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EPILEPSY Epilepsy is a group of neurological diseases where the nerve cell activity in the brain is disrupted, causing seizures of unusual sensations, behavior and sometimes loss of consciousness. Epileptic seizures are episodes that can vary from brief or nearly undetectable to long periods of vigorous shaking. These episodes can result in physical injuries including occasional broken bones. 2
Types There are several types of epilepsy. Each of them have different causes, symptoms and treatment. Idiopathic Generalized Epilepsy If there is a family history of epilepsy and it is diagnosed during childhood, it can be identified by either an EEG or MRI. The results of the EEG may show epileptic discharges affecting a particular area or multiple areas in the brain. Idiopathic generalized epilepsy can be treated with proper medications. Idiopathic Partial Epilepsy Like Idiopathic generalized epilepsy, It is also noticed since childhood and may be a part of the family history. Seizures tend to occur during sleep. Most often simple partial motor seizures tend to occur which involve the face and secondarily generalized (grand mal) seizures. This type of epilepsy is usually diagnosed with an EEG. Symptomatic Generalized Epilepsy It is the result of widespread brain damage. Injury to the newborn during its birth might be the common cause of symptomatic generalized epilepsy. In addition to seizures, these patients mostly suffer with other neurological problems, for e.g., mental retardation or cerebral palsy. 3
Symptomatic Partial Epilepsy It is the most common epilepsy that is noticed during adulthood. Since they are microscopic in nature, sometimes they might not be identified by MRI scan also. This type of epilepsy might be treated with surgery successfully, which is aimed to remove the affected area of brain without compromising the function of the rest of the brain. This type of epilepsy is caused by the defect of the brain, which can result from strokes, tumors, trauma, cysts, or infections. Symptoms Epilepsy can be characterized by a long-term risk of recurrent seizures. These seizures may develop in several ways depending on the part of the brain involved and the age of the person. The symptoms vary depending on the type of the seizure. Focal seizures When the seizures appear to result from the unusual activity of one particular area of your brain, they're called focal or partial seizures. These seizures might be divided into two categories. 4
Simple partial seizures - These seizures may alter the emotions or change the way things look, smell, feel, taste or sound instead of causing a lack of consciousness. This might also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as dizziness, tingling, and flashing lights. Complex partial seizures - These seizures involve in the change or loss of consciousness and awareness. The patient affected with complex partial seizure, might stare into space and may not respond normally to the environment along with performing repetitive movements, such as walking in circles, hand rubbing, swallowing or chewing. Generalized seizures Seizures that appear to involve all the areas of brain are called generalized seizures. There are six types of generalized seizures. They are as follows: Absence seizures - Absence seizures are often noticed among children. The symptoms are continuous staring into space or subtle body movements such as lip smacking or eye blinking. These seizures may occur in clusters and cause a brief loss of awareness. Tonic seizures - Tonic seizures cause stiffening of the muscles. These seizures usually affect the muscles in your back, arms and legs and may cause you to fall in the ground. Atonic seizures - Atonic seizures, also known as drop seizures, may cause loss of muscle control, which may result in a sudden collapse or fall down. 5
Clonic seizures - Clonic seizures are associated with repeated or rhythmic jerking in muscle movements. These seizures usually affect the neck, arms and face. Myoclonic seizures - These usually appear as a sudden and brief jerks or twitches in your arms and legs. Tonic-clonic seizures - This was previously known as grand mal seizures. These are the most dramatic type of epileptic seizure which can cause loss of consciousness, body stiffening and shaking, and sometimes loss of control in bladder and biting your own tongue. Causes There are various factors which might help us to identify as epilepsy symptoms are as follows - Genetic influence - Few types of epilepsy runs in the history of family. They can be categorized by the type of seizure you experience or the affected part of the brain. In these cases, it's likely to be the genetic influence. Head trauma - Head trauma, as a result of car accident or other traumatic injury, can cause epilepsy. Brain conditions - Brain conditions which cause severe damage to the brain, for e.g., brain tumors or strokes, can also cause epilepsy. Stroke is a leading cause of epilepsy in adults older than 35 years of age. 6
Infectious diseases - Infectious diseases, such as meningitis, AIDS and viral encephalitis, can spark to epilepsy. Prenatal injury - Before birth, the unborn babies are sensitive to brain damage that can be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in either epilepsy or cerebral palsy. Developmental disorders - At times, epilepsy can also be associated with few developmental disorders, namely, autism and neurofibromatosis. Diagnosis There are several tests to diagnose epilepsy and determine the actual cause of the seizures. Neurological examination - A doctor may test your behavior, mental function, the motor abilities and other factors to diagnose your condition and determine the type of epilepsy you may have. Blood tests - The doctor may take a sample of blood to check for signs of any infection, genetic or other conditions, associated with the seizures. Electroencephalogram (EEG) - This is one of the common test which is used to diagnose epilepsy. In this test, the doctors attach electrodes in your scalp by putting paste-like substance. The electrodes then record the electrical activities of the brain. 7
Computerized tomography (CT) scan - A CT scan uses X-rays to obtain the cross-sectional images of your brain. CT scans can reveal the abnormalities of your brain that is causing your seizures, such as tumors, cysts or bleeding. Magnetic resonance imaging (MRI) The process of MRI involves the use of powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect the lesions or the abnormalities in your brain that could be causing you seizures.a functional MRI measures the changes of your blood flow that occur when specific parts of your brain are active. Positron emission tomography (PET) - PET scan use a small amount of low-dose radioactive material which is injected through the vein to help in visualizing the active areas of the brain and detect the abnormalities. Single-photon emission computerized tomography (SPECT). This test particularly uses a small amount of low-dose radioactive material which is injected through the vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures. Treatment Epilepsy is usually treated with daily medication. In some cases, a special diet along with the implantation of a neurostimulator, or neurosurgery might be required. 8
Medications The mainstream treatment of epilepsy is anticonvulsant medications, which is possibly to be taken for the entire life. The choice of anticonvulsant is based on the type of seizure, the epilepsy syndrome, the medications used till date, other health issues, the age of the person and his or her lifestyle. Initially, a single particular medication might be recommended. Two medications at once is only recommended when the single medication does not work. There are a number of medications available. Phenytoin, carbamazepine and valproate appear to be equally effective in both the partial and generalized seizures. Both the controlled release of carbamazepine and the immediate release carbamazepine works well. Carbamazepine or lamotrigine are recommended as the first-line treatment for partial seizures, with levetiracetam and valproate being second-line due to issues of cost and side effects. The least expensive anticonvulsant, phenobarbital, is commonly used. Surgery Surgeries are common and are done once the tests confirm that the seizures are located in a small, well-defined area of your brain which doesn't interfere with the other vital functions of the brain such as, speech, language, motor function, vision or hearing. During surgery, the doctor removes the part of your brain which is causing the seizures. 9
Diet In the diet named, ketogenic diet, the body breaks down the fats instead of the carbohydrates for energy. It is being noticed that a ketogenic diet (high-fat, low-carbohydrate, adequate-protein) decreases the number of seizures by half among 30 40% of the children. It is a reasonable option for those who have epilepsy with no signs of improvement with the medications and surgery being a no for them. 10
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