SEIZURES (EPILEPSY)

A sudden, uncontrolled electrical disturbance in the brain is seizure. There are misfiring in the nerve cells in the brain. In case of two or more seizures or recurrent seizures it is labelled as epilepsy. It can change behaviour, movements or feelings and level of consciousness. Epilepsy is the fourth most common neurological disorder that affects people of all ages. About 65 million people around the world have epilepsy and one third of these live with uncontrollable seizures because no available treatment works for them. Epilepsy is characterized by unpredictable seizures and can cause other health problems. It is a chronic disease and often the cause is completely unknown.     

Most seizures last from few seconds to 2 minutes. Any seizures longer than five minutes is considered as medical emergency. There are several types of seizures that vary in severity depending on the site of initiation in the brain.  

Symptoms:

Seizures can affect any process that brain coordinates. The symptoms and signs of epilepsy may include the followings:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerky movements of the arms and legs
  • Loss of consciousness
  • Loss of awareness
  • Psychic symptoms such as fear, anxiety and déjà vu 

The symptoms vary depending on the type of the seizures. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar in each episode.

Focal Seizures:

The abnormal activity in just one area of the brain happens in Focal seizures with or without loss of consciousness. There could be alteration of emotions, alteration in smell, feelings, taste and sound. There may be jerky movements in arms or legs and symptoms like dizziness, tingling and flashing lights. Focal seizures with impaired awareness may involve loss of consciousness or awareness. A person may stare into space or perform repetitive tasks like hand rubbing, chewing, swallowing or walking in circles.

These focal seizures may be confused with migraine or mental illness.           

Generalized Seizures:

Generalized seizures involve all areas of the brain and are characterized into six different types based on the symptoms.

  1. Absence seizures: It often occurs in children and patient has a staring look, eye blinking or lip smacking. These seizures may occur in clusters with brief loss of awareness.
  • Tonic seizures: It causes stiffening of muscles of arm, leg or back and person may fall on the ground.
  • Atonic seizures: There is loss of muscle control and person can suddenly fall or collapse.
  • Clonic seizures: Repeated or rhythmic jerky movement of the muscles. It usually affects face, neck and arm.
  • Myoclonic: Sudden brief jerks or twitches of arms and legs.
  • Tonic-clonic seizures: Most dramatic type of epilepsy with loss of consciousness. Body stiffening and shaking. It can also cause urinary incontinence or tongue biting.   

If the person has any one of the following conditions, he should be urgently referred to the doctor:

  • Any seizure lasting for more than 5 minutes.
  • An immediate second seizure after the first episode.
  • Consciousness does not return after seizure stops
  • Person with high fever
  • Pregnant females
  • Patient with diabetes
  • Injury after any seizure.  

Causes:

In majority of cases there is no identifiable cause of epilepsy. However, in few cases the following conditions may lead to epileptic seizures.

  1. Genetic: Certain types of epilepsy are due to genetic influence. It runs in families due to higher susceptibilities to environmental conditions that trigger seizures.
  2. Head Injury: Head injury due to accident or any other trauma can lead to epilepsy
  3. Brain diseases: Brain tumors and strokes can cause epileptic attack. Stroke is a leading cause of epilepsy in adults above 35 years.
  4. Infectious diseases:  Encephalitis, meningitis, AIDS etc are some of infectious diseases that causes epilepsy.
  5. Developmental disorders: Few developmental disorders in children like autism, neurofibromatosis are associated with high incidences of epilepsy.  
  • Prenatal injury: The brain damage of fetus before birth can cause epilepsy in later years of life. This could be due to infection in mother during pregnancy, poor nutrition or oxygen deficiency during intra-uterine life.  

Besides above causes the potential risk factors for epilepsy are dementia and seizure      in childhood. High fever in childhood can be associated with seizures.

         Complications:

           Epileptic seizures can lead to dangerous situation that could be lethal for the patients.

