Epilepsy
Although it’s not covered in the media as often as cancer and other diseases, epilepsy is, in fact, the fourth most common neurological problem. Each year, 150,000 or 48 out of 100,000 people develop epilepsy in the United States alone. In addition, when the incidence of epilepsy is looked at over a lifetime, 1 in 26 people will develop epilepsy at sometime in their life.
What is epilepsy?
According to MedlinePlus, epilepsy is a brain disorder that causes people to have recurring seizures. Seizures are symptoms of a brain problem. They happen when clusters of nerve cells, or neurons, in the brain send the wrong signals.
According to Epilepsy Ontario, the seizures are then broken down into two major types of seizures: focal (partial) and generalized seizures.
Focal seizures occur when seizure activity is limited to a part of one brain hemisphere. However, they can be broken down even further depending on the person’s awareness. If the person is aware of what is going on during a focal seizure, they will pallor, flushing, sweating, hair standing on end (piloerection), dilation of the pupils, alterations in heart rate and respiration, and urination.
If the person having a focal seizure is unaware of what’s going on during the seizure, he or she will stop and may have a blank look or empty stare. In addition, they will appear unaware of the environment and may seem dazed. Furthermore, the person might mumble, create chewing movements, or picking at their clothes and/or trying to remove them.
Generalized seizures, on the other hand, occur when there is widespread seizure activity in the left and right hemispheres of the brain.
If a person is having a generalized seizure, they might have rapid breathing or rhythmic blinking. The person will usually emit a short, loud cry as the muscles in the chest contract and the air rushes between the vocal cords, making a sound. They might also bite their tongue, which may cause bleeding.
How is it Diagnosed?
There are many other disorders that can cause changes in behavior and can be confused with epilepsy, which is why it can make diagnosing epilepsy difficult.
According to the Epilepsy Foundation, what happens during a seizure is one of the most important pieces of information. And, since seizures rarely happen in a doctor's office, the information given to the doctor and other healthcare professionals by you or other witnesses is extremely important. Yet, even with accurate descriptions of events, other tests are needed to learn more about the brain, what is causing the events and where the problem is located. Genetics are also taken into consideration.
In order to diagnose epilepsy, a neurologist usually has a variety of tests done on the person who had the seizure. These tests may include: “an EEG, which looks for changes in the brain's electrical patterns that are related to seizures, a special x-ray of the brain, a CT scan (sometimes called a CAT scan), or an MRI scan, to look for abnormal areas such as a tumor or infection.”
Furthermore, according to the Foundation, “depending on the urgency of the situation, other tests also might be recommended, such as a lumbar puncture (also called a spinal tap), EKG (electrocardiogram, to check the heart), or a sleep test.”
What are the Different Types of Seizures?
Although seizures are symptoms of a brain problem, they are separated into different types based on what caused them, which in some cases, the cause is unknown. According to the Epilepsy Foundation, seizures are separated into two groups: primary generalized and partial.
So what makes the two different from one another? According the Epilepsy Foundation, with primary generalized seizures, there’s a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures.
Partial seizures, on the other hand, have an electrical discharge in one limited area of the brain. There are also multiple things that can cause them, which includes: head injury, brain infection, stroke, tumor, or changes in the way an area of the brain was formed before birth. However, many times, no known cause is found, but genetic factors may be important in some partial seizures. In addition, partial seizures can be broken down further, depending on whether a person's awareness or consciousness (the ability to respond and remember) is affected.
What are the Symptoms of Seizures?
According to the seizure section on the Epilepsy Foundation’s website, “Some symptoms may be due to other medical problems or even due to side effects of medicine. When sorting out symptoms, consider these four main characteristics of seizures: unpredictable, episodic, which is when the seizures come and go, brief, which is when the seizures last between a few seconds and a few minutes, or stereotypic, which is when the symptoms are similar whenever they occur.”
Before the Seizure (Warning Signs)
Some seizures don’t show warning signs. However, according to the foundation, when they do, they (emotionally) may include the following: “déjà vu (a feeling of being there before but never have), jamais vu (a feeling that something is very familiar but it isn’t), smells, sounds, tastes, visual loss or blurring, strange feelings, fear/panic.
Other symptoms a person might have before a seizure include, pleasant feelings, or racing thoughts.” Some physical signs may include: “dizziness or lightheadedness, nausea or other stomach feelings”.
