Epilepsy
डिस्क्रिप्सन
Definition
Epilepsy is a nervous system disorder characterized by recurrent episodes (not a single attack) of seizure or convulsion. A seizure is an abnormal electrical discharge in the brain cells resulting in a temporary disturbance of sensory, motor or mental functioning.
Depending upon the specific area of the brain affected, a particular type of seizure may occur. There are mainly two types of seizures: generalized seizures which affect the whole brain and focal or partial seizures which affect just a small area of the brain.
Causes And Risk Factors
The exact cause of epilepsy is not known; however, there are a number of risk factors which play a role in their causation.
1. Genetics-patients who have parents or siblings with history of epilepsy.
2. Head injury-a serious injury to the head increases the risk of epilepsy.
3. Infection-infections such as meningitis, encephalitis and AIDS can increase chances of epilepsy.
4. Medical conditions-brain tumors, stroke, Alzheimer’s or disorders of blood vessels can cause epilepsy.
5. Medical conditions during pregnancy-infections during pregnancy or trauma to the baby during birth can cause epilepsy in children.
Few people with epilepsy have noticed that certain triggers can provoke an episode of epilepsy such as:
1. Lack of sleep
2. Fever or any sickness
3. Stress
4. Bright flashing lights
5. Drugs
6. Skipping meals
Signs And Symptoms
Depending upon the types of seizures the symptoms can present as:
Generalized seizures:
All areas of the brain are affected and these are known as Grand mal seizures.
1. Rhythmic movements of the arms and legs.
2. Eyes are generally open.
3. Person may appear as if he/she is not breathing.
4. Return of consciousness is gradual.
5. Involuntary passage of urine, tongue biting and frothing at mouth may occur.
6. Confusion after the seizures is common.
Investigations
Seizure is a sign of a serious medical condition. Immediate medical advice is required. A complete personal and family history will be taken by your doctor with physical examination.
1. A complete blood count and other blood tests will be done to detect presence of any infection, liver or kidney disease. Blood sugar levels will be checked.
2. Electroencephalogram (EEG) will be required to diagnose epilepsy.
3. Imaging tests such as:
a. CT scan
b. MRI
c. PET scan
Treatment
Treatment options include:
1. Anti-epileptic or anti-seizure drugs e.g. phenytoin, phenobarbital
2. Vagus nerve stimulator-a device is placed under the skin on the chest to stimulate the nerves. This helps reduce the chance of seizures.
3. Ketogenic diet-a high fat and low carbohydrate diet may help in reducing the number of seizures.
4. Surgery- the affected area of the brain might be surgically removed in severe cases.
Complications and When Should You See A Doctor
1. Complications in pregnancy.
2. Injury during an attack of a seizure, e.g. tongue bite and severe bleeding.
3. Depression and mood swings.
4. Sudden unexpected death in epilepsy – this happens more so in people who do not respond to medications.
You must visit a doctor after:
1. The first episode of seizure.
2. When seizure lasts for more than 5 minutes.
3. Associated difficulty in breathing.
4. Unconsciousness or confusion lasting for long.
5. Injuries during a seizure.
Prognosis And Prevention
The outlook of epilepsy usually depends upon the cause. If the cause is discovered, prognosis is good. Seizures related to brain tumors and medical conditions have a poor outcome.
Prevention of epilepsy is done by treating the underlying medical condition which is the cause. Take the prescribed anticonvulsant medication regularly. If there are any known triggers, avoid them as far as possible. Sleep deprivation and stress are leading causative factors. Enough sleep, timely and proper diet should be encouraged.
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Last updated on:
04 Sep 2017 | 11:06 AM (IST)
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Epilepsy is diagnosed using history, physical examination, tests like CT scan, MRI scan of brain and Electroencephalogram (EEG). The doctor might order some other blood tests to rule out other conditions mimicking epilepsy.
Severe seizures that last over 5 minutes can lead to death. Thus, timely intervention is a must.
