Epilepsy

Epilepsy
Epilepsy is a brain disorder involving repeated, spontaneous seizures of any

type. Seizures ("fits," convulsions) are episodes of disturbed brain function
that cause changes in attention or behavior. They are caused by abnormally
excited electrical signals in the brain.
Sometimes a seizure is related to a temporary condition, such as exposure to

drugs, withdrawal from certain drugs, a high fever, or abnormal levels of
sodium or glucose in the blood. If the seizure or seizures do not happen again
once the underlying problem is corrected, the person does NOT have
epilepsy.
In other cases, permanent injury to or changes in brain tissue cause the brain
to be abnormally excitable. In these cases, the seizures happen without an
immediate cause. This is epilepsy. Epilepsy can affect people of any age.
Epilepsy may be idiopathic, which means the cause cannot be identified.

These seizures usually begin between ages 5 and 20, but they can happen at
any age. People with this condition have no other neurological problems, but
sometimes have a family history of seizures or epilepsy.
Some other more common causes of epilepsy include:
 Stroke or transient ischemic attack (TIA)

 Illnesses that cause the brain to deteriorate
 Dementia, such as Alzheimer's disease
 Traumatic brain injury
 Infections (including brain abscess, meningitis, encephalitis, neurosyphilis,
and AIDS)
 Problems that are present from before birth (congenital brain defects)
 Injuries near the time of birth (in this case, seizures usually begin in
infancy or early childhood)
 Kidney failure or liver failure
 Metabolic diseases that children may be born with (such as
phenylketonuria)
 Tumors or other structural brain lesions (such as hematomas or
abnormal blood vessels)
Symptoms
The severity of symptoms can vary greatly, from simple staring spells to loss
of consciousness and violent convulsions. For most people with epilepsy,
each seizure is similar to previous ones. The type of seizure a person has
depends on a variety of things, such as the part of the brain affected and the
underlying cause of the seizure.
An aura consisting of a strange sensation (such as tingling, smelling an odor
that isn't actually there, or emotional changes) occurs in some people prior to
each seizure.
A petit mal seizure is the term commonly given to a staring spell, most
commonly called an "absence seizure." It is a brief (usually less than 15
seconds) disturbance of brain function due to abnormal electrical activity in
the brain.
A generalized tonic-clonic seizure is a seizure involving the entire body. It is

also called a grand mal seizure. Such seizures usually involve muscle rigidity,
violent muscle contractions, and loss of consciousness.
Generalized tonic-clonic seizures are the type of seizure that most

people associate with the term "seizure," convulsion, or epilepsy. They
may occur in people of any age, as a single episode, or as part of a
repeated, chronic condition (epilepsy). Symptoms
Many patients have an aura (a sensory warning sign) before the seizure. This
can include vision, taste, smell, or sensory changes, hallucinations, or
dizziness.
The seizure itself involves:
 Loss of consciousness or fainting, usually lasting between 30 seconds and 5

minutes
 General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20
seconds
 Violent rhythmic muscle contraction and relaxation (clonic movement), usually
lasting for 1 -2 minutes
 Biting the cheek or tongue, clenched teeth or jaw
 Incontinence (loss of urine or stool control)
 Stopped breathing or difficulty breathing during seizure
 Blue skin color
Partial (focal) seizures occur when this electrical activity remains

in a limited area of the brain. The seizures may sometimes turn into
generalized seizures, which affect the whole brain. This is called secondary
generalization.
Partial seizures can be further characterized as:
 Simple -- not affecting awareness or memory

 Complex -- affecting awareness or memory of events before, during, and
immediately after the seizure, and affecting behavior
Exams and Tests
A physical examination (including a detailed neurologic examination) may be

normal, or it may show abnormal brain function related to specific areas of the
brain.
Persons with epilepsy will often have abnormal electrical activity seen on an
electroencephalograph (EEG). (An EEG is a reading of the electrical activity in
the brain.) In some cases, the test may show where in the brain the seizures
start. EEGs can often be normal in between seizures, so it may be necessary
to perform a longer test.
Various blood tests and other tests to rule out temporary and reversible
causes of seizures, may include:
 Blood chemistry
 Blood sugar
 CBC (complete blood count)
 CSF (cerebrospinal fluid) analysis
 Kidney function tests
 Liver function tests
 Tests for infectious diseases
Tests for the cause and location of the problem may include:
 EEG
 Head CT or MRI scan
 Lumbar puncture (spinal tap)
Treatment
If an underlying cause for recurrent seizures (such as infection) has been

identified and treated, seizures may stop. Treatment may include surgery to
remove a tumor, an abnormal or bleeding blood vessel, or other brain
problems.
Medication to prevent seizures, called anticonvulsants, may reduce the

number of future seizures. These drugs are taken by mouth.
 The type of medicine you take depends on what type of seizures you
are having. The dosage may need to be adjusted from time to time.
 Some seizure types respond well to one medication and may respond
poorly (or even be made worse) by others. Some medications need to
be monitored for side effects and blood levels.
 It is very important that you take your medication on time and at the
correct dose. Most people taking these drugs need regular checkups
and regular blood tests to make sure they are receiving the correct
dosage.
 You should not stop taking or change medications without talking to
your doctor first.
Some factors increase the risk for a seizure in a person with epilepsy. Talk
with your doctor about:
 Certain prescribed medications

