents should try not to be overprotective. People with epilepsy can lead full, happy, and productive lives.
What is epilepsy surgery?
Epilepsy surgery is a procedure to 1) remove the seizure-producing area of the brain or 2) limit the spread of seizure activity. It can be considered a curative procedure (stopping the seizures) or a palliative procedure (restricting the spread of the seizure). The type of epilepsy surgery you may have depends on the types of seizures you experience, and where they begin in your brain (Fig 1). Curative procedures such as lobectomy, cortical excision, or hemispherectomy are aimed at removing the area of the brain (seizure focus) causing seizures. The goal is to completely remove the seizure focus area without causing brain dysfunction. Palliative procedures, such as corpus callosotomy or vagus nerve stimulation (VNS), prevent the spread of the seizure by disconnecting brain pathways to stop or reduce seizure frequency.
Who is a candidate?
Epilepsy surgery may be an option if you have:
•seizures that are uncontrolled with medications (intractable) or you have severe side effects to the medications
•partial seizures that always start in one area of the brain (localized seizure focus)
•seizures that significantly affect your quality of life
•seizures caused by a lesion such as scar tissue, a brain tumor, arteriovenous malformation (AVM), or birth defect
•seizure discharge that spreads to the whole brain (secondary generalization)
New information- How a new online tool will help epilepsy surgery evaluation
In the August 15, 2012 Neurology ahead of print, Dr. Jette and colleagues, comprising of a group of highly experienced epilepsy specialists from numerous centers across Canada, presented a fascinating study looking at the creation and effectiveness of an online tool to determine if someone is appropriate for an epilepsy surgery evaluation. The authors point out that despite the fact that epilepsy surgery is effective; there is a considerable delay in identifying those patients who should proceed to this aggressive treatment at an earlier point in time. Thirteen national experts rated common clinical epilepsy scenarios for their appropriateness for an epilepsy surgery evaluation individually based on published evidence. The scenarios were then re-rated after a face-to-face expert meeting, and then re-rated again in order to determine a priority list for referring to an epilepsy surgery center for surgery.
The Results…
Of the 2,646 scenarios, 20.6% were appropriate for surgery. In 456 circumstances, an outcome was deemed uncertain and; 61.5% or 1,626 inappropriate scenarios were identified for surgical evaluation. Of the appropriate cases, 55.9% were rated as very high priority.
Not attempting antiepileptic drug treatment was always rated as inappropriate for a referral. A trial of two antiepileptic drugs was usually rated as appropriate, unless seizure-free or not fully investigated. Based on this information a web-based decision tool published at www.epilepsycases.com was created. The investigators concluded that by using the available evidence up to 2008, and the opinions of an expert group of panelists, a web-based decision tool can provide a guide for determining candidacy for epilepsy surgery evaluation. The tool needs to be trialed in a clinical setting with appropriate updates and revisions. This tool is designed for those over the age of 12 years or older with drug resistant focal epilepsy. This tool may also be appropriate in the development of guidelines in other areas of epilepsy care.
Why is this Important?
This study is important because it creates a score able survey sheet in which if an individual has a high score, they are someone who needs to be considered for epilepsy surgery.
This is a clever and innovative manner in which epilepsy surgery evaluations may be able to be better streamlined for potential referring to neurologists across the world. Clearly, more work and research is necessary in order to make certain that patients are not lost or inappropriately sent to centers. However, this is a promising start to deal with a lingering problem that continues to plague so many individuals with epilepsy.
This tool can be found in this address:
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