Epilepsy

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What is Epilepsy?

Epilepsy is a disorder of central nervous system or a neurological disorder characterised by abnormal brain activity that leads to seizures and sometimes loss of awareness.

Causes & risk factors of Epilepsy

  • Head trauma or sudden blow to the head.
  • Brain tumours or brain stroke.
  • Infectious diseases like meningitis, AIDS and viral encephalitis.
  • Injuries before birth or prenatal injury.
  • Having family history of Epilepsy.
  • Dementia can increase the risk of epilepsy in older adults.

Symptoms of Epilepsy

  • Temporary confusion
  • A brief seizure, usually less than 15 seconds, also known as staring spell.
  • Uncontrollable & jerking movements of the arms and legs.
  • Loss of awareness.
  • Fear, anxiety

Types of Seizures

Doctors generally classify seizures either focal or generalized, based on how the abnormal brain activity begins.

Focal Seizures

Focal Seizures occur when there abnormal activity in just one area of brain.

These seizures are of two types:

  • Focal seizures without loss of consciousness. They may change the way things look, smell, feel, taste or sound & may also result in involuntary jerking of a body part, such as an arm or leg but don’t cause a loss of consciousness. They were once called simple partial seizures.
  • Focal seizures with impaired awareness. These seizures involve a change or loss of consciousness or awareness. & were once called complex partial seizures.

Generalized seizures

Generalized seizures involve all areas of the brain.

Types of Generalized seizures.

  • Absence seizures also known as petit mal seizures. They usually occur in children and involve subtle body movements such as eye blinking or lip smacking.
  • Tonic seizures – These usually affect muscles in your back, arms and legs.
  • Atonic seizures – Also known as drop seizures, atonic seizures can cause a loss of muscle control, which may cause sudden collapse.
  • Clonic seizures – Clonic seizures involve repeated or rhythmic, jerking muscle movements.
  • Myoclonic seizures – These usually involve sudden brief jerks.
  • Tonic-clonic seizures – These were previously known as grand mal seizures, can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting the tongue

Diagnosis of Epilepsy

  • A neurological exam is done to check the behaviour, motor abilities and mental function & determine the type of epilepsy.
  • Blood tests to check for signs of infections.
  • Electroencephalogram (EEG) – Electrodes are attached on the brain scalp which help to record the electrical activity of the brain.
  • Computerized tomography (CT) scan reveals abnormalities in the brain that might be causing seizures.
  • Magnetic resonance imaging (MRI)
  • Single-photon emission computerized tomography (SPECT) – A small amount of low-dose radioactive material is injected into a vein to create a detailed, 3-D map of the blood flow activity in the brain during seizures.

Treatment of Epilepsy

Medicines

Most patients of epilepsy can be treated effectively with epileptic medicines. While medication can eradicate seizures in some, in others, the frequency and intensity can come down. Once seizures come down, medications can slowly be discontinued.

 

Surgeries

When medications fail to provide adequate control over seizures, surgery may be an option. Surgery is generally considered when:

  • Seizures originate in a small and well-defined region of the brain
  • The said area doesn’t control any vital function of the body like vision, hearing, speech etc.

 

The surgical options for the treatment of Epilepsy are as follows:

  • Resective Surgery: This is the most common surgery used for the treatment of Epilepsy. This surgery involves removal of brain tissues in the area of the brain where seizures originate.
  • Corpus Callostomy: Corpus callosotomy is the surgery of bundle of nerves that connects the right and left sides of the brain & is usually used in children.
  • Hemispherectomy: Hemispherectomy involves removal of one side (hemisphere) of the folded gray matter of the brain.
  • Functional Hemispherectomy: Functional hemispherectomy, is primarily used in children & involves the undercutting of the seizure-inducing hemisphere.

Therapies

Apart from medications and surgery, the following therapies can offer an alternative for treating epilepsy.

Vagus Nerve Stimuulation

A device called Vagus Nerve Stimulator is implanted underneath underneath the skin of the chest that sends bursts of electrical energy through the vagus nerve and to the brain & reduces seizures by 20 to 40 percent.

Deep Brain Stimulation

An electrode is permanently implanted deep inside the brain which releases regularly timed electrical signals that disrupt abnormal, seizure-inducing activity.

Ketogenic Diet

Ketogenic diet is usually advised to children suffering from Epilepsy & reduces their seizures by following a strict diet that is high in fats and low in carbohydrates.

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