Download How is Epilepsy Diagnosed?

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EPILEPSY
- Introduction
Epilepsy is one of the most common serious disorders of the brain, affecting
about 50 million people worldwide. The term "epilepsy" encompasses a group of
syndromes that vary in its associated pathology and seizure types. The diagnosis
of the epileptic syndrome is one of the primary objectives undertaken when
managing a patient with seizures.
Epilepsy was one of the first brain disorders to be described. It was mentioned
in ancient Babylon more than 3,000 years ago. The strange behaviour caused by
some seizures has contributed through the ages to many superstitions and
prejudices. People once thought that those with epilepsy were being visited by
demons or gods. However, in 400 B.C., the early physician Hippocrates
suggested that epilepsy was a disorder of the brain and we now know that he
was right.
The term "epilepsy" is derived from the Greek word "epilambanein”, which
means "to seize upon", "to attack". Thus epilepsy is a seizure or rather a disease
which causes seizures to occur. As, however, there are many very different types
of seizure, it is better to speak of epilepsies.
Epilepsy is a common neurological disorder marked by involuntary, recurrent
seizures that arise from excessive discharges of neurons in the brain. Seizures
vary in type, severity and intensity, and can be manifested by changes in
consciousness, movement, sensation, or behaviour. Epilepsy — that is, the
occurrence of more than one unprovoked seizure — affects both men and
women, yet gender-specific patterns have been noted. Females develop seizures
at greater rates in the first five years of life, but males predominate after this
age, with the greatest differences noted in the older age groups.
Epilepsy can present itself at any age; however, the incidence and prevalence is
highest in the very young and the elderly. Depending on age of manifestation,
the causes for epilepsy can differ widely. Epilepsy is not a mental illness, and it
is not a sign of low intelligence. It is also not contagious. Between seizures, a
person with epilepsy is no different from anyone else.
How can epilepsy be defined? When someone repeatedly has epileptic seizures
then we say that that person is suffering from epilepsy. An epileptic seizure itself
is one of the many pathological forms of reaction which can take place in the
brain; it is the brain’s "response" or reaction to a disturbing, irritating or
damaging stimulus. This reaction to the stimulus is accompanied by abnormal
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electro-chemical excitatory processes in the cerebral nerve cells. This
pathological process takes place when suddenly an unnaturally large number of
nerve cells are stimulated simultaneously, causing a difference in voltage
between the outer side of the cell wall and the inside of the cell (membrane
potential). This voltage difference is then suddenly discharged, creating a kind
of "storm in the brain", or, to put it another way, "making a fuse blow".
- What is epilepsy?
Epilepsy is a disorder of the brain. In people with epilepsy, brain cells create
abnormal electricity that causes seizures. The term "seizure" is widely used to
describe an abnormal spasm or convulsion, generated by excessive electrical
activity in the brain. Seizures vary from a momentary disruption of the senses, to
short periods of unconsciousness or staring spells, to convulsions. Some people
have just one type of seizure; others have more than one type. A seizure may
cause "jerking" movements. In some cases, seizures cause:
 only a loss of consciousness,
 a period of confusion,
 a staring spell or muscle spasms.
A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures.
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 Absence epilepsy
People with absence epilepsy have repeated absence seizures that cause
momentary lapses of consciousness. These seizures almost always begin in
childhood or adolescence, and they tend to run in families, suggesting that
they may be at least partially due to a defective gene or genes. Some people
with absence seizures have purposeless movements during their seizures,
such as a jerking arm or rapidly blinking eyes. Others have no noticeable
symptoms except for brief times when they are "out of it." Immediately after
a seizure, the person can resume whatever he or she was doing. However,
these seizures may occur so frequently that the person cannot concentrate in
school or other situations. Childhood absence epilepsy usually stops when
the child reaches puberty. Absence seizures usually have no lasting effect on
intelligence or other brain functions.