In addition, according to Mayo Clinic, some people (specifically for those who have grand mal seizures) might feel a sense of unexplained dread or numbness.
During the Seizure
The middle of a seizure, according to the Epilepsy Foundation, is “often called the ictal phase. It’s the period of time from the first symptoms (including an aura) to the end of the seizure activity.” According to WebMD, in the event of a person possibly having a grand-mal seizure, symptoms (for grand-mal seizures) may include: loss of consciousness, stiffening body, convulsions, isolated, jerking movements, repetitive, jerking movements, and loss of muscle tone.
Additionally, according to the Epilepsy Foundation, some (awareness/emotional) changes may include: “confusion, feeling spacey, periods of forgetfulness or memory lapses, loss of awareness, numbness, tingling, or electric shock like feeling in body, arm or leg, out of body sensations, or body parts feels or looks different.”
Physical changes may include: “difficulty talking (may stop talking, make nonsense or garbled sounds, keep talking or speech may not make sense), unable to swallow, drooling, and repeated non-purposeful movements (lip smacking or chewing movements, dressing or undressing, walking or running).
Also, other physical changes include: “repeated purposeful movements, convulsion (person loses consciousness, body becomes rigid or tense, then fast jerking movements occur), losing control of urine or stool unexpectedly, sweating, change in skin color, pupils may dilate or appear larger than normal, biting of tongue, difficulty breathing, or heart racing.”
After the Seizure
According to the Foundation, when a seizure ends, the recovery period begins. Some people recover immediately while others may take a little longer.
Some (emotional) symptoms that indicate that the seizure has ended include: Slow to respond or not able to respond right away, sleepy, memory loss, confusion, Difficulty talking or writing, Feeling fuzzy, light headed or dizzy Feeling depressed, sad, upset scared anxious frustrated, embarrassed, or ashamed.
Physical symptoms that indicate that the seizure has ended include: injuries, such as bruising, cuts, broken bones or head injury if the epileptic fell during seizure. They also may feel tired, exhausted or sleep for minutes or hours. In addition, the person who had the seizure may have a headache or other pain, nausea or upset stomach; they may be thirsty, have general weakness or feel weak in one part or side of the body, or have the urge to go to the bathroom or lose control of bowel or bladder.
Treatment
Treatments are available that can stop or control seizures for most people with seizures and epilepsy. These include medication, surgery, vagus nerve stimulation (VNS), and dietary therapy.
Medication
According to Johns Hopkins Medicine, “decisions about seizure or epilepsy medication should be made by the patient or parent/guardian and the physician, using a risk-benefit analysis. There is no “correct” dose of medication to treat seizures or epilepsy; the proper dose of medication is the one that controls a seizure without significant side effects.”
The risks and consequences will vary with each medication. The “type of medicine, dosage, individual’s reaction to the medication, other medications and medical conditions, age of the patient,length of time the patient takes medication, type and frequency of seizures, and the time of day the seizures occur,” are all taken into consideration when deciding whether medication treatment is the right one.
Surgery
Many people consider surgery, especially brain surgery, as the last alternative if all other treatment methods are not effective.
However, “if seizures occur in one area of the brain, and that area can be removed easily and without causing other problems, surgery should be considered. If epilepsy is caused by a tumor, cyst, lesion or other growth that won’t respond well to medication, your physician can help patients decide if surgery is an appropriate option.”
Surgery options for epilepsy include: laser interstitial thermal therapy (LITT), corpus callosotomy, focal resection, and hemispherectomy.
Vagus Nerve Stimulation (VNS)
Vagus nerve stimulation (VNS) is designed to stimulate the vagus nerve by using a small pacemaker-like device placed in the chest. In addition, VNS has been proven to increase inhibition in the brain’s cortex; as a result, it reduces the likelihood of seizures.
Dietary Therapy
When the term “dietary therapy” is being used by a neurologist or epileptologist (neurologists that have specific training in epilepsy), they are referring to the ketogenic diet.
The ketogenic diet is one of the oldest diet treatments. It consists of consuming high-fat foods and very few carbohydrates. This diet should be carefully calculated and monitored by a knowledgeable doctor.
According to Johns Hopkins Medicine, “The ketogenic diet requires strict compliance, precise food measurements, a hospital stay for observation, and plenty of patience.”
For more information about epilepsy and seizures, visit the following websites: MedlinePlus.gov, Epilepsy.com, Mayo Clinic.org, PubMed.gov, and Hopkins Medicine.org.
