What is Epilepsy?
Epilepsy represents a diverse, yet common set of chronic neurological disorders whose main characteristic is the presence of seizures. There are some definitions that point out the fact that the seizures have to be unprovoked and recurrent in order to be categorized as epilepsy. On a different note, there are others that point out to the link between the first seizure and future ones due to potential brain alternations.
The seizures represent a result of an excessive, hypersynchronous, or abnormal brain activity. Some statistics reveal that there are approximately fifty million individuals that suffer from epilepsy and that eighty percent of the cases occur in developing countries. It is suggested that the disorder has increased chances of development with age. Its onset is more frequent in elderly and infants.
From a historical point of view, this disorder has affected human beings since the down of species and has been observed and written about even in the first medical documents. There are even some certain medical writings that generated too much controversy. The first book about epilepsy was written by the Hippocrates, a Greek philosopher that lived in 400 B.C. Its name was “On the Sacred Disease” and tried to come against the idea of those times that epilepsy was a curse from a prophetic power. Hippocrates states: “It is with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause like other affections.”
There are some who see the references even in the Gospel according to Mark (9:14-28) in which Jesus manages to save a young man that suffered from epilepsy and was believed to have a demon in him. “‘Teacher, I brought my son to you, for he has a spirit that makes him mute. And whenever it seizes him, it throws him down, and he foams and grinds his teeth and becomes rigid. So I asked your disciples to cast it out, and they were not able.’ And he answered them, ‘O faithless generation, how long am I to be with you? How long am I to bear with you? Bring him to me.’ And they brought the boy to him. And when the spirit saw him, immediately it convulsed the boy, and he fell on the ground and rolled about, foaming at the mouth. And Jesus asked his father, ‘How long has this been happening to him?’ And he said, ‘From childhood.’ “
Later on, in 1904, the term “epileptologist” was introduced and described an individual specialized in epilepsy. In 1968, the Epilepsy Foundation of America is created and since then, people have fought against this terrible disorder, either by making patient’s life easier or by trying to combat it.
Depending on the type of seizures, the etiology of this disorder varies. Even though the exact cause behind its development isn’t currently identified, there are a series of factors that contribute to its apparition. For instance, there are the symptomatic seizures that are called like this when their apparition can be linked to brain abnormalities or identifiable diseases. On the other hand, there are the cryptogenic seizures in which there is no connection with the brain. Generally, the primary or idiopathic seizures are diagnosed when a genetic cause is possible. Similar terms are also utilized when there is the necessity of classifying epilepsy depending on the cause.
On a much concrete level, the causes behind the seizures are further divided into acute and remote. The acute cause refers to the connection with an active brain disease, while the remote cause represents a result from an injury that was determined by an event that happened in the past. For instance, when a child that suffers from meningitis has a seizure throughout the illness, the term “acute symptomatic seizures” would be used to describe its situation. On the same note, if the same kid had seizures four years after he was cured, the term would be “remote symptomatic epilepsy.”
Additionally, there are some potential causes behind the apparition of epilepsy and they depend on the age of the patient. When it comes to newborns, factors like deprival of oxygen during birth, maternal drug utilization, inborn metabolism errors, intracranial hemorrhage, or brain malformations are taken into account because they have the highest influence on the possibility of developing epilepsy. For children or adults, the possible negative influence are head traumas, progressive brain disease (although it’s rare), congenital conditions including tuberous sclerosis, Dorn Syndrome, neurofibromatosis, Angelman’s syndrome, and some genetic factors. Elders generally develop this disorder as a result from Alzheimer’s disease, head trauma, or strokes.
Signs & Symptoms
Considering the fact that epilepsy is often determined by an abnormality in the brain cells activity, the seizures may affect any process that is linked to the brain. Among the most commons symptoms of patients who suffer from epilepsy there are uncontrollable jerking moves in the legs and arms, psychic symptoms, loss of awareness as well as consciousness, temporary confusion, and a starring spell. However, there are linked to the form in which the seizure is experienced. In most of situations, an individual that has this disorder is more likely to have similar seizures at various times; the symptoms experienced will be relatively similar.
In addition, there are some classifications of seizures. There are the generalized seizures and the focal seizures. The first ones affect all brain regions. There are six of this type which go as followed; absence, tonic, clonic, myoclonic, atonic, and tonic-clonic. The second ones only affect a specific region of the brain and are also divided into two categories: dyscognitive focal seizures and simple focal seizures.
