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About Epilepsy

About Epilepsy2019-02-06T12:31:28+00:00
Throughout history people with epilepsy have been stigmatized as a result of superstitions surrounding the disorder. Beliefs surrounding demonic possession and witchcraft associated with seizures have led to people with epilepsy being sterilized, imprisoned and shunned by society.

Despite modern medicine providing a better understanding of the causes of epilepsy prejudices unfortunately still exist.

In addition to the increased risks of injury and premature death associated with epilepsy, social stigmas and discrimination connected with the disorder have a negative impact on the quality of life of those with epilepsy. Fear of people finding out about the disorder results in suffering from not seeking treatment, children facing psychological problems caused by bullying and teasing and restrictions placed on driving and employment opportunities limiting independence.

Epilepsy affects all races, ages and genders. It is most frequently diagnosed in children, adolescents and older adults. Although there is no cure for epilepsy treatments are available and people with epilepsy can lead normal productive lives.

Normal Physiology

The brain is responsible for all functions of the body.

The brain consists of two types of cells, neurons and glial cells. Neurons are nerve cells that communicate messages from the body about functions, senses and emotions, glial cells support and protect the neurons. Messages are sent through specialized networks of neurons using chemical and electrical signals.

Chemical messages are dispatched by various substances known as neurotransmitters. They are released by neurons and target receptors in other cells or neurons. Electrical messages are conveyed when the voltage of the neuron is altered by ions such as calcium, potassium and sodium. Any disruption in these pathways will lead to abnormal brain activity.

A seizure is the result of abnormal electrical activity of the brain activity which temporarily alters behavior.

Seizures

Around 10% of people worldwide will suffer at least one seizure in their lifetime (WHO)

Seizures can occur for many different reasons and can vary greatly in their appearance. Two or more seizures unprovoked can suggest epilepsy. A diagnosis is made by a physician based on many factors such as results of diagnostic tests, symptoms and cause of seizures.

Depending on where in the brain abnormal activity occurs and how it spreads will determine the features of the seizure. A seizure can affect functions such as movements, thoughts and consciousness and as a result many types of seizures exist.

Seizure types have been categorized by the ILAE into two groups based upon where they start in the brain and if consciousness is impaired.

Partial Seizures

Start in a single area of the brain and are subdivided further into simple partial and complex partial according to the degree of impairment of consciousness during the seizure. In the course of a simple partial seizure the person remains aware whilst during a complex partial seizure consciousness is altered. Both of these seizure types can progress to generalized seizures, these are then referred to as secondary generalized seizures.

Generalized Seizures

Start in both sides of the brain and quickly spread; consciousness is lost at the beginning of the seizure. These seizures are also subdivided into several types. See ILAE.org for more details about seizure classification.

Status Epilepticus

Usually seizures last from a few seconds to minutes; if seizures do not stop this is called status epilepticus. It is a very serious condition requiring immediate medical attention. Call 911.

Non Epileptic Seizures

Seizures are caused by abnormal brain activity which is diagnosed by EEG. Non epileptic seizures physically look like seizures but do not show abnormal brain activity on EEG. These are also known as pseudo seizures.

Causes

The majority of epilepsy cases diagnosed are classified as Idiopathic or Primary Epilepsy which means no known cause can be found. If a cause for seizures can be identified this is known as Symptomatic or Secondary Epilepsy.

Specific conditions known to cause damage to the brain have been identified as risk factors to developing epilepsy, these include:

  • Congenital birth defects,
  • Birthing difficulties,
  • Head traumas,
  • Infections affecting the brain,
  • Tumors affecting the brain,
  • Cerebral vascular disease.

Genetic links have been identified with some types of epilepsy and a family history of epilepsy has also been identified as a risk factor.

Seizures can occur either at the time of the injury, months or even years after the injury. Seizures that take place at the onset of injury are known as acute symptomatic seizures. Those that start after a period of time are known as remote symptomatic seizures.

Types of Epilepsy

An Epilepsy Syndrome refers to a specific diagnosis determined by various details. Information needed to diagnose includes not only seizure types but also severity, time of day they occur, age of onset, causes and seizure trigger’s. Clinical data from EEG’s and results of diagnostic tests prove valuable as well as a full medical history. It is important to find the right diagnosis to ensure the correct treatment is established.

In addition, determining the type of syndrome can provide useful information about the characteristics of the disorder such as if seizures will lessen or not and what treatments will work best. Genetic links can also be identified in certain epilepsy syndromes.

Treatment Options

Medications called Anti Epileptic Drugs( AED’s) are the most widely used treatment for epilepsy. Other treatments include devices such as the Vagus Nerve Stimulator(VNS) and surgery for some types of epilepsy. Diets such as the Ketogenic diet and Atkins diet are also available.

Prevention

The majority of the epilepsies have no known cause however, for those with a known cause preventative measures can be taken to minimize the risks, these include;

  • Preventing head injuries, reducing the risks of post traumatic epilepsy
  • Adequate perinatal care will reduce the risks associated with birthing injuries
  • Treating fevers in children will reduce the risk of febrile seizures
  • Preventing infection, particularly in areas where parasites exist known to cause central nervous system infections.

As there is no cure for epilepsy adequate treatment along with appropriate preventative measures are the only steps we can take in reducing the burden of this disorder.

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