Epilepsy Treatment

Epilepsy is a neurological disorder causing recurrent seizures due to abnormal neural activity in the brain cortex. Seizures are sudden and erratic electrical impulses that disturb the normal activity of the brain. A person is said to be suffering from epilepsy if they have two or more seizures without any trigger.

Associated Anatomy

Brain

Types of Epilepsy

Epilepsy is divided into four, depending on the type of seizures:

• Generalized seizures:affects both sides of the brain which may or may not involve muscle movements. When muscles are involved, they are called motor seizures and cause jerky movements that lead to muscle rigidity and weakness. If there are no muscles involved, then they are termed non-motor seizures and cause brief twitching, blinking or staring, and a confused look. Some other types of generalized seizures are
  • Petit Mal or absence seizures
  • Myoclonic seizures
  • tonic and atonic seizures
  • grand mal or tonic-clonic seizures
• Focal seizures: affect only one part of the brain and spread to other parts causing symptoms that range from mild to severe. They are the most common seizures that begin with a typical sensation called Aura, a feeling of blankness or an unpleasant sensation in the stomach.
• Generalized and focal seizures: involves the features of both generalized and focal seizures
• Unknown seizures: when there is no clear-cut distinction between the type of seizures, and even medical professionals do not have information about its origin.

Epilepsy Symptoms

The most typical feature of epilepsy is recurrent seizures which may or may not be accompanied by erratic muscular movements. Different types of seizures have different symptoms:

Symptoms of Simple or Focal Seizures

• A feeling of uneasiness in the stomach
• A feeling of having a deja vu
• Tingling sensation in hands and legs
• Sudden twitching movements of hands and arms

A person doesn't lose consciousness in focal seizures and it is always accompanied by an Aura, a premonition sign that something is about to happen.

Symptoms of Complex Focal Seizures

• Accompanied by the smacking of lips, swallowing, and chewing
• Random movements of arms

Tonic-clonic Seizures (Grand mal Seizures)

A typical epileptic fit occurs in two stages, lasting for a few minutes.

Stage 1 or Tonic stage: Unconsciousness, stiffness in the body, and chances of falling down

Stage 2 or Clonic stage: Jerky limb movements with chances of injury to the tongue, lips, and cheeks.

Absence or Petit Mal Seizures

• Loss of consciousness of the surroundings
• Gazing blankly into space
• Fluttering of eyes
• Jerking movements of the body

Myoclonic Seizures

• Resembles a person having an electric shock
• Lasts for a few seconds and generally occurs after waking up from sleep

Status Epilepticus

• A severe form of seizure and requires immediate medical attention
• lasts for a long time
• loss of consciousness

Causes of Epilepsy

• Most seizures have an unknown origin. However, genetics and some acquired factors are known to cause epileptic seizures.
• People having a family history of epilepsy in parents, siblings and immediate relatives, have a higher chance of developing this condition in the future
• Congenital conditions
• A serious brain injury during childbirth
• Metabolic diseases like Phenylketonuria
• Brain tumors
• Infections like meningitis, encephalitis, neurocysticercosis and cerebral malaria
• A brain stroke
• Accidents causing injury to the brain
• Chronic alcohol and drug use

Epilepsy Diagnosis

If someone reports two or more seizures, a detailed medical history will be taken. After that, some specific tests are done to evaluate the cause and severity of the epileptic seizures:

• Neuroimaging: CT scans, MRI
• Cerebrospinal fluid tests to look for brain infections

Differential Epilepsy Diagnosis

Epileptic seizures take a long time to get diagnosed and are commonly misdiagnosed due to the presence of other diseases that may share similar symptoms, such as:

• Hypoglycemia
• Syncope
• Panic attacks
• Paroxysmal movement disorders
• Migraine attacks

Epilepsy Treatment

Medications

Anticonvulsants or antiepileptic drugs like valproic acid, zonisamide, phenytoin, and oxcarbazepine are prescribed. They work by altering the chemicals in the brain and hence control the onset of seizures.

Surgery

• Laser interstitial thermal therapy (LITT): a minimally invasive procedure that targets the defective lesion that is causing seizures
• Focal resection: removes the defective part of the brain through a procedure called Craniotomy.
• Vagus nerve stimulation: a device is inserted inside the brain to stop the distorted electrical impulses.
• Hemispherectomy: This procedure removes the entire defective hemisphere of the brain. Usually done in case of severe seizures.

Epilepsy Prevention

Primary Prevention

Epilepsy can be triggered by numerous factors. The only way to prevent an epileptic attack in vulnerable people is to avoid certain triggers

• Different people may have different triggers. So the first step is to identify those potential triggers and avoid them. Strong flashing lights, emotional outbursts, loud noise, and visual stimulation are a few common triggers.
• Avoid stress and anxiety
• Adopt a proper sleeping schedule
• Avoid alcohol and other brain-altering substances like drugs

Secondary Prevention

• Ketogenic diet: A diet low in carbohydrates and high in fats helps in controlling seizures. However, this should be carefully monitored, especially in people who are obese or suffering from other cardiovascular conditions
• Alternative therapy for emotional management.

Typical Test Required for Epilepsy

An electroencephalogram (EEG) is the most common test for diagnosing epilepsy. It records the electrical activity of the brain. Small electrodes are attached to various places on the head, and the activity of the brain is monitored. Any abnormal activity is reflected on the screen and a diagnosis is made accordingly.

Other tests that are needed:

• Positron emission tomography (PET) scan
• Single-photon emission computerized tomography (SPECT)
• Magnetoencephalography (MEG)
• Neuropsychological tests for the assessment of other secondary symptoms like speech, memory, etc.

Risk factors of Epilepsy

• Trauma during birth that may have caused injury to the brain
• Premature birth
• Brain tumors
• Injury in any part of the brain that damaged blood flow
• Stroke
• Brain infections like meningitis and encephalitis
• Fever in childhood that lasted for a long time, affecting the brain
• Family history of epilepsy
• Alcohol and drug abuse
• Cerebral palsy

Complications of Epilepsy

Epilepsy alters the quality of life of an individual, if not treated. Possible complications that may arise are:

• Permanent brain damage
• Difficulty in learning and thought
• Prone to grievous injuries like accidents, drowning, etc.
• Choking on saliva or food during seizures