Yes. A fair number of people face behavioral problems with epilepsy like aggressiveness, irritability, hyperactivity and poor attention. Depression, anxiety and social dysfunction are commonly seen in persons with epilepsy.
Epilepsy is the recurrence of seizures more than once. It occurs due to irregular discharge of electrical activity in the brain.
Epilepsy is treated by using medications that prevent and stop seizures. If there is an underlying cause like a brain tumor causing epilepsy, then it needs to be surgically removed.
Yes. Epilepsy can lead to premature labor or miscarriage of an unborn baby if left untreated. Thus, it is extremely important to take medicines regularly throughout the pregnancy.
Epilepsy can cause temporary memory loss after a seizure. However, permanent memory loss is rare.
No. If there is an obvious cause in the brain that is causing the epilepsy, then it might be visible on an MRI. Epilepsy is a symptom and cannot be seen on MRI.
No. Epilepsy is not a contagious or infectious disease and does not spread from person to person.
Yes. Epilepsy is a disease marked by repeated convulsions or seizures. The cause behind it may be detected and treated with medicines or surgery.
Drugs used in the treatment of fits are aimed at suppression of activity of the brain. Antiepileptic medications can control fits in 80 % of patients. Effective control of fits after stopping antiepileptic medications can be considered as 'cured'. In some cases, surgery can cure fits
Few patients with bleeding in the brain can develop seizure or epilepsy. The exact cause of seizure post bleed is unknown, but proposed mechanisms include direct irritation of brain by blood, mass effect of blood on the brain, and decreased blood supply to the brain.
Pinched nerve has not been found to cause a seizure. On the contrary, stimulation of vagus nerve is used in the management of seizures. Numbness, tingling sensation and limb spasms are some common symptoms seen in patients with both pinched nerve and seizures.
Psychiatric disorders like anxiety and psychotic disturbances are common in epileptic patients. Psychotic symptoms like delusions, hallucinations, thought disorder or mania are seen in 6- 10 % patients after seizure attack. Type and severity of epilepsy, anti-epileptic medications, alteration in brain chemicals like dopamine, GABA, and underlying brain pathology have been implicated in the development of psychosis in epileptic patients.
Driving regulations for epileptic patients differ from country to country. In India, the law prohibits epileptic patients from driving vehicle.
Seizure activity generally last for few seconds to 2-3 minutes which is manifested as loss of consciousness with muscle jerking or sometimes only as staring spells. The seizure should be considered medical emergency if seizure last for more than 30 minutes (conditions called as status epilepticus), confusion lasting for more than 15 minutes after a seizure, if the person is unresponsive, and if there is any accident during seizure attack.
The majority of antiepileptic drugs are not addictive. However, benzodiazepine class of drugs (diazepam, lorazepam) which are used in the treatment of epilepsy may have addictive potential.
Fever-related seizures are not common in adults; however, fever does increase the risk of seizures in some people. Febrile seizures (seizure due to high fever) are common in children up to 5 years of age. Seizures in adult patients due to an underlying brain pathology or disorder might be sometimes associated with fever but its direct correlation is yet to be proven.
Lifelong antiepileptic medications are required in many forms of epilepsy. But, some forms of childhood-onset epilepsy will decrease in intensity or even stop over a period of time with appropriate medications, and in some cases curative surgery.
Some forms of epilepsy like Petit mal epilepsy (absence seizure) manifests as staring spells lasting for less than 15 seconds. The patient is awake, clear in thinking and remains unaware of seizure attack in Petit mal epilepsy.
Epilepsy is one of the common neurological disorder resulting from interactions between various genes and environmental factors. Some of the genetically determined epileptic seizures are autosomal dominant e.g. Familial nocturnal frontal lobe epilepsy, Benign familial neonatal convulsions, Benign familial infantile convulsions.