People who experience any type of seizures, either as symptom of medical condition or out of the blue, should immediately contact a personal healthcare provider, particularly if the individual has had previous health problems.
As it was previously mentioned, if any type of seizure is experienced, a personal doctor should be visited in order to properly diagnose its cause. The doctor will first ask for the patient’s medical history. This is soon followed by a series of test that include neurological examination and blood tests. The neurological examination implies the behavioral, mental functioning, motor abilities as well as other regions so the type of epilepsy can be chosen. For the blood test, the specialized doctor usually takes a blood sample that is meant to reveal any potential medical or genetic condition and infections that may be directly associated with this disorder.
Additional tests like electroencephalograms, computerized tomography or CT scans, magnetic resonance imagining (MRI), positron emission tomography, single-photon emission computerized tomography, or functional MRI (fMRI) may be required for a better analysis, specifically if the cause behind it is uncertain. The most common of these is the electroencephalogram in which doctors attach a series of electrodes to the scalp by using a paste-like substance. The electrodes are then used to record the electrical activity of the brain. As compared to healthy people, an individual that suffers from epilepsy has changes in the pattern of brain waves. This change occurs even if there is no seizure at that moment. The doctors can monitor these waves even if the patient is asleep. When a seizure takes place, the modification in brain wave pattern helps the doctors identify the cause behind its development, thus increasing the chances of treating it.
Treatment for Epilepsy
The first step in treating epilepsy is medication. If this approach doesn’t help the patients, another type of treatment or surgery is the next best approach. Most of the individuals that suffer from this disorder may become seizure-free when an anti-seizure medication treatment is followed. This includes taking anti-epileptic medication. Additionally, the intensity and frequency of the seizures can also be decreased when the proper treatment is taken. More than fifty percent of children that suffered from epilepsy and haven’t experienced any type of seizures in a long period of time can interrupt medication and continue their lives seizure-free.
However, finding the proper treatment is a complex process that requires a specialized intervention. It is important that people don’t take medication according to what they read online or heard from some people, but that they visit a doctor so that further complications can be avoided and the treatment ends up being a success. Factors like frequency of seizures, age, sex, or physical condition are taken into account before a treatment is decided. Furthermore, any other previous medication that the individual was taking will be renewed so interactions can be avoided. For the first time, the doctor will prescribe an easy drug in low amounts in order to observe the evolution of the condition. If the person responds well to treatment, these parameters will be kept. Otherwise, the dose may be increased or the drug swapped.
Unfortunately, most of the anti-seizure medication prescribed nowadays comes with a series of side effects. The mild side effects are skin rashes, speech impairments, coordination loss, thinking and memory problems, weight gain, fatigue, dizziness, and loss of bone density. The rare, but more severe side effects that may occur throughout treatment include suicidal behavior and thoughts, severe rash, depression, and inflammation of some bodily organs such as the liver. These side effects are more likely to be prevented if the patient takes the pills as they were prescribed, addresses the doctor prior to switching to another version of the drug or taking alongside certain herbal remedies or over-the-counter-drugs, notify a specialized healthcare provider if increases in depression, suicidal thoughts, or increase in migraine number are observed, and don’t interrupt the treatment without a specialized consult.
Chances are that fifty percent of the individuals that get epilepsy diagnose will become seizure-free after the first series of medication. In case the initial treatment doesn’t work, the doctor can recommend other therapies or surgery. Moreover, regular follow-up appointments meant to evaluate one’s medication and condition will be established to provide the best care for epileptics. Some of these therapies are ketogenic diet which refers to eating foods that are high in fats, but low in carbohydrates and vagus nerve stimulation in which doctors implant a device named a vagus nerve stimulator underneath the chest which can reduce seizures by twenty to forty percent.
There are some rare situations in which neither drug nor therapy helps the individual and the only solution that remains is surgery. These cases are generally avoided because the surgery may irremediably damage the brain.
“Patient Fact Sheet Epilepsy” American Academy of Neurology, retrieved january 24, 2013
“Epileptic seizures and epilepsy: definitions proposed by the international League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE)”
“Epilepsy: a comprehensive textbook” (2nd ed. ed) written by Woltern Kluwer Health/ Lippincott Williams
“On the Sacred Disease” written by Hippocrates