Help for Patients and Caregivers

What is Epilepsy?

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness. During a seizure, neurons may fire as many as 500 times a second, much faster than normal. In some people, this happens only occasionally; for others, it may happen up to hundreds of times a day.

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Common Symptoms

While many  types of repetitive behavior may represent a neurological problem, a doctor needs to establish whether or not they are seizures.

 Generalized seizures: All areas of the brain (the cortex) are involved in a generalized seizure. Sometimes these are referred to as grand mal seizures.

·         The person experiencing such a seizure may cry out or make some sound, stiffen for several seconds to a minute and then have rhythmic movements of the arms and legs. Often the rhythmic movements slow before stopping.

·        Eyes are generally open.

·         The person may appear to not  be breathing and actually turn blue. This may be followed by a period of deep, noisy breathes.

·         The return to consciousness is gradual and  the person may be confused for quite some time –minutes to hours.

·         Loss of urine is common.

·         The person will frequently be confused after a generalized seizure.

Partial or focal seizures: Only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary. 

·         If the part of the brain controlling movement of the hand is involved, then only the hand may show rhythmic or jerky movements.

·         If other areas of the brain are involved, symptoms might include strange sensations like a full feeling in the stomach or small repetitive movements such as picking at one's clothes or smacking of the lips.

·         Sometimes the person with a partial seizure appears dazed or confused. This may represent a complex partial seizure. The term complex is used by doctors to describe a person who is between being fully alert and unconscious.

Absence or petit mal seizures: These are most common in childhood.

·         Impairment of consciousness is present with the person often staring blankly.

·         Repetitive blinking or other small movements may be present.

·         Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day

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Whats Causes Epilepsy/Seizures

The causes of epilepsy can be divided into two groups: brain injuries and chemical imbalances in the brain. Anything that injures the brain can lead to seizures. But in over half the cases no cause can be identified.

The type of injury that can lead to a seizure is age-dependent. Seizures in children often are caused by birth traumas, infections, such as meningitis, congenital abnormalities or high fevers. Seizures in the middle years commonly are caused by head injuries, infections, alcohol, stimulant drugs or medication side effects. In the elderly, brain tumors and strokes cause a higher proportion of seizures.

Not all seizures result from a structural problem in the brain. Chemical imbalances also can cause seizures. Common chemical imbalances that can produce seizures include drugs like alcohol, cocaine and others, low blood sugar, low oxygen, low blood sodium or low blood calcium. Kidney failure or liver failure can also produce seizures. Doctors will evaluate you for these imbalances by taking a careful history and doing blood tests. Although these disorders and injuries can explain many cases of epilepsy, often the cause of epilepsy remains idiopathic, which is the medical term for unknown. About half the time no cause for seizure can be identified. Fortunately, we do not need to know the cause to treat the seizures.

Scientists increasingly recognize the importance of genetic factors in the origin of epilepsy. Genetics or heredity are most relevant to generalized seizures, including absence, generalized tonic-clonic and myoclonic seizures. Defects in genes don't directly lead to epilepsy, but they can alter the excitability of brain in a way to predispose to the seizures. Typically, epilepsy develops because of multiple gene abnormalities or because of a gene abnormality in concert with an environmental trigger.

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Treatments/Medications

Medications:

Decisions about seizure or epilepsy medication should be made by the patient or parent/guardian and the physician, using a risk-benefit analysis. There is no “correct” dose of medication to treat seizures or epilepsy – the proper dose of medication is the one that controls a seizure without significant side effects.

The risks and consequences of each medication vary with:

·         The type of medicine

·         Dosage

·         Individual’s reaction to the medication

·         Other medications and medical conditions

·         Age of the patient

·         Length of time the patient takes medication

·         Type and frequency of seizures

·         The time of day the seizures occur

The brain is a complex organ, and since the interactions occurring inside it cannot be accurately simulated in a lab, it is hard to identify the best medication for treatment. The only way to determine the best treatment for each patient is through appropriate medication trials.

 Surgery:

Many people consider surgery – especially brain surgery – as the last alternative if all other treatment methods are not effective. In reality, surgery should be among the first options considered if early trials with anticonvulsant medications are ineffective.

If seizures occur in one area of the brain, and that area can be removed easily and without causing other problems, surgery should be considered. If epilepsy is caused by a tumor, cyst, lesion or other growth that won’t respond well to medication, your physician can help patients decide if surgery is an appropriate option.

There are three main surgery's done for Epilepsy Seizures.These consist of:

·         Focal Resection

·         Hemispherectomy

·         Corpus Colostomy                                                                  

There is alsoVagus nerve stimulation (VNS). It is designed to stimulate the vagus nerve by using a small pacemaker-like device placed in the chest. VNS has been proven to increase inhibition in the brain’s cortex; therefore, reducing the likelihood of seizures. 

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Additional Information