 Temporal lobe epilepsy
Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome
with focal seizures. These seizures are often associated with auras. TLE often
begins in childhood. Research has shown that repeated temporal lobe
seizures can cause a brain structure called the hippocampus to shrink over
time. The hippocampus is important for memory and learning. While it may
take years of temporal lobe seizures for measurable hippocampal damage to
occur, this finding underlines the need to treat TLE early and as effectively as
possible.
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 Neocortical epilepsy
Neocortical epilepsy is characterized by seizures that originate from the
brain's cortex, or outer layer and maybe caused by a lesion, such as a tumour
or vascular malformation; an injury to the brain, such as a traumatic injury or
an infection; or abnormal brain development before birth. In this condition,
the morphology, or structure, of the neurons changes so that the region is
more easily excitable and more prone to seizures. Neocortical epilepsy
involves both ictal (during seizure) and interictal (between seizures) neuronal
activity.
The seizures can be either focal or generalized. They may include strange
sensations, visual hallucinations, emotional changes, muscle spasms,
convulsions, and a variety of other symptoms, depending on where in the
brain the seizures originate.
- Seizures
Today specialists speak of "grand mal" and "petit mal" seizures, or "generalised"
and "focal" seizures.
These manifestations often occur in combination, for instance stiffening,
jerking; salivation, wetting oneself and loss of consciousness are symptoms of a
"major seizure", a "grand mal" ("great evil"). In the past, people differentiated
between such "major" seizures and "lesser", "petit mal" attacks, which manifest
themselves in a short clouding of the consciousness or absence) which only lasts
for a few seconds, in a single jerk (myoclonia) or in a so-called twilight state.
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These seizures, which are also termed psycho-motor or partial complex seizures,
are characterised by a twilight state lasting between 30 seconds and 3 minutes,
during which the patient is confused, displays inappropriate behaviour (e.g.
chewing movements, fiddling with the hands, running away) and sometimes
utters intelligible but meaningless words, or incomprehensible sounds. The
salaam spasm is a special form of petit mal seizure which occurs almost
exclusively in infants and which is generally a pointer for a severe type of
epilepsy. (The "salaam seizure" is so called because of the nature of the seizure,
during which the patient suddenly jerks nods or slowly bends forward, as if to
make an oriental greeting.)
During a generalised seizure, both halves of the brain are affected
simultaneously and thus the attack influences both sides of the body from the
onset. This does not necessarily mean that the whole body is affected by the
seizure; what is primarily important is the simultaneous nature of the attack from
the onset. The above-mentioned grand mal seizures, absences and salaam
seizures are all generalised seizures.
Focal seizures are in contrast attacks which at the onset only affect one side of
the body or a certain part of the body. (This in its turn means that in the brain
only a certain part of one hemisphere is affected by the seizure.) Examples of
focal seizures are one sided grand-mal seizures, one-sided jerking, stiffening or
dysaesthesia, and psychomotor (partial complex) seizures.
A grand mal seizure — also known as a tonic-clonic seizure — is a type of
seizure characterized by loss of consciousness, falling down, loss of bowel or
bladder control, and rhythmic convulsions. Seizures result from an abnormal
electrical discharge in the brain. When a person is having this type seizure, you
may see the following:
- Sudden crying, falling or slumping, loss of consciousness;
- The body may become stiff, then start to jerk and relax involuntarily;
- Breathing becomes shallow, or temporarily suspended. The skin takes on
a bluish tone;
- Possible loss of bladder or bowel control because of the involuntary
muscle spasms;
- The seizure may last two minutes or longer;
- The spasms will slowly subside;
- When breathing resumes, it may be noisy;
- There will be a slow return to full consciousness.
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A generalized tonic clonic seizure
Here the whole brain is affecting from the beginning. In (a) there is a cry and loss of consciousness, arms
flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking
movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is
slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to
keep the airway clear
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 Generalized Seizures
Seizures may affect an isolated part of the brain or may involve abnormal
activity in the whole brain (called generalized seizures). They affect the
entire brain and often cause a person to lose consciousness or awareness of
their surroundings.