Failure to achieve a seizure-free state in an epileptic patient after adequate doses of two appropriate anti-epileptic drugs (AEDs) can be labeled as drug-resistant epilepsy. Factors responsible for drug-resistant epilepsy include wrong diagnosis, wrong drug, and/or exposure to various seizure triggers. So, a patient with drug-resistant epilepsy needs careful evaluation to diagnose and treat the exact cause of drug resistance.
Epilepsy is a common neurological disorder caused by various brain pathologies or gene abnormalities. Anti-epileptic drugs are the mainstay of epilepsy treatment. Choice of medications depends on the type of epilepsy. The majority of people with epilepsy can achieve seizure-free state with appropriate antiepileptic medications.
Weight alteration is a common adverse effect associated with anti-epileptic medications. Anti-epileptic medications such as valproate, gabapentin, pregabalin, vigabatrin, and carbamazepine are associated with weight gain.
Massage therapy is manual manipulation of body's soft tissue in order to improve person's overall health such as relaxation of body and increased sleep. It includes the application of fixed or variable movable pressure on the body. Epilepsy is not included as an indication for massage therapy in western countries, though massage therapy has not shown to lead to seizure onset in epileptic patients. Few studies have shown the beneficial effect of massage therapy in seizure control. People with epilepsy should always consult treating physician before taking any massage therapy.
For reasons unknown, people with epilepsy and on antiepileptic medications are prohibited from donating blood. It is postulated that these people are more prone to develop adverse reactions but such is not confirmed. People with epilepsy can donate blood if they are not receiving antiepileptic medications or have a seizure free interval in the last three years.
Emotional stress, tiredness, and inadequate sleep can act as seizure triggers in some epileptic individuals. The exact mechanism of seizures due to inadequate sleep and tiredness is still unknown, but reduced seizure threshold and increased abnormal electrical activity in the brain has been implicated in the causation of seizures.
Yes, a seizure-free state can be achieved in epileptic patients by surgery like lobectomy. Temporal lobe removal has been found to achieve cure in 60% to 70 % patients with epilepsy.
Antiepileptic drugs (AEDs) are the mainstay of management of epilepsy. Complete seizure control can be achieved in the majority of epileptic patients with appropriate AEDs. Though these medications differ in the mechanism of seizure control in epilepsy, they eventually either increase inhibitory chemical, e.g., GABA or decrease excitatory chemical, e.g., glutamate in the brain. Thus, these AEDs reduce abnormal electrical discharge in the brain which results in prevention/management of seizures.
Wearables or seizure alert devices are the specialized devices with algorithms to monitor and record various physiological and pathological processes in the body. These devices are helpful in conditions such as heart arrhythmia, sleep apnea, and epileptic seizures. Currently, SmartWatch and Embrace are the two smart watches available in the market which sense any abnormal activity in the brain and send alert to a connected smartphone which in turn send alert to caregivers of the patient.
The majority of people with epilepsy can live a full life with appropriate management. The cause of death in patients with epilepsy might be attributed to an underlying disorder, accidents during epileptic attacks like drowning or trauma, and rarely due to antiepileptic medications related deaths or status epilepticus. People with epilepsy can also experience sudden unexpected death in epilepsy (SUDEP), the cause of which is still unknown.
A balanced diet containing an appropriate amount of carbohydrates, proteins, fats, and vegetables helps the body to stay healthy. There is hardly any evidence suggesting the effect of balanced diet on seizures, but it reduces the risk of seizures in some individuals. This might be attributed to improved sleep pattern and improved overall health with balanced diet. Currently, there is insufficient data suggesting the role of certain types of food as seizure trigger, but some epileptic patients may experience seizures after ingestion of food containing coloring agents, artificial sweeteners or preservatives.
The ketogenic diet is special fat-rich, low carbohydrate diet used in the treatment of epilepsy to control seizures. The exact mechanism by which it controls seizure is still unknown, but ketone bodies derived from ketogenic diet might improve mitochondrial function, and thereby reduces seizure occurrence. The other possible mechanisms in seizure control include improved inhibitory neurotransmission and decreased excitatory neurotransmission."