 Emotional stress
 Illness, especially infection
 Lack of sleep
 Pregnancy
 Skipping doses of epilepsy medications
 Use of alcohol or other recreational drugs
Epilepsy that does not get better after two or three seizure drugs have been
tried is called "medically refractory epilepsy."
 Some patients with this type of epilepsy may benefit from brain surgery
to remove the abnormal brain cells that are causing the seizures.
 Others may be helped by a vagal nerve stimulator. This is a device that
is implanted in the chest (similar to a heart pacemaker). This stimulator
can help reduce the number of seizures, but rarely stops the seizures
completely.
Sometimes, children are placed on a special diet to help prevent seizures.

The most popular one is the ketogenic diet. A diet low in carbohydrates, such
as the Atkins diet, may also be helpful in some adults.
Persons with epilepsy should wear medical alert jewelry so that prompt
medical treatment can be obtained if a seizure occurs.
Some people with certain types of seizures may be able to reduce or

completely stop their seizure medicines after having no seizures for several
years. Certain types of childhood epilepsy goes away or improves with age --
usually in the late teens or 20s.
For some people, epilepsy may be a lifelong condition. In these cases, the
seizure drugs need to be continued.
Death or permanent brain damage from seizures is rare. However, seizures

that last for a long time or two or more seizures that occur close together
(status epilepticus) may cause permanent harm. Death or brain damage are
most often caused by prolonged lack of breathing, which causes brain tissue
to die from lack of oxygen. There are some cases of sudden, unexplained
death in patients with epilepsy.
Serious injury can occur if a seizure occurs during driving or when operating
dangerous equipment. For this reason, people with epilepsy whose seizures
are not under good control should not do these activities.
People who have infrequent seizures may not have any severe restrictions on
their lifestyle.
The Anti-epileptic Drugs
 Tegretol (Carbamazepine)
 Epilum (Sodium valproate)
 Dilantin (Phenytoin sodium)
 Zarontin (Ethosuximide)
 Rivertril (Clonazepam)
 Frisium (Clobazepam)
 Valium (Diazepam)
 Mogadon (Nitrazepam)
 Prominal (Methylphenobarbitone)
 Mysoline (Primidone)
 Phenobarbitone
 Ospolot (Suthiame)
 Gabapentin
 Progabide
 Vigabatrin
 Lamotrigine
 Topiramate
 Gabitril
Possible Complications
 Difficulty learning
 Inhaling fluid into the lungs, which can cause aspiration pneumonia
 Injury from falls, bumps, or self-inflicted bites during a seizure
 Injury from having a seizure while driving or operating machinery
 Many epilepsy medications cause birth defects -- women wishing to
become pregnant should alert their doctor in advance in order to adjust
medications
 Permanent brain damage (stroke or other damage)
 Prolonged seizures or numerous seizures without complete recovery
between them (status epilepticus)
 Side effects of medications
Prevention
Generally, there is no known way to prevent epilepsy. However, proper diet

and sleep, and staying away from illegal drugs and alcohol, may decrease the
likelihood of triggering seizures in people with epilepsy.
Reduce the risk of head injury by wearing helmets during risky activities; this
can help lessen the chance of developing epilepsy.
Persons with uncontrolled seizures should not drive. Each state has a
different law that determines which people with a history of seizures are
allowed to drive. If you have uncontrolled seizures, you should also avoid
activities where loss of awareness would cause great danger, such as
climbing to high places, biking, and swimming alone.

Epilepsy

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Epilepsy

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any

Sometimes a seizure is related to a temporary condition, such as exposure to

Epilepsy may be idiopathic, which means the cause cannot be identified.

Some other more common causes of epilepsy include:

 Stroke or transient ischemic attack (TIA)

A generalized tonic-clonic seizure is a seizure involving the entire body. It is

Generalized tonic-clonic seizures are the type of seizure that most

The seizure itself involves:

 Loss of consciousness or fainting, usually lasting between 30 seconds and 5

Partial (focal) seizures occur when this electrical activity remains

Partial seizures can be further characterized as:

 Simple -- not affecting awareness or memory

A physical examination (including a detailed neurologic examination) may be

If an underlying cause for recurrent seizures (such as infection) has been

Medication to prevent seizures, called anticonvulsants, may reduce the

 Certain prescribed medications

Sometimes, children are placed on a special diet to help prevent seizures.

Some people with certain types of seizures may be able to reduce or

Death or permanent brain damage from seizures is rare. However, seizures

The Anti-epileptic Drugs

Generally, there is no known way to prevent epilepsy. However, proper diet

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