Epilepsy

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Seizures (“fits,” convulsions) are episodes of disturbed brain function that cause changes in attention or behaviour. They are caused by abnormally excited electrical signals in the brain.

Classification

A.

• Symptomatic epilepsy (damage /disruption to the brain)
• Cryptogenic epilepsy (no evidence of damage to the brain)
• Idiopathic epilepsy (no obvious cause)

B.

Generalized

• Grandmal
• Petitmal
• Myoclonic

Partial seizures

• Simple
• Complex

Causes of epilepsy

General

• Stress
• Lack of sleep
• Alcohol, particularly binge drinking and during a hangover
• Illegal drugs –

1. cocaine
2. amphetamines
3. ecstasy
4. heroin
5. methadone
6. codeine

• Flashing lights (photosensitive epilepsy)
• High temperature (fever)
• Just before, during or after menstruation in women
• Noise
• Pain
• Shock 
• Starvation
• Trauma

Specific

Symptomatic epilepsy

• Cerebral palsy
• Drugs
• Alcohol
• Birth defects (umbilical cord getting twisted or compressed during labour)
• Meningitis
• Head injuries
• Strokes
• Brain tumours

Idiopathic epilepsy

No apparent cause for epilepsy can be found. Researchers have suggested that small genetic changes in the brain could be the cause of epilepsy.

Cryptogenic epilepsy

• No definite cause for epilepsy
• Only a few pieces of evidence in favour of diagnosis–

Learning difficulties,

Developmental condition (autistic spectrum disorder),

Unusual EEG readings                  

Simple partial seizures

• Tumour
• Vascular abnormality
• Developmental abnormality
• Infective abnormality.

Complex seizure

• Hippocampus sclerosis
• Developmental or brain damage during a febrile convulsion.

 Symptoms and signs

General

• Staring spells
• Loss of consciousness
• Violent convulsions
• An aura consisting of a strange sensation (tingling, smelling an odour that isn’t actually there, or emotional changes) prior to each seizure.

Specific

Grandmal epilepsy

• Prodrome

Irritability

Tension for hours/days.

• Loss of consciousness without warning.

The patient becomes rigid and may urinate.

A patient may have an apnoeic spell of breathing due to the contraction of the thoracic and abdominal muscles.

• Tonic phase (10sec)

The patient eyes are open

Elbows flexed

Arms pronated

Breath held

Cyanosis

Bladder/bowel control lost

• Clonic phase (1-2min)

Tremor due to generalized shaking

Eyes roll backwards and forwards

Tongue bite may occur.

• Post-ictal phase

Confusion

Headache

Sleep

Petitmal epilepsy

• Consciousness not lost
• Abrupt onset with full recovery.
• Blinking and rolling of eyes several times a day.

Myoclonic seizures

• Single or multiple muscle jerks
• Consciousness not lost

Partial seizures

Simple partial seizures (SPS)—-

1. Short lasting seizure
2. Abrupt onset.
3. Epileptic discharge site–

• The frontal lobe of the brain–Jerking of limbs
• The parietal lobe of the brain–Sensory
• The temporal lobe of the brain–Psychic

Investigations

• Neurologic examination
• Electroencephalograph — EEGs can often be normal after a seizure or between seizures, so it may be necessary to perform a longer test.
• PBF
• Blood sugar
• CSF (cerebrospinal fluid) analysis
• Kidney function tests
• Liver function tests
• Head CT
• MRI scan
• Lumbar puncture

Treatment

• Care of patient during seizures

1. Move patient to a place of safety (away from fire, water and machinery).
2. Do not try to forcibly introduce a gag or tightly rolled handkerchief once a seizure begins. Do not use metallic or plastic objects.
3. After the seizure is over, keep the patient in a semi-prone position, ensuring a patent airway and proper oxygenation.
4. With continued convulsions, hospitalize the patient.

• Ayurvedic Medicines
• Surgery

Surgical removal of an epileptic lesion in the temporal lobe is highly effective.

Complications

• Difficulty learning
• Aspiration pneumonia(By inhaling fluid into the lungs)
• Injury from falls, bumps, or self-inflicted bites during a seizure
• Injury from having a seizure while driving or operating machinery
• Many epilepsy medications cause birth defects
• Permanent brain damage (stroke or other damage)
• Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
• Side effects of a few medications

Prevention

• Proper diet and sleep
• Staying away from illegal drugs
• No to alcohol        
• wear helmets(to prevent head injury)
• Persons with uncontrolled seizures should not–

1. Drive
2. Climb to high places
3. Go for biking
4. Swim alone