Stress can act as a trigger for seizure onset in the majority of epileptic patients. Alteration in the brain chemicals and increased brain neurons excitability in response to stress might be responsible for the occurrence of seizure in epileptic patients.
Essential oils like jasmine, ylang-ylang, camomile, and lavender can be used as aromatherapy along with anti-epileptic medications in epileptic patients. These essential oils have a calming and relaxing effect on the brain, and hence can prevent seizure occurrence. Use of certain essential oils like rosemary, fennel, sage, eucalyptus, hyssop, camphor, and spike lavender is not recommended for the epileptic patient as these oils have a stimulant effect on the brain and hence may trigger seizure attack.
Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment. AEDs can be withdrawn in epileptic patients after having seizure free period of at least 1 to 2 years for children and 2-5 years for adults with normal electroencephalogram (EEG), normal CT scan or MRI, and normal neurological examination. The decision to stop AEDs is taken by the physician after having a proper evaluation of the patient.
Epilepsy is one the common neurological disorder after stroke and dementia in the elderly population. The increase in the incidence of age-related Alzheimer's disease, stroke, brain tumor, and brain trauma has been contributed to the growing prevalence of epilepsy in the elderly population. This might be attributed to abnormal changes in the brain induced by these disorders leading to seizures.
A seizure occurs due to an abnormal electrical activity of brain neurons which can be detected by electroencephalogram (EEG). Abnormal EEG along with history and clinical examination is used to diagnose seizure and epilepsy. However, normal EEG does not exclude chances of having seizures as it lasts for a few minutes and EEG might show a normal electrical activity of brain once seizure attack subsides. Magnetic resonance imaging (MRI) can diagnose an abnormality in the brain which might be causing epilepsy. However, in some patients, MRI can even be normal in epilepsy like in functional causes due to hypoglycemia.
Both epilepsy and Parkinson's disease are diseases of the central nervous system, but there is no proven relationship between two conditions. Epilepsy is a condition where there is irregular, excessive activation of part of the brain or whole brain leading to alterations in behavior, sensation, or consciousness. In Parkinson's disease, there is a decrease in chemical named dopamine in the brain resulting in shaking movements, decreased movements, and stiffness of muscles and joints.
Sleep disorders like decreased sleep and sleep apnea can act as a trigger for seizure occurrence in epileptic patients. Sleep apnea induced decreased oxygenation of blood, and night time awakening might reduce seizure threshold (electrical potential at which seizure activity occurs) which in turn increases the likelihood of a seizure episode.
Nervous system disorders like anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are common in epileptic patients. Various factors like underlying brain pathology, genetic predisposition, anti-seizure medications, and altered chemical balance in the brain also contribute to the concurrent presence of epilepsy and ADHD.
Seizure attack generally last from few seconds to 3-4 minutes. If a seizure lasts for more than 30 minutes, it is called as status epilepticus and should be managed as an emergency situation.
Many anti-epileptic medications are associated with potential to cause various disorders in growing baby in womb (spina bifida, cleft palate due to sodium valproate; phenytoin-induced foetal hydantoin syndrome). Drugs like phenobarbitone, carbamazepine, levetiracetam, and lamotrigine has shown to have minimal adverse effects on foetus and hence can be used in treatment of epilepsy during pregnancy, but only after due consideration by your doctor.
In epilepsy, abnormal electrical activity in the brain is either due to decrease activity of inhibitory neurotransmitters like γ-aminobutyric acid (GABA) or increased activity of excitatory neurotransmitters like glutamate. Anti-epileptic medications act on various targets either to increase inhibitory neurotransmitter activity or decrease excitatory neurotransmitter activity.
