Epilepsy

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Epilepsy
Epilepsy Neurological Evaluation

Epilepsy is a chronic disease of the central nervous system (CNS). It presents itself in recurrent unprovoked seizures. The incidence of epilepsy is 0,3 - 0,5 % in the world.

Causes

An epileptic seizure starts as a very intense and sudden electric discharge of the CNS cortex neurons. This phenomenon happens periodically when the brain is damaged due to causes mentioned below:

  • Symptomatic epilepsy - when the brain lesion is clear (tumours, strokes, alcohol impact, trauma, birth anomalies, brain infections).
  • Cryptogenic epilepsy - the brain lesion is so small that it is undetectable using current diagnostic methods.
  • Idiopathic epilepsy - the causes are unknown (it is believed that genetic predisposition plays a role in these cases).

The most common forms of epilepsy are symptomatic and cryptogenic.

Signs and symptoms

The main symptoms of epilepsy are seizures. The seizures are unprovoked; usually they start and end suddenly. The specifics of the seizures depend on the CNS site where they arose. Recurrent seizures are usually similar in their nature and depend on individual features of the patient. Other common symptoms are impaired consciousness as well as changes in senses and behavior.

The seizures are classified as partial and generalized. Partial seizures are further divided into simple partial seizures (consciousness remains, but motor, sensory, autonomic or psychic signs might develop) and complex partial seizures (accompanied by loss of consciousness). During generalized seizures the abnormal discharge spreads throughout the entire brain cortex. An aura (a specific sensation) is usually present before the seizure (e.g. taste of metal in the mouth, a certain smell, etc.).

Primary generalized seizures are further classified into:

  • Absence (petit mal) - very short losses of consciousness (usually a few seconds). After the seizure the patient continues his interrupted action as if nothing had happened.
  • Tonic-clonic seizures (grand mal) are the most common type of generalized seizures. They usually begin abruptly, sometimes they are preceded by an aura. These seizures start with an initial contraction (tonic phase) and then are followed by a clonic (relaxation) phase.
  • Tonic seizures - during such seizures all muscles contract (usually for a few seconds). The patient might become bluish as respiratory muscles also contract.
  • Atonic - all muscles relax.
  • Myoclonic seizures are short twitches of one or more muscles (in the hand, legs or face).

Frequently, the patients urinate or defecate during seizures. If the patient bites his tongue, some bleeding in the mouth might be present.

Complications

Some complications of epilepsy might develop during a seizure (head trauma, biting of the tongue, muscle ruptures). Another severe complication is status epilepticus (state of epilepsy). It is diagnosed when a seizure lasts more than 30 minutes; status epilepticus is potentially fatal.

Diagnostics

Epilepsy is diagnosed by performing certain tests and by clinical evaluation. During a seizure, the state of consciousness as well as breathing are monitored. It is important to determine the type of the seizure. One of the most accurate tests is electroencephalography (EEG). During EEG electric impulses arising in the brain are recorded. EEG should be performed during a seizure. Other visual methods, such as CT (computed tomography) and MRI (magnetic resonance imaging) are used to determine possible causes of epilepsy (such as a tumor). Psychiatric and psychological examinations are also conducted.

Treatment

Medical treatment and prophylaxis. Epilepsy is treated using certain drugs. Different types of seizures are treated using different types of drugs. The treatment is long and it is very important to follow the plan if the treatment. The most common drugs used to treat epilepsy are carbamazepine, valproic acid and ethosuximide.

First aid during a seizure: firstly, the patient must be put on the side, his/her clothes should be loosened. All harmful objects must be moved away, a soft pillow must be put under the patient’s head. It is forbidden to put anything into the patient’s mouth (biting of the tongue is not as dangerous as choking), not even drugs. There is no need to try and stop the twitches or perform artificial respiration.

Diazepam injections could be used. The treatment of status epilepticus. State of epilepsy is treated in an intensive care unit. The patient must be carefully monitored and all the bodily functions should be preserved. Diazepam, phenytoin, as well as valproic acid are given intravenously.

Tips for people with epilepsy

  • Avoid alcohol, fatigue, blinking lights, as they increase the incidence of seizures.
  • Have meals regularly; avoid infections (fever and hypoglycemia also increase the risk of seizures).
  • Take prescribed drugs regularly. Do not discontinue the treatment on your own, even if the seizures have stopped.
  • Learn to recognize an approaching seizure - once you’ve felt the aura, sit down (even on the ground), finish crossing the street or warn the people around you.
   

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