The following are different types of generalized seizures:
 Absence seizure:
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sometimes called "petit mal" seizure
most common in childhood
may last from a few seconds to a minute
may cause clouding of consciousness, staring, minor facial
movements and eye movement
Scientists are unsure of the underlying reasons for absence seizures in
most cases. Some research suggests that genetics may play a role.
Affecting two of every 1,000 people, absence (formerly called petit mal)
seizures are caused by abnormal and intense electrical activity in the
brain.
Normally, the brain's nerve cells (neurons) communicate with one another by firing tiny electric signals.
But with a seizure, these signals become abnormal.
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Absence seizures are one form of generalized seizure. Typically, this type of
seizure lasts between 10 and 30 seconds. The person, most often a child aged 5
to 15, abruptly stops whatever he's doing (talking, walking) and appears to "stare
into space." Absence seizures rarely cause a true convulsion in which the person
falls down or collapses, and despite briefly losing consciousness, the person
recovers fully with no lingering confusion or other ill effects. These "spells"
may occur infrequently or several times per hour. In children, absence seizures
may interfere with learning and are often misinterpreted as impertinence or
inattention. About a quarter of people who have absence seizures will develop
another type of generalized seizure called tonic-clonic (formerly called grand
mal) seizures. The vast majority of children, however, will outgrow them.
Ictal EEG of typical absence seizure of childhood absence epilepsy :
Note the regular rhythm of the discharge, the constant spike and slow wave relation, and the abrupt onset. The opening
phase is often variable and unreliable. The child remains unresponsive from the onset of the initial phase to the onset of
the terminal phase of the discharge. However, she is able to understand the technologist during the terminal phase, when
the ictal discharge is waning.
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 Tonic-clonic seizure:
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sometimes called "grand mal" seizure
begins suddenly and without warning
may cause loss of consciousness, stiffening of the body, jerking of
the arms and legs
may cause loss of bladder control
may last one to two minutes
full consciousness may not return for 10 to 15 minutes
may cause lingering confusion or fatigue, which could last for hours
or days
 Atonic seizure:
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a sudden loss of muscle tone that makes a person drop to the floor
may last a few seconds
can occur without loss of consciousness
 Myoclonic seizure:
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quick muscle jerk
often occurs early in the morning
usually does not cause loss of consciousness
may be triggered by lack of sleep or too much alcohol
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 Tonic seizure:
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a sudden increase in muscle tone, with stiffening of the arms and
legs
may cause a person to fall
most common in childhood
 Clonic seizure:
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jerking of the muscles
causes loss of consciousness common in children
 Partial Seizures
Partial seizures occur when an abnormal electrical discharge takes place
only in one part of the brain. The following are different types of partial
seizures:
 Simple partial seizure:
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consciousness is not altered
may cause brief changes in how things look, taste, feel or sound
may last a few seconds
may involve body movement
may progress to a complex partial seizure or to a generalized tonicclonic seizure
 Complex partial seizure:
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person will appear to be conscious, but will lose contact with the
world around him/her
may vary in length from seconds to minutes
person may exhibit "automatisms," or non-purposeful movements,
such as rubbing hands, smacking lips, fidgeting with objects or
grinding teeth
may cause a period of confusion after the seizure is over
person may not be able to recall any of the events that happened
during the seizure
may progress to a generalized tonic-clonic seizure
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 Secondarily generalized seizure:
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any partial seizure may progress to a generalized tonic-clonic
seizure
Repeated brain seizures characterize a seizure disorder known as epilepsy. Only a small
percentage of people who experience at least a single seizure episode go on to develop epilepsy.