Previously epilepsy was thought to be a sacred disease because of its mysterious, unforeseen and brief periodic attacks of symptoms. The word seizure derived from Latin word Sacire meaning 'to take possession of someone by supernatural power, spirit or god'. This myth was busted first by Hippocrates. Later on, researchers discovered that epilepsy is not a sacred disease but it is due to an abnormality in the brain or genes.
Memory problems like memory loss is common in epileptic patients. Memory loss in the epileptic patient might be due to underlying brain pathology. Many antiepileptic medications have also been found to worsen memory loss in epileptic patients. Consult your doctor to discuss possible effects of your antiepileptic medications on memory loss.
All seizures are not related to epilepsy. There can be multiple causes for a seizure. A seizure is defined as abnormal, excessive electrical activity (single episode) of the brain leading to alterations in behavior, sensation, or consciousness whereas epilepsy refers to the occurrence of two or more unprovoked seizures.
Childhood absence epilepsy is also called as Petit mal epilepsy. It is common in children 2to 9 years of age. Seizure attack in absence seizure usually lasts for 10 to 15 seconds and is manifested as vacant staring, eyeball rolling upwards without loss of consciousness and muscle jerks. Seizure attack in absence epilepsy is often misinterpreted as inattentiveness or daydreaming.
Many drugs have been found to be associated with the occurrence of seizures. A seizure is a rare adverse effect of drugs like bupropion, clozapine, amphetamine, theophylline, fentanyl, tramadol, cocaine, heroin, cephalosporins, and carbapenems.
Sleeping pills have not been found to be associated with seizures. Sleeping pills like diazepam, clonazepam, triazolam, in fact, suppresses brain activity. Sudden stopping of sleeping pills can, however, lead to the occurrence of seizure in some people. Always consult your doctor before starting or stopping the use of sleeping pills.
There is limited data available to prove epilepsy as one of the causes of Alzheimer's disease. Some form of epilepsies like temporal lobe epilepsy can; however, lead to memory problems.
A small amount of alcohol like a drink or two has not been found to cause seizures. Such small amounts also don't change the anti-seizure medicine concentration in the blood or EEG findings. However, the risk of seizure increases with three or more alcoholic beverages. An epileptic patient must avoid alcohol and should consult his/her doctor for further advice.
All types of epileptic seizure can be seen in children with cerebral palsy. The onset of an epileptic seizure also occurs earlier in children with cerebral palsy. Primary brain pathology has been implicated in the association of epilepsy and cerebral palsy.
Epilepsy and migraine both are episodic disorders of the brain, share some common features and the mechanism. Migralepsy is a rare disorder defined as migraine-triggered seizures. It is manifested as a migraine with visual symptoms such as temporary loss of vision and flashes of light with nausea, vomiting followed by seizures. Changes in seizure threshold induced by a migraine have been implicated in the etiology of migralepsy.
History of epilepsy is as old as human civilization. The word epilepsy derived from the Greek verb epilambanein, meaning to be seized or overwhelmed by surprise.
Various studies indicate increased chances of mental retardation, learning disabilities, and behavioral disorders in children with epilepsy. Brain damage, reactions to antiepileptic medications, and epilepsy itself has been implicated in the causation of mental retardation in epileptic children.
Few epileptic individuals may experience seizure attack due to exposure to the flickers or rolling images and flashing of lights at variable intensity, which is called as photosensitive epilepsy. This phenomenon is common in children and visual stimuli induced abnormal electrical activity in the brain has been implicated in its cause.
Severe anxiety can lead to abnormal and excessive activation of the brain which may lead to a seizure attack in epileptic patients. However, most of the times, it is a panic attack which gets mistaken with a seizure due to common symptoms like sweating, trembling, or faintness.
Epilepsy can occur at any age. Causes of epilepsy may differ depending upon age. While childhood onset epilepsy can occur due to various metabolic disorders, brain disorders, and fever associated seizure, adult onset epilepsy commonly occurs due to bleeding in the brain, brain pathology, and brain infections.
