Epilepsy

What is Epilepsy?

Epilepsy is a neurological disorder characterized by recurrent seizures. It may include convulsions, staring spells, confusion, and loss of consciousness caused due to abnormal electrical activity in the brain. The brain contains numerous neurons that transmit electrical impulses to transfer messages between the brain cells. Epilepsy disrupts this process and can result in seizures as well as other neurological effects.

There are two main types of seizures:

• Generalized seizures: This condition occurs when the electrical signals in both halves of the brain are disrupted. Generalized seizures are of different types:
  • Absence seizures: This is usually seen in children and is characterized by staring spells with loss of awareness or certain body movements such as eye blinking.
  • Clonic seizures: This condition causes muscle spasms that result in spasms or jerking of the neck, face, and arm muscles in a rhythmic pattern.
  • Myoclonic seizures: In this condition, the legs and upper body twitch and jerk suddenly in an irregular manner.
  • Tonic seizures: This results in sudden stiffness in the muscles of the trunk and legs.
  • Atonic seizures: This results in loss of muscle control causing you to fall suddenly.
  • Tonic-clonic seizures: This is the most classical form of seizure resulting in body stiffness, jerks, unconsciousness, tongue biting, and sometimes loss of bowel and bladder control. It is usually followed by a period of lethargy.
• Focal seizures: Also known as partial seizures, this is a condition that occurs when the electrical signals are disrupted in a particular part of the brain. They are further classified into the following:
  • Simple focal seizures: This does not result in loss of awareness but rather in symptoms such as strange smells or taste, loss of vision, and twitching of the arms and legs.
  • Complex focal seizures: This condition impairs awareness resulting in unresponsiveness, staring, and involuntary repetitive movements such as lip-smacking, chewing, or hand rubbing.

Causes of Epilepsy

There is no specific cause for epilepsy, but some of the factors that can disrupt the electrical signals in the brain include:

• Head injury
• Hereditary factors
• Brain tumor
• Brain infections such as encephalitis, meningitis
• Prenatal injury
• Lack of oxygen to the brain
• Dementia
• Stroke
• Vascular disease
• Drug abuse
• Cerebral palsy

Symptoms of Epilepsy

The most common symptom of epilepsy is recurrent seizures. Symptoms that could indicate epilepsy include unexplained episodes of:

• Dizziness
• Convulsion without fever
• Sudden stiffness of muscles
• Collapsing
• Anxiety
• Depression
• Confusion
• Staring blankly
• Tongue biting
• Loss of bladder control
• Twitching of the limbs
• Memory loss

Diagnosis of Epilepsy

Your doctor will review your medical history and symptoms and a neurological examination will be performed to determine your mental function and motor ability. Certain diagnostic tests will be recommended that include:

• Blood tests: Blood tests are performed to look for infections or the presence of certain conditions associated with seizures.
• Electroencephalogram (EEG): This test is performed by attaching electrodes to your scalp to assess the electrical activity of the brain which can show changes in people with epilepsy.
• Magnetic Resonance Imaging (MRI) Scan: An imaging study that uses a large magnetic field and radio waves to visualize the brain and detect any damage.
• Computed Tomography (CT) Scan: This scan uses multiple X-rays to produce detailed cross-sectional images of the brain and skull.
• Positron Emission Tomography (PET): Radioactive compounds are injected into the bloodstream and help visualize the brain and any damage on a PET scan.
• Single-Photon Emission Computerized Tomography (SPECT): This test uses a low-dose radioactive substance injected into the blood to produce a 3D image of the blood flowing in the brain.
• Magnetoencephalography(MEG): This test measures the magnetic fields produced by activity in the brain and helps identify the area in the brain where the seizure started.

Treatment for Epilepsy

Treatment for epilepsy depends on your frequency of seizures, age, health condition, and other factors including how well you respond to a particular treatment. It may include:

• Medications: Medications are usually the first line of treatment. Your doctor will prescribe anti-seizure or anticonvulsant medications to reduce the frequency of seizures. You should be careful to follow the prescribed dosage to maintain an effective level of medication in your body. Children and adults who don’t have any seizures for a prolonged duration may be able to discontinue the medication after speaking with their doctor.
• Ketogenic diet: A ketogenic diet that contains high fat and low carbohydrate content may be recommended to reduce seizure activity.
• Vagus nerve stimulation: A small electrical device is placed under the skin and connected to the vagus nerve in the neck through a wire. This stimulates the vagus nerve thereby sending signals to the brain that inhibit seizures.

Medical marijuana is recommended in the management of this condition as it is shown to alleviate symptoms and improve quality of life.

If conservative measures are not effective your doctor may recommend surgery to either remove the region producing seizures or to interrupt nerve pathways that spread the seizures in the brain. Some of the surgical methods include:

• Lesionectomy: A specific lesion (tumor, abnormal blood vessel, or scar tissue) in your brain causing the seizure is removed.
• Corpus callosotomy: This involves cutting the band of nerve tissue that connects the two halves of your brain to prevent seizures from spreading to the opposite side.
• Thermal ablation: This is a minimally invasive procedure that involves introducing highly concentrated energy to specific sites in the brain to destroy certain cells that cause seizures.
• Deep brain stimulation: Electrodes are placed in certain areas of the brain to transmit electrical impulses to control abnormal brain activity.
• Responsive Neurostimulation: This method involves the implantation of a neurostimulator in your skull to detect brain electrical activity. If any abnormal activity is detected, an electric impulse is sent to the brain in order to prevent a possible seizure.