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- Causes
The brain consists of more than 100 billion nerve cells. These all communicate
with one another; some provoke others into sending further messages
(excitation), while others tend to block them (inhibition). The proper working of
the brain depends on a balance between these: too many nerve cells sending
messages at once without enough being blocked can produce a sort of electrical
storm - or a seizure. Common causes include brain damage from birth injuries,
head injuries, stroke, brain tumours and alcoholism. Some seizures probably
have a genetic basis, although it's rare for epilepsy to run in families. However,
no one apparent cause has been found.
How can epilepsy be defined? When someone repeatedly has epileptic seizures
then we say that that person is suffering from epilepsy. An epileptic seizure
itself is one of the many pathological forms of reaction which can take place in
the brain; it is the brain’s "response" or reaction to a disturbing, irritating or
damaging stimulus. This reaction to the stimulus is accompanied by abnormal
electro-chemical excitatory processes in the cerebral nerve cells. This
pathological process takes place when suddenly an unnaturally large number of
nerve cells are stimulated simultaneously, causing a difference in voltage
between the outer side of the cell wall and the inside of the cell (membrane
potential). This voltage difference is then suddenly discharged, creating a kind
of "storm in the brain", or, to put it another way, "making a fuse blow".
If a person has one epileptic fit, it does not mean that he or she has epilepsy.
Only when that person suffers repeated spontaneous epileptic seizures (i.e.
without any direct trigger), should they be diagnosed as having epilepsy.
Epilepsy is therefore always a chronic illness which can go on for many years
(but which does not necessarily last a lifetime!).
Seizures result from paroxysmal and excessive electrical neuronal discharges in
the brain that cause a variety of clinical manifestations. The term "epilepsy" is
usually restricted to those cases with a tendency for recurrent seizures. The
identification of a seizure as a symptom and not a disease diagnosis is important.
Seizures are the clinical manifestation of epilepsy; the challenge is to identify
the disease that explains the symptom. Often the underlying disease is epilepsy,
but at other times it may be a non-epileptic disorder that causes a symptom
resembling an epileptic seizure.
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During normal waking and sleeping, your brain cells produce various electrical
discharge patterns. If the electrical discharges by your brain cells become
abnormally synchronized, a convulsion or seizure occurs. The abnormal firing of
your brain cells can remain localized to a small area or can spread rapidly to
involve your entire brain.
Many factors may contribute to the onset of epilepsy. The cause of an
individual's epilepsy can be divided into two categories: symptomatic and
idiopathic. The term cryptogenic is used to describe epilepsy where the cause is
suspected to be symptomatic but the underlying illness or damage has not been
identified.The term idiopathic means "a disorder unto itself", and not "cause
unknown". No other condition has been implicated as the cause of the epilepsy.
Idiopathic epilepsies are often but not exclusively genetic and generalised - for
example Juvenile Absence Epilepsy.
Symptomatic epilepsies originate due to some structural or metabolic
abnormality in the brain. Often, the cause of a seizure is unknown. Generally,
some of the known causes of seizures include:
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Metabolic disturbances: diseases of the kidney or liver can cause
chemical disturbances in the body, as can very low levels of
sodium, calcium or magnesium.
Previous brain trauma: traumatic head injuries, such as those
sustained in automobile accidents or serious sports injuries can
cause seizures.
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Vascular system problems: blood vessel disorders, such as
arteriovenous malformation of the brain — in which an abnormal
connection exists between arteries and veins, and strokes are
common causes of seizures in older adults.
Toxic substances: using drugs or other chemicals or withdrawing
from addicting substances, especially alcohol, can affect the brain's
electrical activity and the nervous system.
Infection: an inflammation of the brain, such as that caused by
meningitis or encephalitis (bacterial or viral), may trigger a seizure.
Birth defects: congenital malformations in the brain can be
responsible for seizures in infants and young children.
Brain tumour: although a brain tumour is an uncommon cause, a
seizure may be an indication of a brain tumour
genetic conditions such as tuberous sclerosis
complications during pregnancy or birth
stroke
neurosurgical operations
parasitical infection
Drug or alcohol abuse
Brain abnormalities present before birth or brain damage
related to birth
Lead poisoning
Family history of seizure disorders
Low blood sugar
Exposure to toxic fumes
Genetic predisposition
…
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- How is Epilepsy Diagnosed?
