Epilepsy

A still image of a generalized seizure

A bite to the tip of the tongue due to a seizure

An EEG can aid in locating the focus of the epileptic seizure.

Anticonvulsants

Wristbands or bracelets denoting their condition are occasionally worn by epileptics should they need medical assistance.

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. These seizures are the result of sudden, excessive electrical discharges in the brain. Epilepsy affects people of all ages, genders, and ethnicities, making it one of the most common neurological disorders globally. This article provides an overview of epilepsy, including its causes, symptoms, diagnosis, treatment, and impact on daily life.

Causes

The exact cause of epilepsy is unknown in about 50% of cases. However, various factors are associated with the development of epilepsy, including:

• Genetic predisposition: Some types of epilepsy are hereditary and result from genetic mutations.
• Brain injury: Traumatic brain injuries, such as those caused by accidents or strokes, can lead to epilepsy.
• Infections: Certain infections, like meningitis or encephalitis, can cause epilepsy.
• Developmental disorders: Conditions like autism and neurofibromatosis can increase the risk of developing epilepsy.
• Prenatal factors: Complications during pregnancy or childbirth can result in epilepsy in the child.

Types of Seizures

Epileptic seizures can be categorized into two main types:

Focal Seizures

Focal seizures, also known as partial seizures, occur when the abnormal electrical activity is limited to a specific area of the brain. These seizures can be further classified as:

• Focal aware seizures (simple partial seizures): The person remains conscious during the seizure and may experience sensory or motor disturbances.
• Focal impaired awareness seizures (complex partial seizures): The person loses awareness during the seizure and may exhibit automatisms, such as lip-smacking or fumbling.

Generalized Seizures

Generalized seizures involve the entire brain and are classified into several types, including:

• Absence seizures (petit mal seizures): These are characterized by brief lapses in consciousness, often accompanied by staring or subtle movements.
• Tonic-clonic seizures (grand mal seizures): These seizures involve a sudden loss of consciousness, body stiffening (tonic phase), and convulsive movements (clonic phase).
• Myoclonic seizures: These involve sudden, brief, and involuntary muscle contractions.
• Atonic seizures (drop attacks): These seizures cause a sudden loss of muscle tone, leading to falls or collapses.
• Tonic seizures: These seizures involve a sudden increase in muscle tone, causing stiffness.

Symptoms

The symptoms of epilepsy vary widely, depending on the type of seizure and the area of the brain affected. Common symptoms include:

• Involuntary jerking movements
• Staring spells
• Loss of consciousness
• Confusion
• Emotional or sensory disturbances

Diagnosis

Diagnosing epilepsy typically involves a comprehensive evaluation, including:

• Medical history: A detailed account of the patient's seizure episodes and any relevant medical conditions.
• Neurological examination: A thorough examination to assess the patient's cognitive and motor functions.
• Electroencephalogram (EEG): This test measures electrical activity in the brain and can help identify the type of seizure.
• Imaging studies: Magnetic resonance imaging (MRI) or computed tomography (CT) scans may be used to identify structural abnormalities in the brain.

Treatment

Treatment for epilepsy aims to control seizures and minimize their impact on daily life. Common treatment options include:

• Antiepileptic drugs (AEDs): These medications help to reduce the frequency and severity of seizures. AEDs are often the first line of treatment for epilepsy, and the choice of drug depends on the type of seizure and the individual's response to the medication.
• Vagus nerve stimulation (VNS): This is a surgical procedure that involves implanting a device under the skin of the chest, which sends electrical impulses to the vagus nerve. VNS can help reduce seizure frequency in some people who do not respond to AEDs.
• Responsive neurostimulation (RNS): This is another type of implantable device that monitors brain activity and delivers electrical stimulation directly to the seizure focus when abnormal activity is detected.
• Deep brain stimulation (DBS): This procedure involves implanting electrodes in specific areas of the brain and using electrical pulses to help control seizures.
• Dietary therapy: Some individuals with epilepsy, particularly children, may benefit from a ketogenic diet or a modified Atkins diet. These high-fat, low-carbohydrate diets help to control seizures in some cases.
• Surgery: In cases where seizures are caused by a specific brain lesion or abnormality, surgical removal of the affected tissue may be a viable treatment option.

Living with Epilepsy

Living with epilepsy can present challenges, but with appropriate management, many people can lead full and active lives. Key aspects of living with epilepsy include:

• Adhering to prescribed treatment plans
• Regular medical check-ups and monitoring
• Educating oneself and others about the condition
• Identifying and managing seizure triggers
• Implementing safety measures at home and work
• Seeking support from friends, family, and support groups

Epilepsy in History and Culture

Epilepsy has been documented since ancient times, and its portrayal in history and culture has evolved over the centuries. In the past, epilepsy was often misunderstood and associated with supernatural or demonic influences. However, advances in medical knowledge have led to a greater understanding of the condition and reduced stigma. Today, many organizations and initiatives work to raise awareness about epilepsy and support those affected by the condition.

References

• Fisher, R. S., et al. (2014). "ILAE official report: A practical clinical definition of epilepsy." Epilepsia 55(4): 475-482.
• Beghi, E. (2020). "The Epidemiology of Epilepsy." Neuroepidemiology 54(2): 185-191.
• Löscher, W., & Schmidt, D. (2011). "Modern antiepileptic drug development has failed to deliver: ways out of the current dilemma." Epilepsia 52(4): 657-678.
• Wiebe, S., et al. (2001). "A randomized, controlled trial of surgery for temporal-lobe epilepsy." New England Journal of Medicine 345(5): 311-318.
• Kwan, P., & Brodie, M. J. (2000). "Early identification of refractory epilepsy." New England Journal of Medicine 342(5): 314-319.

Epilepsy Resources
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Classification	ICD-10: G40 -G41 ICD-9-CM: 345 MeSH: D004827 DiseasesDB: 4366
External resources	MedlinePlus: 000694 eMedicine: neuro/415