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Epilepsy

Definition


Disease: Epilepsy Epilepsy
Category: Neurological diseases

Disease Definition:

This disorder is caused by the generation of electrical signals inside the brain, which causes recurring seizures. The symptoms of seizures vary. Although some people with epilepsy may simply stare blankly for a few seconds during a seizure, however, others may have full-fledged convulsions. If someone has a solitary seizure it doesn’t mean that they have epilepsy. For an epilepsy diagnosis, at least two unprovoked seizures are required.

 

Because seizures may be dangerous during activities like driving or swimming, even mild seizures require treatment. In some cases treatment may include surgery, but usually it includes medications, which reduces or even eliminated the frequency and intensity of the seizures. Many children with epilepsy outgrow the condition with age.
 

Work Group:


Symptoms, Causes

Symptoms:

Seizures could affect any process the brain coordinates because epilepsy is caused by an abnormal activity in the cells of the brain. A seizure may cause:

 

  • A staring spell
  • Temporary confusion
  • Complete loss of consciousness
  • Uncontrollable jerking movements of the arms and legs.

 

Depending on the type of the seizure, symptoms could vary. Usually, a person with epilepsy tends to have the same type of seizure each time, meaning that the symptoms will be similar in all the episodes.

 

Based on how the abnormal brain activity begins, seizures are classified as either partial or generalized. Sometimes, seizures could begin as partial and then become generalized.

 

PARTIAL SEIZURES:

Partial or focal seizures occur when the seizure results from abnormal activity in just one part of the brain. These seizures could be divided into:

 

Simple partial seizures:

These seizures could alter emotions or change the way things look, smell, feel, taste or sound. They may result in involuntary jerking of part of the body, such as an arm or leg and spontaneous sensory symptoms, including vertigo, flashing lights and tingling. However, these seizures don’t result in loss of consciousness.

 

Complex partial seizures:

These seizures cause loss of awareness for a period of time because they alter consciousness. They result in staring and unpurposeful movements, including swallowing, twitching, walking in circles, hand rubbing and chewing.

 

GENERALIZED SEIZURES:

These seizures involve all of the brain, and they have four types:

 

Petit mal or absence seizures:

These seizures could cause a brief loss of consciousness, and they result in staring and subtle body movement.

 

Atonic seizures:

These seizures, also called drop attacks, cause loss of normal muscle tone, which could lead to falling down or collapsing.

 

Myoclonic seizures:

These seizures cause sudden jerks or twitches of the arms and legs.

 

Grand mal or tonic-clonic seizures:

These seizures, which are the most intense of all types of seizures, cause loss of bladder control, body stiffening and shaking, and loss of consciousness.

 

In case someone experiences a seizure for the first time, they should seek medical advice, however, they should seek immediate medical help in case:

 

  • They're pregnant
  • Have diabetes
  • A second seizure follows immediately
  • The seizure lasts more than five minutes
  • They've injured themselves during the seizure
  • Breathing or consciousness doesn’t return after the seizure stops.
     

Causes:

In about half of the people with epilepsy, the cause is not known. In the other half, the condition could be due to various factors, including:

 

Head trauma:

Epilepsy could be due to head injury sustained during a car accident or some other traumatic injury.

 

Genetic influence:

It is likely that there’s a genetic influence because some types of epilepsy, which are categorized by the type of seizure, run in families. Some types of epilepsy have been linked with specific genes, though it’s estimated that up to 500 genes could be tied to the condition. In some cases, genes only make a person more susceptible to environmental conditions that trigger seizures, meaning that they’re only a part of the cause.

 

Diseases:

Epilepsy could be caused by diseases, such as viral encephalitis, meningitis and AIDS.

 

Medical disorders:

Epilepsy could also be caused by strokes or heart attacks that result in damage to the brain. In people over the age of 65, almost half of the cases of epilepsy are caused by stroke.

 

Developmental disorders:

Autism and Down syndrome are developmental disorders that could be associated with epilepsy.

 

Dementia:

Among older adults, dementia is the leading cause of epilepsy.

 

Prenatal injury:

Poor nutrition, oxygen deficiencies or an infection in the mother could make fetuses susceptible to brain damage, which may lead to cerebral palsy in the child. Almost 20% of seizures in children are associated with neurological abnormalities, including cerebral palsy.
 

Complications

Complications:

Seizures could sometimes lead to circumstances that are dangerous to the patient or others, such as:

 

Drowning:

In case someone has epilepsy, due to the possibility of having a seizure while in the water, that person is 15 times more likely to drown while swimming or bathing than the rest of the population.

 

Falling:

A person may injure their head or break a bone in case they fall during a seizure.

 

Car accidents:

In case someone has epilepsy, driving could be quite dangerous, because they may lose their awareness or control while driving or operating other equipment.