It's not uncommon for a person to experience a single seizure during his or her
lifetime. Isolated seizures may occur during early childhood, or they may be
brought on by certain circumstances, such as a high fever or prolonged sleep
deprivation. However, if a person has more than one seizure, a diagnosis of
epilepsy should be considered. When a seizure occurs, the person affected
usually won't be able to recall it. If a spouse, family member or friend witnessed
the episode, he or she will be able to provide important information to help a
doctor determine what happened.
If the patient loses consciousness or experience unusual body movements, the
doctor will need to determine whether the patient had an actual seizure. If it was
a seizure, the doctor will try to determine whether it was caused by a short-term
problem, such as an infection or fever. In these cases, the problem can be treated
easily. In other cases, there may be a structural problem in the brain that's
causing to have seizures, or may have problems with the way brain's electrical
system works.
The doctor will order tests to confirm the diagnosis and to see whether there is
any identifiable cause for the epilepsy. Tests may include:
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Blood test
This will help to give a picture of the general health; a blood test also may show
any metabolic reason for the seizures.
Electroencephalogram (EEG)
An EEG measures electrical activity of the brain. The procedure is painless and
lasts about 35 to 45 minutes. Small electrodes are placed on several areas of the
scalp. The electrodes transmit information about brain waves. This information
is then recorded on to paper for analysis. An EEG is most valuable if patterns of
epilepsy or hyper-excitability occur during the procedure. A negative EEG does
not rule out a diagnosis of epilepsy.
Computed tomography (CT)
A CT-scan is a computerized X-ray that provides a three-dimensional view of
body structures. Prior to the test, a technician may inject dye into one of the
veins to make the scan easier to read. The dye may make feel hot and flushed, it
may leave a metallic taste in the mouth, or it may make feel nauseated for a
moment.
Magnetic resonance imaging (MRI)
Similar to a CT scan, an MRI provides a three-dimensional view of body
structures. However, an MRI uses magnetic fields – not radiation – for imaging.
MRI may provide better definition of brain structures than a CT scan.
Symptoms caused by a seizure may vary depending on where the seizure starts.
(if a seizure begins in the "sight" area, a person may see flashing lights at the onset of the seizure, etc…)
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- Treatment
Treatment for seizures is normally anti-epileptic medication, which does not
cure epilepsy or the tendency to have seizures but usually does help control the
seizure activity. For the people on these drugs, seizures are eliminated in about
50% of cases. Drugs reduce the frequency and/or intensity of seizures in another
30%. The remaining 20% of people have seizures that can not be brought under
control by conventional drug therapy. They may require large doses or more
than one drug, or they may be drug-resistant. The "traditional" anti-epileptic
drugs are: phenobarbital, primidone (Mysoline), phenytoin (Dilantin),
carbamazepine (Tegretol), valproic acid (Depakene), divalproex sodium
(Epival), clonazepam (Rivotril), and ethosuximide (Zarontin).
There is an increasing awareness of the benefits of surgery in the treatment of
certain patients who continue to have seizures despite of the best treatment with
anticonvulsants. The last decade has seen significant advances in the surgical
treatment of epilepsy. This has come about with the development of better
imaging techniques such as magnetic resonance imaging (MRI) and - better
seizure localization with increasing sophistication of electroencephalographic
(EEG) technology, single photon emission computed tomography (SPECT) and
positron emission tomography (PET).
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These advances together with improvements in surgical techniques have
increased the safety and efficacy of operations for the treatment of epilepsy.
Recent data suggest that Gamma Knife Radiosurgery can be used with
acceptable safety and efficacy in patients with medial temporal lobe epilepsy
and offers a potentially valuable modality to provide long-term seizure control
in patients with a single temporal lobe seizure focus. This procedure may offer a
way to treat patients effectively that have a single, well-defined seizure focus
and avoid the risks associated with a craniotomy (following standard temporal
lobectomy).
