Epilepsy

EpilepsyDescription:Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown.Epilepsy is a symptom, not a disease. It may have many causes, some obvious, some unknown. This condition is common and affects one in 200. It is common in all socio-economic groups and in people of all levels of intelligence. It can occur at any age but most sufferers will experience their first fit before the age of 18.The fit, convulsion, seizure, turn or attack is the hallmark of epilepsy. These turns may take various forms.The commonest and most obvious is the grand mal or major fit. This may be preceded by an aura, where the person is aware that he is about to have a fit. The attack comes on suddenly, usually with a cry, and he falls to the ground.There is an initial phase when the breath is held and he goes blue. The muscles are held rigid. This is followed after a number of seconds by involuntary jerking movements. At this time the bladder, or, rarely, the bowels may be used.The medical profession now recognizes about twenty different kinds of epilepsy. These forms of the disorder vary on the basis of severity and the parts of the body affected by the seizure. Most patients have only one form of epilepsy. About 30 percent have two or more forms of the disorder.Experts estimate that about 2 percent of the general population has some form of epilepsy. One in ten Americans experience at least one epileptic seizure at some time in their lives. At least 200,000 Americans have at least one seizure a month.About 125,000 new cases of epilepsy are diagnosed in the United States each year. About a quarter of those cases are diagnosed in children younger than five years old.The two most common types of epilepsy are called tonic-clonic seizures and absence seizures. At one time, these forms of the disorder were better known as grand mal ("great illness") and petit mal ("small illness"). About 90 percent of people with epilepsy experience tonic-clonic seizures, and 25 percent experience absence seizures. Less than 20 percent of patients experience other forms of epilepsy alone or in various combinations.Epilepsy is usually classified as symptomatic or idiopathic. Symptomatic epilepsy is a form of the condition for which a cause is known. For example, a person may receive a blow to the head. The injury may cause damage that leads to the development of epilepsy. Some conditions that can cause symptomatic epilepsy include:Serious infections of the central nervous system.
  • Heat stroke.
  • An abscess (open sore) in the brain.
  • Rabies, tetanus, and malaria.
  • Toxic (poisonous) materials, such as lead or alcohol.
  • Damage to the brain or skull.
  • Drug allergy.
  • Stroke.
Idiopathic epilepsy is epilepsy for which no specific cause has been identified. Some authorities believe that idiopathic epilepsy is caused by damage to a newborn baby's brain during delivery.About 75 percent of all cases of epilepsy are idiopathic. Individuals with this condition usually experience their first seizure between the ages of two and fourteen. Symptomatic epilepsy usually does not appear until later in life, after the age of twenty-five.Symptoms:EpilepsyThe following symptoms may indicate someone has epilepsy. A medical exam is advised if one or more of these symptoms are present. The symptoms include:
  • A convulsion with or without a fever.
  • Short periods of blackout or confused memory.
  • Occasional "fainting spells" in which bladder or bowel control is lost, followed by extreme fatigue.
  • Episodes of blank staring.
  • Brief periods of no response to questions or instructions.
  • Sudden stiffening or falls for no apparent reason.
  • Episodes of blinking or chewing at inappropriate times.
  • Dazed behavior; being unable to talk or communicate for a short time.
  • Repeated movements that look out of place or unnatural.
  • Sudden fear, anger or panic for no reason.
  • Odd changes in the way things look, sound, smell or feel.
  • Muscle jerks of arms, legs or body.
  • Clusters of swift jerking movements in babies.
Conditions that may be mistaken for epilepsy:Seizures associated with high fever.
  • Fainting.
  • Sleep disorders: nightmares, narcolepsy, and cataplexy.
  • Psychiatric disorders: panic attacks, fugue states, psychogenic seizures.
  • Transient ischemic attacks (TIAs): brief interruptions of blood flow to the brain.
  • Migraine headaches.
  • Childhood breath-holding episodes.