  1. Falling: There could be head injury or severe fractures after fall during seizures.
  2. Drowning: There is a high risk of drowning for epileptic patients while swimming or bathing.
  3. Road accidents: There is high chance of road traffic accident due to seizures that causes loss of awareness or consciousness. Person should refrain from driving for few months to years after control of seizures depending on his doctor’s advice.
  4. Complications during pregnancy: Seizures during pregnancy are dangerous for both mother and baby. Moreover, certain anti-epileptic drugs increase the risk of birth defects. Female patient with epilepsy should discuss with her doctor before planning for pregnancy.     
  5. Emotional problems: The patients with epilepsy develop psychological issues like depression, anxiety and suicidal thoughts.
  6. Status epilepticus: This is a life threatening complication of epilepsy that occurs as a state of continuous seizure lasting more than five minutes or recurrent seizures without regaining full consciousness in between them. It can lead to increased risk of brain damage or even death.
  7. Sudden unexpected death in epilepsy (SUDEP): There is a small risk of sudden unexpected death in patients with epilepsy. This may be due to cardiac or lung conditions. The risk is higher in patients with tonic clonic seizures or people who do not respond to medications.     

     Diagnosis:

Epilepsy is diagnosed by detailed medical history and neurological examination by the physician or neurologists. There could be few blood tests that can be recommended to exclude other conditions like infections or genetic conditions. Neurologist may suggest the following investigations to diagnose this disease.

  1. Electroencephalogram (EEG): This is the most common tests done to diagnose epilepsy. An EEG is used to check for unusual electrical activity in the brain. A sensor (electrode) is placed to the scalp and electrical signals are recorded through a machine to identify any abnormal signals.
  2. CT scan of brain: CT scan help diagnose any underlying disease in the brain that can cause epileptic seizures. This could be brain tumor, bleeding, cysts, stroke or scarring in the brain.    
  3. Magnetic Resonance Imaging (MRI): MRI uses magnetic fields and radio waves to create an image of the brain.  
  4. Positron Emission Tomography (PET): PET scans visualize active areas in the brain and identify abnormalities in the brain.

          Treatment :         

Most of the patients with epilepsy are recommended to take oral anti-epileptic medications. Majority of patients respond to one anti-seizure medication whereas few of them require combinations of medications to decrease the frequency and intensity of seizures. Many adults can discontinue medications after two or more years without seizures. Many children with epilepsy live a seizure free life and eventually discontinue medications. The physician/neurologist will suggest the appropriate time to stop these medications.

Selection of right medicine for epilepsy depends on several factors like age, frequency & intensity of seizures, type of epilepsy and any other concomitant illness or condition. The initial prescription of drug is usually as single drug in lower dosage. The dosage can be gradually increased depending on the tolerance and clinical response till the seizures are well controlled. The best treatment outcome can be achieved with few important facts as:

  • Regular adherence to the prescribed medication (s)
  • Inform your doctor in case of switching to any other brand or generic version of the same drug.
  • Do not miss the dosage
  • Get enough sleep
  • Wear a medical alert bracelet
  • Exercise
  • Manage stress
  • Limit alcoholic beverages
  • Avoid tobacco & smoking
  • Inform your doctor in case of any new symptoms like depression, suicidal thoughts, and mood changes.

Anti-epileptic drugs may have following side effects:

  • Fatigue
  • Dizziness
  • Weight gain
  • Loss of bone density
  • Skin rashes
  • Loss of coordination
  • Speech problems
  • Memory and thinking problem.

In case of lack of response with anti-epileptic medicines, doctor may suggest for surgery or other therapies. In surgery, surgeons removes the area of brain that causes seizures. The patient undergone surgery may require lower dosage of fewer anti-epileptic medications Few other treatment modalities in epilepsy include vagus nerve stimulation, ketogenic diet, and deep brain stimulation. These treatments are given only after proper assessment of the disease condition and failed cases to drug treatment.         

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