 

Pregnancy complications:

Certain anti-epileptic medications increase the risk of birth defects, and seizures during pregnancy pose dangers to the mother and the baby. A woman should consult her doctor in case she has epilepsy and wants to have children. Most women with epilepsy could have healthy children. Planning pregnancy with a doctor is very important. The woman will be carefully monitored throughout her pregnancy and her medications will be adjusted.

 

There are some uncommon but life-threatening complications that could result from epilepsy, such as:

 

SUDEP (sudden unexplained death in epilepsy):

People with epilepsy have a small risk of sudden unexplained death in case their condition is poorly controlled. Less than one in 1,000 people with epilepsy die from SUDEP, however, it is more common in people whose seizures aren’t treated. When generalized tonic-clonic seizures are frequent, the risk of SUDEP increases.

 

Status epilepticus:

In case someone has frequent recurrent seizures without regaining consciousness in between them or if the seizures last more than five minutes, status epilepticus could occur. This complication makes the person vulnerable to permanent brain damage and death.
 

Treatments:

Epilepsy is first treated with medications. However, surgery or another type of treatment may be recommended in case medications don’t work.

 

MEDICATIONS:

By using a single anti-epileptic drug, most people with epilepsy could become seizure-free. The frequency and intensity of seizures could be decreased for other people. Most children with controlled epilepsy could eventually stop the medications and live a seizure-free life. While adults, after two or more years without seizures could discontinue medications. However, finding the right medication and dosage is a complex task. First, the patient will be prescribed a single drug at a relatively low dosage and then the dosage will be increased gradually, until the seizures are controlled. The patient may also be recommended trying a combination of two drugs in case they've tried two or more seizure medications without success. Some of the mild side effects of anti-seizure medications include:

 

  • Skin rashes
  • Dizziness
  • Fatigue
  • Loss of coordination
  • Weight gain
  • Speech problem
  • Loss of bone density

 

Some of the more severe but rare side effects of anti-seizure drugs include:

 

  • Severe rash
  • Depression
  • Suicidal thoughts and behaviors
  • Inflammation of certain organs, such as the pancreas.

 

Someone should take these steps in order to achieve the best seizure control possible with medications:

 

  • Medications should be taken exactly as prescribed
  • Never stoping any medications without talking to the doctor.
  • Informing the doctor before taking other prescription medications, switching to a generic version of the medication, herbal remedies, or over-the-counter drugs.
  • In case the patient notices any new or increased feelings of depression, suicidal thoughts or unusual changes in their mood or behaviors, they should let their doctor know immediately.

 

With their first medication, almost half of all people who are newly diagnosed with epilepsy will become seizure-free. However, they may be suggested surgery or other therapies in case their anti-epileptic medications don’t provide satisfactory results.

 

SURGERY:

When tests show that the seizures originate in a small and well-defined area of the brain that doesn’t interfere with vital functions like language, hearing or speech, then surgery will be performed. During the surgery, the area of the brain that is causing the seizures will be removed.

 

However, in case the seizures originate in a part of the brain that cannot be removed, the patient may be recommended a different sort of surgery, in which a series of cuts are made in the brain, designed to prevent seizures from spreading to other parts of the brain.

 

Despite the fact that some people will still need to take medications after successful surgery to help prevent seizures, but they could take fewer drugs with low dosages. Sometimes, surgery could cause complications, including permanently altering the patient's cognitive abilities. In case someone's thinking of having a procedure, they should choose a doctor well-experienced in that field.

 

THERAPIES:

Vagus nerve stimulation:

During this therapy, a device called a vagus nerve stimulator is implanted underneath the skin of the chest, just like a pacemaker. The wires from the stimulator are wrapped around the vagus nerve in the neck. Short bursts of electrical energy are delivered to the brain by the battery-powered device through the vagus nerve. This device could reduce seizures by 30 to 40%; however, it’s not clear how and most people still need to take anti-epileptic medication. Coughing, hoarseness, shortness of breath, throat pain, muscle pain and tingling are some of the side effects of vagus nerve stimulation.

 

Ketogenic diet:

Be maintaining a diet called ketogenic, high in fats and low in carbohydrates, some children with epilepsy have been able to reduce their seizures. This diet causes the body to break down fats for energy, instead of carbohydrates. After a few years, some children could go off this diet without having seizures.

 

In case someone's considering a ketogenic diet, they should talk to a doctor. When taking the diet, it is important to make sure that the child doesn’t become malnourished. Constipation, dehydration, buildup of uric acid in the blood that can result in kidney stones, and slowed growth due to nutritional deficiencies are some of the side effects of a ketogenic diet. However, if the diet is properly and medically supervised, these side effects are uncommon.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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