Causes and Risk factors:Epilepsy has no identifiable cause in about half of those who have the condition. In the other half, the condition may be traced to various factors.Genetic influence: Some types of epilepsy, which are categorized by your type of seizure, run in families, making it likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, though it's estimated that up to 500 genes could be tied to the condition. For some, genes are only part of the cause, perhaps by making a person more susceptible to environmental conditions that trigger seizures.Head trauma sustained during a car accident or other traumatic injury can cause epilepsy.Medical disorders: Events like strokes or heart attacks that result in damage to the brain also can cause epilepsy. Stroke is responsible for up to one half of epilepsy cases in those over age 65.Dementia is a leading cause of epilepsy among older adults.Diseases like meningitis, AIDS and viral encephalitis can cause epilepsy.Prenatal injury: Fetuses are susceptible to brain damage caused by an infection in the mother, poor nutrition or oxygen deficiencies. This can lead to cerebral palsy in the child. About 20 percent of seizures in children are associated with cerebral palsy or other neurological abnormalities.Developmental disorders: Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome.Risk factors: Certain factors may increase your risk of epilepsy.Your age: The onset of epilepsy is most common during early childhood and after age 65, but the condition can occur at any age.Your sex: Men are slightly more at risk of developing epilepsy than are women.A family history: If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.Head injuries: These injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.Stroke and other vascular diseases: These can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of such diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet and exercising regularly.Brain infections: Infections like meningitis, which causes an inflammation in the brain or spinal cord, can increase your risk of epilepsy.Prolonged seizures in childhood: High fevers in childhood can sometimes be associated with prolonged seizures and subsequent epilepsy later in life, particularly for those with a family history of epilepsy.Complications: Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.Falling: If you fall during a seizure, you can injure your head or break a bone.Drowning: If you have epilepsy, you are more than 15 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.Car accidents: A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment. Many states have driver's licensing restrictions related to your ability to control seizures and impose a minimum amount of time that you've been seizure-free — ranging from three months to two years — before you're allowed to drive.Pregnancy complications: Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you're considering becoming pregnant, talk to your doctor. Most women with epilepsy can become pregnant and have a healthy baby. You'll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It's very important that you work with your doctor to plan your pregnancy.Other life-threatening complications from epilepsy are uncommon, but do occur.Diagnosis:The first goal of diagnosis is to eliminate other possible causes of the patient's symptoms. Other disorders of the brain, such as small strokes, fainting, and sleep disorders (see sleep disorders entry), can be confused with seizure disorders. A doctor needs to eliminate these possibilities before deciding how to treat the patient.One goal of diagnosis is to distinguish between symptomatic and idiopathic epilepsy. In symptomatic epilepsy, it may be possible to provide treatment to cure the disorder. For example, a person may have had a severe allergic reaction to a food or drug. The allergic reaction may be responsible for the epileptic attack. This type of case can be treated by avoiding whatevercaused the attack in the first place. In cases of idiopathic epilepsy, where a cause is not found, other types of treatment are necessary.The primary means of diagnosing epilepsy is the electroencephalogram (EEG). The EEG is a device that measures electrical activity in the brain. The results obtained from an EEG test are recorded on graph paper as a pattern of wavy lines. A doctor is able to read the lines on the paper and determine whether or not the brain is functioning normally. Seizure disorders produce characteristic patterns in an EEG test.Doctors may try to schedule an EEG test during a seizure. They know that flashing lights (like strobe lights) or forcing the patient to breathe very deeply can trigger a seizure in patients with epilepsy. Or the patient may simply be kept in the hospital until an attack occurs. In such cases, the electrical activity of the brain during an attack can be observed and recorded.Treatment:Cases of symptomatic epilepsy are treated by treating the basic cause that brought on the seizure disorder. Treatment of idiopathic epilepsy involves two steps. The first step involves protecting the patient during an attack. The second step involves the use of medications to reduce the frequency and severity of symptoms.Patients with absence epilepsy usually require little protection. They may need help in case they lose consciousness for long enough to lose their balance and fall. Attacks of tonic-clonic epilepsy require somewhat more attention. The patient should be made comfortable during an attack by loosening clothing around the neck and providing a pillow under the head. A soft object, such as a folded handkerchief, should be placed between the teeth. The object prevents the patient from biting his or her tongue. No effort should be made to hold the tongue, however.Several medications are now available for the treatment of epilepsy. Most of these drugs fall into the category of anticonvulsants. That is, they tend to prevent or minimize the shaking and thrashing that accompanies a seizure. Some examples of these drugs are phenobarbital, primidone, and trimethadione.No one drug is effective for all patients or for any one form of epilepsy. In fact, effective treatment of epilepsy requires finding exactly the right dose of exactly the right drug (or combination of drugs) for