Gamma Knife® radiosurgery is a sophisticated radiation therapy technique that precisely delivers a
single, finely focused, high dose of radiation to well-defined, small intracranial targets. It is especially
effective for treating tumors, epilepsy, trigeminal neuralgia, and arteriovenous malformations.
Only patients whose seizures are not well controlled on medical treatment are
considered for surgery. Before seizures are considered medically intractable, the
physicians must ensure that the correct seizure diagnosis has been made and that
the correct drugs have been used in the appropriate amounts. Even then,
however, there is no clear definition of when to move to surgery.
Among the factors to consider are seizure type, frequency and severity, the
length of time since the diagnosis and the impact of the epilepsy on the patient's
quality of life. There are also other reasons to consider surgical therapy.
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For instance, repeated seizures may lead to neurological deterioration and
certain patients may have intolerable side effects to anticonvulsant medications.
It is important to stress that not all patients with medically refractory epilepsy
can be helped with surgery. The best surgical candidates have seizures arising
from a single location and from an area of the brain that is relatively silent
meaning that the seizure focus can be safely and completely removed.
Vagus Nerve Stimulation is a mild electrical stimulation of a nerve called the
vagus nerve that runs through the neck and carries information to the brain. A
pacemaker-like generator implanted in the patient's chest delivers electrical
impulses to this nerve at regular intervals around the clock.
Vagus nerve stimulation therapy is another form of treatment that may be tried when medications fail to
stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial
seizures that resist control by other methods. The therapy is designed to prevent seizures by sending
regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.
It is thought that nerve fibers from the vagus nerve carry information to the
brainstem and thence to areas of the brain known to be involved in
seizures. Epileptic seizures are caused by normally well-organized brain waves
becoming completely disorganized. It has been suggested that stimulation of the
vagus nerve may be able to intercept this abnormal brain activity, preventing
seizures. Patients must undergo a 1-2 hour operation performed under general
(or local and regional) anaesthesia.
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Two incisions are made – each about 5-6 cm.long – one on the left chest wall, and the other
on the neck.
A small pulse generator, about the size of a stopwatch, is surgically implanted in the
patient's upper left chest.
Wires are tunnelled under the skin and attached to the vagus nerve in the neck.
The electrical connection between the vagus nerve and the pulse generator is checked
before the incision is closed.
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After a short healing period, the battery-powered pulse generator is programmed
by the doctor to begin sending a particular "dosage" of stimulation to the vagus
nerve, say 30 seconds of stimulation, at five minute intervals, with a strength of
0.25 milleamperes of electrical current. During follow-up visits the generator
can be "ramped up" to higher levels of stimulation to achieve better seizure
control.
The vagus nerves branch off the brain on either side of the head and travel down the neck, along the
oesophagus to the intestinal tract. They are the longest nerves in the body, and affect swallowing and
speech. The vagus nerves also connect to parts of the brain involved in seizures. In many seizures
disorders, electrical stimulation of the vagus nerves may afford relief of symptoms.
There has not been much research done into alternative therapies for epilepsy,
and, as yet, there is little scientific evidence of their effectiveness. On the other
hand, some people who have tried complementary treatments have felt that these
have helped their epilepsy and improved their quality of life. Certainly, reducing
stress can reduce seizures in some people, and alternative therapies that include
stress-reduction techniques can help some people better control their seizures.
Furthermore, the greater involvement of the person with epilepsy in his or her
own seizure management through these therapies can be positive in itself.
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Alternative therapies include such techniques as acupuncture, chiropractic,
massage therapy, relaxation, guided imagery, biofeedback, aromatherapy,
yoga, therapeutic touch, homeopathy, diet, etc. These are unconventional or
non-medical therapies that tend to focus on the integration of the body, mind and
spirit, sometimes referred to as the holistic model.Most people with epilepsy
need to take anti-epileptic medication to control their seizures, so the nonmedical therapies are more often "complementary" to their conventional
medical treatment, and not truly "alternative".
