Epilepsy is a chronic disease affecting the central nervous system causing multiple seizure attacks without any known trigger or underlying disease. A seizure is a sudden increased electrical firing within the brain. It’s more commonly seen in younger and elderly populations with more female cases.
Seizures affect different people in different ways but some of the common signs and symptoms are:
- Uncontrollable shaking
- Loss of consciousness
- Sudden rigidity
- Sudden loss of muscle power and falling
- Blank stare into space
- Strange taste or smell
- Tingling in feet or arms
- Dropping of head
- Repeated hand movements
- Loss of memory
- Rapid eye blinking
- Breathing troubles
- Loss of bowel and bladder control
Although there is no one specific cause for epilepsy development, the commonly associated triggers can be:
- Penetrating trauma of the brain
- Genetic history: People with epilepsy running in families are more prone to developing the disease.
- Infections like meningitis
- Brain tumours
- Autoimmune diseases attacking the brain cells
- Drugs like certain anti-malarial, anti-depressants can increase risk
- Substance abuse of alcohol, cocaine, etc.
- Stroke or vascular diseases that cause a decrease in the blood supply to the brain cells.
Types of seizures
The seizures are primarily divided on the basis of the part of the brain involved. If there is electrical disturbance in only a single focus, then the type of seizure is said to be focal whereas if the entire brain gets stimulated during the attack, then the seizure is called a generalised seizure.
Types of focal seizures are:
- Simple focal seizure: This involves only a part of the brain with usually no impairment of consciousness.
- Complex focal seizure: This involves only a part of the brain but there is impairment of consciousness for the duration of the seizure.
- Secondary generalised seizure: Here, the seizure starts from a limited part of the brain just like focal seizures but later involves the complete brain.
Types of generalised seizures are:
- Absence seizure: This is manifested as a short loss of awareness after which the person becomes normal without the loss of postural control. The person can have rapid eye blinking, repetitive finger movements and a failure to interact with their surroundings for that period of time.
- Tonic seizure: This type of seizure causes sudden development of rigidity in the muscles and violent muscle contraction.
- Atonic seizure: This causes a sudden loss of muscle control and complete flaccidity in the body causing the person to fall to the ground.
- Clonic seizure: This is manifested as repeated muscle jerks alongside neuronal firing in the brain involving the face, neck, arm, etc.
- Myoclonic seizure: In this type of seizure, there is a sudden brief muscle contraction involving either a single body part or the complete body.
- Tonic-clonic seizure: This is the most dramatic type of seizure where there is a loss of consciousness along with muscle rigidity and contraction all over the body.
Making the diagnosis of epilepsy is difficult as the neural firing becomes abnormal usually only during the time of the attack. Taking a thorough history of events prior to, during and after the seizure attack can be useful.
Some of the common tests are:
- EEG (Electroencephalogram) records the electrical activities of the brain
- MRI Scan shows the presence of any tumour, stroke or injury, etc.
- Blood tests show levels of toxins, glucose, autoantibodies, etc.
The primary approach is to decrease the uncontrolled electrical firing happening inside the brain and decrease the frequency and intensity of the attacks to prevent brain damage.
Drugs of various groups can be used like sodium channel blockers, calcium channel blockers, GABA mimetic drugs:
- Sodium valproate
Besides medications the alternate approaches used are:
- Brain surgery: During this, the part of the brain acting as the focus of the seizures is removed.
- Vagus nerve stimulation: It decreases the stimulation of neurons in the brain.
- Consumption of ketogenic diet, which is high in fats and low in carbohydrates.
Although complete cure or prevention of the disease is not possible, doing the preventative measures mentioned below helps in decreasing the frequency of attacks. It also ensures proper care during the time of the attack to prevent complications.
- Taking anti-epileptic drugs regularly
- Keeping track of known triggers and avoiding them in the best possible way
- Wearing a medical alert bracelet
- Training relatives on how to deal with a seizure attack
- Regular check-ups
- A healthy diet and regular exercise
- Joining a support group for mental strength
This is a medical emergency in a person with epilepsy where a single attack lasts for more than five minutes or there are multiple attacks within the span of five minutes where the person doesn’t regain consciousness. This can be a fatal condition in the absence of a timely management as the breathing gets hampered, and there can be permanent brain damage. Patients with this condition require immediate hospitalisation and care.
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