each individual patient. Most patients go through a period of testing in which various drugs in various combinations are tried. Eventually, the most suitable dose and combination are determined.Medications have made it possible for most patients with epilepsy to lead relatively normal lives. However, there is one problem with drug therapy. Many drugs have side effects that can range from mild to severe for any one patient. The most common side effects are drowsiness, nausea, lethargy, and skin rash.An important aspect of treating epilepsy is teaching the patient and his or her family how to live with the disorder. Patients are encouraged to pursue a normal life with moderate exercise and regular social activities. Families are encouraged not to become overprotective and, insofar as possible, to treat the patient as if he or she had no disorder.Surgery: Intractable seizures are seizures that cannot be controlled without medication or without sedation or other unacceptable side effects. Surgery may be used to eliminate or control intractable seizures. This treatment is not very common as only seizures meeting very specific criteria can be controlled this way.Alternative Treatment: Relaxation techniques can help people with epilepsy avoid some of the pressures that may bring on an attack. Yoga, meditation, hydrotherapy, aromatherapy, and acupressure may be helpful in this regard. These approaches, however, should never be substituted for the patient's regular program of medication.For people with symptomatic epilepsy, dietary changes may be essential. Patients may need to identify the foods to which they are allergic and then eliminate those foods from their diets.Medicine and medications:Medicines to prevent epileptic seizures are called antiepileptics. The goal is to find an effective antiepileptic medicine that causes the fewest side effects.Taking only one antiepileptic medicine prevents seizures in up to 7 out of 10 people with partial seizures. About 8 out of 10 people have complete seizure control when they take more than one antiepileptic medicine. Although many people experience side effects, medicine is still the best way to prevent epileptic seizures. The benefits of treatment with medicine usually outweigh the drawbacks.There are many antiepileptic medicines, but they do not all treat the same types of seizures. The first step your doctor takes in choosing a medicine to treat your seizures is to identify the types of seizures you have.It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dosing of medicine to best manage your epilepsy. The goal is to prevent seizures while causing as few unwanted side effects as possible. After you and your doctor figure out the most effective medicine program for you, it is important that you follow your program exactly as prescribed.Using a single antiepileptic medicine is often better than using more than one medicine. Single medicine use causes fewer side effects and does not carry the risk of interacting with other medicines. The chances of missing a dose or taking it at the wrong time are also lower with just one medicine.When treatment with one medicine does not work, adding a second medicine can sometimes improve seizure control. Also, if you have several types of seizures, you may need to take more than one medicine.Medication Choices: Many medicines are used to treat epilepsy. Some are used alone, and some are used only along with other medicines. Your medicine options depend in part on what types of seizures you have.Medicines that may be used first to treat epileptic seizures include:Carbamazepine (Tegretol, Carbatrol).
  • Ethosuximide (Zarontin), for absence seizures only.
  • Topiramate (Topamax).
  • Oxcarbazepine (Trileptal).
  • Phenytoin (Dilantin, Phenytek) or fosphenytoin (Cerebyx).
  • Valproic acid or divalproex sodium (Depakene, Depakote).
  • Phenobarbital (Luminal Sodium, Solfoton). Phenobarbital is a first-line medicine for newborns.
  • Primidone (Mysoline). The body converts primidone into phenobarbital.
If epileptic seizures continue even though you are being treated, your doctor may prescribe one or more of the following medicines:Felbamate (Felbatol).
  • Gabapentin (Neurontin).
  • Lamotrigine (Lamictal).
  • Levetiracetam (Keppra).
  • Tiagabine (Gabitril).
  • Topiramate (Topamax).
  • Zonisamide (Zonegran).
  • Benzodiazepines (for example, Diastat, Tranxene, Valium).
  • Phenobarbital (Luminal Sodium, Solfoton) (Phenobarbital is a first-line medicine for newborns.).
  • Primidone (Mysoline). The body converts primidone into phenobarbital.
  • Pregabalin (Lyrica). This medicine is intended to be used along with other antiseizure medicine.
Many of the first-line medicines control the same types of seizures equally well. Most antiepileptic medicines can cause nausea, dizziness, and sleepiness when you first start taking them, but these effects usually go away after your body adjusts to the medicine. Liver and blood problems are common to many of them. You may need to have regular blood tests to monitor for these side effects as long as you are taking the medicines.Aside from these common problems, though, the medicines have different side effects, health risks, and costs. A medicine that works for someone else may not work for you.When the more commonly used medicines fail to control seizures or cannot be used for some other reason, you may still have other medicine options.Many new investigational medicines are being developed and tested in clinical trials but are not in regular use yet. One of these might be an option. People with epilepsy who have not responded to standard therapy sometimes choose to participate in these trials. To learn more about clinical trials, talk to your doctor or visit the National Institutes of Health clinical trials Web site at www.ClinicalTrials.gov.There are also a few medicines that are only used for certain rare or severe forms of epilepsy in children. Children with infantile spasms, for instance, may respond to a corticosteroid (such as prednisone), adrenocorticotropic hormone (ACTH), or a medicine called vigabatrin, which has not yet been approved in the United States but has been approved in other countries.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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