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Conclusion
The adult human brain weighs 1.4 kilograms and contains approximately one
hundred billion nerve cells or neurons. The abnormal excessive and
synchronous discharge of a group of neurons is the basis for epilepsy. In this
respect, epilepsy is very much like a thunderstorm inside the brain. The location
of this disturbance, its duration and spread to neighbouring areas determine the
clinical features of seizures.
1% of the population has a tendency for recurrent seizures, making epilepsy a
common disorder. Anticonvulsant drugs suppress abnormal neuronal discharges
and limit the spread of seizure activity in the brain. 60% of patients are well
controlled with these medications. This leaves 40% of patients who are not
adequately controlled for whom alternate strategies need to be considered.
If a person has one epileptic fit, it does not mean that he or she has epilepsy.
Only when that person suffers repeated spontaneous epileptic seizures (i.e.
without any direct trigger), should they be diagnosed as having epilepsy.
Epilepsy is therefore always a chronic illness which can go on for many years
(but which does not necessarily last a lifetime!).
Hardly any other illness can be traced back in medical history as far as epilepsy
can. Many pointers from early history indicate that this condition has been part
of the human lot from the very beginning. Then as now, it is one of the most
common chronic diseases that there are: 0.5% of all human beings suffer from
epilepsy.
Just as there are many different kinds of seizures, there are many different kinds
of epilepsy. Science has identified hundreds of different epilepsy syndromes -disorders characterized by a specific set of symptoms that include epilepsy.
Some of these syndromes appear to be hereditary. For other syndromes, the
cause is unknown. Epilepsy syndromes are frequently described by their
symptoms or by where in the brain they originate. People should discuss the
implications of their type of epilepsy with their doctors to understand the full
range of symptoms, the possible treatments, and the prognosis.
The causes of seizures can vary. Often, the cause is unknown. Sometimes
seizures run in families. Finding the underlying cause can help stop seizures. A
seizure is a sudden burst of electricity in the brain, very much like a tiny bolt of
lightning. This electricity is a signal that causes the body to feel different, or
makes the body do things that the patient can't control. Sometimes the electrical
signal only reaches part of the brain.
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Then a part of the body, like an arm or a leg, may move on its own. If the signal
goes all through the brain, the patient may shake all over or may fall asleep for
a short time. The whole seizure is usually rather short (usually 10 – 60 seconds).
Epileptic seizures can look very different. There is hardly any function of the
brain which cannot also be part of an epileptic seizure.
As a result, seizures can manifest themselves in many different ways: in
movements (e.g. jerking, trembling, stiffening of the muscles), in paralgiae/
sensory disturbances (e.g. tingling, numbness, hearing or seeing something), in
so-called vegetative signs (e.g. flushing, lips turning blue, salivation, bowel
sounds, wetting oneself), or in psychological changes (e.g. fear, sudden memory
impairment, loss of consciousness).
In the United States e.g., there are approximately 1.6 million people who have
epilepsy (roughly 0.6% of the population). Epilepsy has a lifetime prevalence of
3% - that is, 7.2 million persons (U.S) will become affected by this disorder.
Almost 10% of the population will experience at least one epileptic seizure in 80
years of life.
For many years, epilepsy, though clearly a chronic disease with both medical
and social components was not a public health priority. This was partly because
public health has traditionally focused on tracking sources of infectious disease
and related health hazards with a view to controlling and preventing their
effects and promoting a more healthy society. However, as medical care extends
the lives of the chronically ill, their issues are increasingly affecting the social
fabric and the character of public health. The need to track the incidence,
prevalence, health status, quality of life, and social outcomes of chronic disease
is now more pressing, requiring the public health community to pay ever greater
attention to these issues, using many of the same strategies with which they
formerly tracked infection and its management…
HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1