Some comatose patient may experience seizure which can be diagnosed by abnormal EEG activity and muscle jerking. The exact mechanism of seizure during coma is unknown, but underlying brain pathology might be responsible for seizure during coma.
A ketogenic diet is a special form of low carbohydrate, a high fat-containing diet which is used to control seizures in some epileptic patients. The word ketogenic means genesis of ketones in the body. Ketogenic diet is generally recommended to children with drug resistant or intractable epilepsy. The exact mechanism of seizure control by ketogenic diet is still unknown, but, increased inhibitory chemical in the brain like GABA and decreased oxidative stress are thought to be responsible for seizure control in epileptic patients.
Grand-mal epilepsy or generalized tonic-clonic seizure is the most common type of epilepsy. This type of seizure is manifested as generalized stiffening of the body for 30 to 60 seconds followed by violent muscle jerking. This may be associated with loss of consciousness along with biting of tongue, loss of urine or stool control. Seizure attack generally lasts for 1 to 3 minutes. After seizure attack, the patient may experience drowsiness, headache, and loss of memory about seizure attack.
Epilepsy is a highly variable brain disorder with recurrent and unprovoked seizures attacks. Today, many people with epilepsy are successfully employed at a variety of jobs that might be considered high risks for them like firefighters, construction workers, and doctor. According to Persons with Disability Act 2016, in India, discrimination in employment of an epileptic person on basis of disability is strictly forbidden. Home based and internet driven jobs like Computer programmer, web designer, and writer are the best-suited jobs for an epileptic person with frequent seizure attacks.
Post-traumatic epilepsy is recurrent seizure disorder after brain trauma. Seizures if occur within first 7 days of brain insult are called as provoked seizures, whereas if seizures occur even after this period, it is labeled as post-traumatic epilepsy (PTE). Brain trauma-induced changes in blood flow to the brain, structural damage, and alteration in brain chemicals have been suggested as causative factors for PTE.
Epileptic attacks can occur at any time (even during sleep), but in some types of epilepsy, seizure attack occurs during sleep. These type of epilepsy are called as Nocturnal seizures. The majority of nocturnal seizures occur soon after falling asleep or before waking, such as in temporal lobe seizures, frontal lobe epilepsy, myoclonic seizures or atypical seizures. Change in the brain cells activity during various phases of sleep cycle has been implicated in the causation of nocturnal seizures.
Sleep deprivation, tiredness, stress, and flashing of lights are the common seizure triggers in person with epilepsy. Rarely in an epileptic patient, seizure attack can be triggered by bathing with hot water. Although the mechanism of such reflex epilepsy is still unknown, hot water induced abnormal activation of brain cells has been suggested as a causative factor.
A person with epilepsy may have confusion after seizure attack which is called as post-ictal confusion. Postictal confusion typically lasts for few minutes but, can rarely extend to several days. It is commonly seen with generalized tonic-clonic seizures and complex seizures. Abnormal brain cell recovery has been suggested as a possible mechanism for post-ictal confusion.
A person with epilepsy may experience seizure attack due to exposure to certain seizure triggers. Common seizure triggers are sleep deprivation, alcohol withdrawal, stress, and exposure to flashing lights. Identification of such triggers and lifestyle changes in order to avoid triggers can help an epileptic person to prevent themselves from getting seizures.
A person with epilepsy needs special care during seizure attack. If someone you love experiences seizure attack, measures need to be taken to provide personal care and comfort. If person experiences seizure attack, move them away from anything that could cause injury e.g. busy road, electricity, water etc. Turn them onto their side to prevent them from choking on vomit. Tight clothing around neck such as a collar, if any need to be loosened to aid breathing. If the person is on the floor, cushion their head to prevent head injury. When seizure stops, stay with a person till full recovery as a patient might have confusion post-seizure attack. If seizure attack lasts for more than 5 minutes, call an ambulance immediately for medical intervention.