Epilepsy is a chronic disorder that affects the brain and causes recurrent, unprovoked seizures.
What are Seizures?
As we know, the human Brain is a complex structure made up of a delicate mix of nerve cells, electrical impulses and chemicals, known as neurotransmitters. The communication between Neurons or Brain cells is through electrical signals producing chemical messengers. Any damage that disrupts the workings of the brain can cause seizures. In a seizure, abnormal bursts of neurons start firing off electrical impulses, which can cause the brain and body to behave strangely. The severity of seizures can differ from person to person. It can be an odd feeling for someone with no loss of awareness, or it can be a “trance-like” state for a few seconds or minutes; while others lose consciousness and have convulsions (uncontrollable shaking of the body).
Epilepsy most often begins during childhood but it can start at any age though it is often not possible to pinpoint why someone develops the condition. In some cases Epilepsy that occurs later in life is associated with damage to the brain.
Epilepsy can be caused by:
1. Cerebrovascular disease caused by a problem that affects the blood supply to the brain.
a. Stroke – When one part of the brain is damaged by a lack of blood supply (clot) or bleeding into the brain from a burst blood vessel (haemorrhage).
b. Subarachnoid haemorrhage where blood leaks out of the brain’s blood vessels on to the surface of the brain below the middle layer of the 3 brain coverings.
2. Brain tumours are growths occurring when cells in the brain multiply in an abnormal, uncontrollable way. It can either be cancerous (malignant) or noncancerous (benign).
3. Severe head injuries which require immediate medical attention because there’s a risk of serious brain damage.
4. Hereditary – gene inheritance.
Certain things or conditions trigger Epileptic seizures. The trigger may be:
*Lack of sleep (sleep deprivation).
*Some medications and illegal drugs.
*In women, monthly periods.
*Flashing lights (this is an uncommon trigger that affects only 5% of people with epilepsy, and is known as photosensitive epilepsy)
*Not eating well, low blood sugar.
*Specific foods, excess caffeine or other products that may aggravate seizures.
It is better to maintain a seizure diary to help find out what might trigger your seizures. Each time you experience a seizure, record it and make a note of what you were doing. Over the time, you might notice some things that seem to trigger your symptoms & can avoid them.
There are two main categories of Epilepsy:
1. Idiopathic (or primary) epilepsy – No apparent cause for epilepsy other than family history can be found, suggesting that the condition is inherited. Research is on for finding out defects in certain genes that may affect electrical transmission in the brain.
2. Symptomatic (or secondary) epilepsy – There is a known cause for a person’s epilepsy (refer causes).
Repeated seizures form the main symptoms of Epilepsy. These can occur when you are awake or asleep. Depending on the area of the brain affected there are many different types of seizure.
1. Partial (or focal) seizures – Only a small part of the brain is affected.
Simple partial seizures: The patient remains fully conscious & there is a feeling of déjà vu, an unusual taste or smell, feeling of fear or joy, pins or needles, stiffness or twitching.
Complex partial seizures: The patient becomes unconscious and cannot remember the event. There is smacking of the lips, rubbing of the hands, moving of the arms, fiddling with objects, chewing or swallowing, unusual postures, and picking at clothes.
2. Generalized seizures – where most or all of the brain is affected.
Absence seizures: They mainly affect children, but can also occur in adults. The patient loses awareness of their surroundings, usually for up to 15 seconds. The patient stares vacantly into space with fluttering of the eyes or smacking of the lips.
Myoclonic seizures: The arms, legs, or upper body jerks or twitches, as if you have received an electric shock only lasting for a fraction of a second.
Clonic seizures: The symptoms will last longer, normally up to two minutes with same sort of twitching as myoclonic jerks.
Atonic seizures: These seizures cause all your muscles to suddenly relax & there is a chance you may fall to the ground and risk injury.
Tonic seizures: The muscles suddenly become stiff causing you to lose balance and fall over.
Tonic-clonic seizures: These convulsions are named grand mal & can have two stages. The body will initially become stiff and then arms and legs will begin twitching. All consciousness is lost, and some people will wet themselves. The seizure normally lasts a few minutes, but can last longer.
3. Unclassified seizures – that do not fit into these categories.
4. Status Epilepticus: It lasts more than 30 minutes and the person does not regain consciousness in between. This is a medical emergency and requires treatment as soon as possible.
Epilepsy cannot be diagnosed quickly. Until more than one seizure is experienced, in most cases, it cannot be confirmed. EEG and MRI are the usual tools employed.
In an EEG test, through electrodes placed on your scalp unusual brain activity associated with epilepsy can be detected by measuring the electrical activity of your brain.
EEG may be carried out even while you are asleep (sleep EEG). You may be given a small, portable EEG recording device to monitor your brain activity over 24 hours (ambulatory EEG).
Magnetic resonance imaging (MRI) scan
In an MRI scan strong magnetic fields and radio waves are used to produce detailed images of the inside of your body. MRI’s tend to be useful in cases of suspected epilepsy because it can detect possible causes of the condition, like defects in the structure of your brain or the presence of a brain tumour.
Even though not everyone with Epilepsy will need to be treated, the treatment is used to control seizures.
1. Medicines: Epilepsy is generally treated at first with Anti-epileptic drugs (AEDs). Nearly 70% of people with the condition are able to control their seizures with AEDs. The most commonly used AEDs are Sodium Valproate, Carbamazepine, Lamotrigine, Levetiracetam, Oxcarbazepine, Ethosuximide & Topiramate.
2. Surgery: If the medicines show no effect to control Epilepsy, you are usually referred to a specialist Epilepsy center where the possibilities of surgery to remove the part of your brain causing seizures without causing much brain damage are evaluated.
3. Vagus Nerve Stimulation (VNS): When the possibilities of surgery are ruled out, implanting a small device under the skin of your chest is an alternative. The device sends electrical messages to the Brain. This is called Vagus Nerve Stimulation.
4. Deep brain stimulation (DBS): Electrodes are implanted into specific areas of the brain to reduce the abnormal electrical activity associated with a seizure in the DBS technique.