For the proper definition of epilepsy it is also required that the seizures are the result of a chronic underlying pathology rather than a temporary or avoidable condition like hypoglycemia (low blood glucose).
What causes Epilepsy?
Epilepsy or seizures are the result of irritation or injury to the neurons (brain cells) that are generally located in the cortex area of brain (the outer layers). These neurons produce a burst of abnormal electrical activity that manifests as seizures.
The causes of irritation or injuries to the neurons include;
- Idiopathic (cause unknown)
- Genetically mediated
- Structural abnormalities of brain like scars, tumors, stroke etc
- Electrolyte abnormalities like low sodium, glucose in the blood
- Infections e.g. encephalitis
These seizures are of two types based on what we see from out side;
- With major motor manifestations
- With minor or no motor manifestations
Patients with the first category present with various prominent motor activities mentioned below in isolation or in various combination;
- Stiffening of limbs and/or body
- Convulsive or shaking movements of limbs and/or body
- Head or eye turning to one side
In the second category you may see these manifestations including;
- Blank stare
- Eye blinking
- Lip smacking
- Semi-purposeful gestures & movements
However not all seizures are expressed outside, some of them are sensory phenomenon or just experienced by the patients and you see nothing outwardly.
Patient may experience recurrent abnormal sensations of touch, pins & needles, hot or cold feelings, pain etc. Special senses including visual, hearing, taste, smell may be experienced too.
The three distinct phases of a seizure include;
- Actual seizure presentation (see clinical manifestations)
- Post-ictal phenomenon
Aura is the earliest manifestations of a seizure and not necessarily occurs always. They could be any kind including experiencing of abnormal smell, taste or motor, sensory manifestations etc.
Post-ictal phenomena are the temporary manifestations after the actual seizure presentation is over. The presentation is protean and generally include;
- Psychotic manifestations
- Temporary limb paralysis etc
Some of the commonly encountered seizure types
Grand mal seizures:
Also called as tonic-clonic seizures, the term tonic means stiffening of the body and clonic means convulsive movements. The seizure commences abruptly and patient loses consciousness.
Stiffening of the limbs and body takes place, some times with head and eyes twisted to one side and this is followed by usually violent convulsive movements.
Tongue bites and losing bowel, bladder control are common. After few minutes of shaking the seizure subsides followed by post-ictal phenomena.
There are no major motor manifestations with this seizure. They are usually brief lasting for several seconds and recurrent in nature. During the attack they manifest with a blank stare, and do not respond.
Some eye blinking, lip smacking may accompany. No auras or post-ictal manifestations are seen. This type of epilepsy is more frequent in children.
Complex partial seizures:
Initially some aura is felt then the actual seizure will manifest as a change in mental status like confusion or disorientation.
Minor motor phenomena like semi-purposeful body or limb movements (called as automatism) are generally seen e.g. repeated lip smacking etc. The seizure may last for few minutes then post-ictal manifestations are seen.
Patient here experience sudden & brief jerking movements of limbs or body as if they were jolted by electric shocks.
Sometimes a seizure may start at one focal point in your body like a limb and then spread to the whole body and this called a partial seizure with secondary generalization.
Epilepsies are mostly diagnosed clinically however certain investigations are usually required for;
- To confirm diagnosis if still doubt exits
- To classify the epilepsy
- To detect the cause for the fits
- To choose the right treatment etc.
The common investigations performed are;
- CT scan (CAT scan) of brain
- MRI of brain
- CSF (cerebrospinal fluid) analysis
- Certain blood tests
- Special tests (e.g. genetic tests)
The EEG test studies the brain waves and there are many types like routine, ambulatory, video-EEG monitoring etc.
The CT or MRI of brain is done with and without a contrast injection, and used to detect any structural problems causing seizures.
The blood tests are done to look or electrolyte imbalance, infections etc. A CSF analysis will detect infections of brain.
- Stabilize the patient
- Hospitalize if necessary
- To treat with medication like diazepam under supervision
- If necessary to treat with anti-epileptics like phenytoin, or other drugs
Chronic & preventive management;
- Long term anti-epileptic medications (if necessary)
- Epilepsy surgeries (if medications not helpful)
- Driving precautions as needed
- Precautions & modifications with your occupation & lifestyle as necessary
Some of the common antiepileptic medications include;
- Sodium valproate
- Levetiracetam etc.
Although in general majority of the patients do well on these medications however not all respond adequately and side effects are a concern in some patients too.
Implantation of VNS (vagal nerve stimulator) and excision of the epileptic focus in the brain are some of the surgical options available.
Lifestyle/ occupational modification include for example avoiding;
- swimming alone,
- working with dangerous equipments or near fire, water etc
- Stressful situations
- Sleep deprivation etc.
There are effective medications and surgeries for many epilepsy disorders in the modern era and lot of patients can hope for either a seizure free and/or quite productive life.