Epilepsy cause, symptoms and treatment
Even though the words epilepsy and seizures used interchangeably among the general population, they are distinct from one another. A seizure is defined as a set of clinical symptoms associated with abnormal, hypersynchronous electrical activity of the brain. Epilepsy is the tendency to have recurrent seizures.
If a person
- Experiences two or more unprovoked seizures 24 hours apart or
- Experiences one seizure and have more than 60% chance to experience another or
- Is diagnosed to have an epileptic syndrome, he is considered an epileptic patient.
Causes of epilepsy
The causes of it significantly vary from the causes of seizures. An epileptic person invariably has a structural or functional abnormality of the brain. But a seizure can occur even in people who have a perfectly normal brain.
Genetics has a significant influence on this disease. If you have a 1st-degree relative who’s having this disease, you are more vulnerable to develop it than a person who doesn’t.
Head trauma is one of the major causes of adult-onset epilepsy. Head injuries may lead to permanent brain damage that’ll subsequently manifest as epilepsy.
Post-stroke epilepsy is very common among the elderly. Stroke can cause ischemic damage to the brain that will result in this disease.
People with space-occupying lesions in the brain like tumors or intracranial hematomas may also present to the hospital with newly experienced seizures.
Birth injuries like birth asphyxia (severe oxygen deficiency at the time of birth) and cerebral palsy can cause epilepsy in infants.
Infections of the brain; meningitis or encephalitis, during the neonatal and infantile period are also risk factors for this disease.
Symptoms of epilepsy
The symptoms of this disease are similar to that of the seizures. A person may experience auras preceding a seizure. The common auras are
- Auditory and visual hallucinations
- Smell changes
- Abnormal sensations about the surrounding environment
During the seizure following changes can occur.
- Abnormal, jerky movements involving a single limb or the entire body
- Rigidity of the limbs without jerky movements
- Frothing from the mouth
- Urinary and fecal incontinence
- Abnormal starring episodes, during which the person becomes unresponsive (absence seizures)
- Automatism – Abnormal, repetitive and stereotypic movements like lip-smacking and finger rubbing
- Loss of consciousness
After regaining consciousness, the person may enter a post-ictal period that lasts about 10-20 minutes. During this period following features may be seen.
- Deep sleep
- Abnormal behavior
Types of epilepsy
Childhood epilepsy syndromes
Childhood absence epilepsy – A type of it is characterized by absence seizures. Multiple seizures (even 100) can happen in a single day. Commonly occur in the primary school age group. 95% of the children having childhood absence epilepsy recover as they become adolescents.
Benign Rolandic epilepsy – A type that manifests as focal seizures. Commonly occur in the age group between 6-11 years. Seizures occur mainly during sleep.
Infantile spasms (West syndrome) – Occur in the infancy, between the age of 5-8 months. Most of the babies have an underlying structural abnormality. Unfortunately, the outcome is poor as a result of the repetitive damage to the brain.
Adulthood epilepsy syndromes
Juvenile myoclonic epilepsy – Age of onset is usually between the age of 8-26 years. A lifelong disease, but has a good outcome.
Juvenile absence epilepsy – Age of onset is between 9-13 years. Characterized by frequent absence seizures. This is also lifelong.
Epileptic patients have a high chance to develop status epilepticus (a seizure that lasts more than 30 minutes). It has a risk to do permanent damage to the brain.
Sudden unexpected death– People with this disease rarely can die during a seizure. The cause of this condition is unknown. Overall 1% of the epileptic patients die by Sudden unexpected death.
Diagnosis of epilepsy
The diagnosis of it is mainly clinical. Therefore, the doctor will ask you the exact details of each seizure when you seek the aid of a doctor. Video recording the seizure will be greatly helpful in that.
The investigation findings can support the diagnosis. EEG scan of the brain may reveal epileptiform electrical discharges of the brain.
If an otherwise healthy adult (more than 20 years old) develops epilepsy, MRI or CT scan of the brain is mandatory to exclude any space-occupying lesions inside the skull.
Medications and treatment of epilepsy
The treatment of this disease depends on the cause and the characteristics of it.
If the patient is having a space occupying lesion in the brain like a tumor, surgical removal has to be done to stop epilepsy.
Epilepsy syndromes are treated with anticonvulsants. However, an epileptic patient should never self-medicate using anticonvulsants. It should be done only by a certified Physician.
Structural defects of the brain are 1st treated with anticonvulsants. If the patient is not responding to any of the drugs even when tried in combinations, surgical correction can be done (if possible).
Some good reads: