Epilepsy – Symptoms, Causes and Treatment of Epilepsy

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Epilepsy is a type of neurological disorder that results from a temporary failure of the brain that manifests as sudden and paroxysmal discharges inside nerve cells. A characteristic symptom of epilepsy is attacks of strong shocks associated with loss of consciousness.

Epileptic seizures are a heterogeneous group and have different symptoms, therefore not every disturbance of consciousness or seizures will be classified as epilepsy. Epilepsy results from altered responsiveness or the physiological state of part or all of the brain. It should be remembered that any sudden or even short-term disturbance of the nervous system for no apparent reason can be epilepsy.

The incidence of epilepsy

According to the incidence rate, about 1% of the population suffers from epilepsy, this is about 50 million people worldwide. When it comes to Poland – epilepsy occurs in about 400. people. Epilepsy can affect anyone, regardless of age, but most seizures occur in children under 1 year of age, while in the elderly, the increase in the incidence occurs after 65 years of age.

Important! Epilepsy is one of the most common neurological diseases because it is ten times more common than MS and a hundred times more common than motor neuron diseases.

Epilepsy – causes

The cause of epilepsy is not clear. In almost 65% of patients the cause of epilepsy is not diagnosed. In Poland, the most common cause of epilepsy is all kinds of head injuries, which account for 20% of all cases. Epilepsy is much more common in men than in women. Epilepsy can arise from:

1. cancer,
2. subarachnoid hemorrhage
3. strike,
4. inflammation of the brain and meninges
5. toxic-metabolic damage to brain tissue,
6. genetic conditions – most often in childhood.

The cause of epilepsy may also be a brain injury that has already occurred in the perinatal period or later in life. Most often it is damage, and in the elderly, cerebral ischemia. Most cases of epilepsy in children do not have an established cause – this is called idiopathic epilepsy. Epilepsy in adults is most often associated with another disease or alcohol dependence.

Epilepsy is caused by disturbances in the bioelectrical activity of the brain, which can develop in a specific place (epileptic focus) and then spread to the entire brain (generalized discharges). We divide epileptic seizures into:

1. generalized – discharges cover both hemispheres;
2. partial – discharges cover part of one hemisphere.

Although epilepsy is a very common condition, identifying a single genetic factor is not an easy task. Genetic predisposition was demonstrated on the basis of numerous observations and data of families with a specific type of epilepsy. Genetic factors decrease significantly with the degree of relatedness.

Epilepsy symptoms

A characteristic symptom of epilepsy are seizures, among which we distinguish:

1. major seizure – that is, a tonic-clonic seizure, in which the patient loses consciousness and falls, his muscles undergo strong tension and the head tilts back. In addition, the patient stops breathing, convulsions of the limbs and head appear; as a result of seizures, you may bite your tongue, involuntarily pass urine or stool;
2. minor seizure – people freeze while performing some activity, lose contact with the environment;
3. myoclonic seizures – characterized by muscle spasms, but not the sick person loses consciousness;
4. atonic seizures: in addition to loss of consciousness, the muscles relax and the patient falls.

A dangerous situation is status epilepticus, during which a seizure lasts more than half an hour or shorter seizures that continue, one after another. Accumulating hypoxia in the brain leads to swelling of the brain and can be fatal. On the other hand, a single seizure of a typical course does not threaten the patient’s life. The danger may potentially arise when a seizure occurs, for example while bathing, working at height or using a sharp tool.

Classification of epileptic seizures

Among epilepsy we can distinguish:

PARTIAL SEIZURES

They are the most common and most common group of epilepsy that originates in a given area of ​​the brain. They then disappear or secondarily expand to the entire brain, causing clinical seizure disorder. We divide partial seizures into:

1. simple – with accompanying autonomic and motor symptoms as well as mental and somatosensory disorders;
2. complex – the beginning is simple at first, and then there are disturbances in consciousness;
3. partial seizures developing in general.

GENERATED SEIZURES

1. clonic seizures;
2. unconsciousness seizures – are characterized by a sudden loss of consciousness, but without the patient falling. These types of seizures may occur frequently (even several times a day) and be associated with other accompanying symptoms, e.g. changes in muscle tension;
3. myoclonic seizures and myoclonic jerks – are short and sharp muscle jerks. They usually appear in the morning after a sleepless night, affect children and adolescents, may last a few seconds (without losing consciousness);
4. atonic seizures – there is a rapid loss of muscle tone, which in turn causes the patient to fall down and possibly injure the head. Atonic seizures can occur in conjunction with, for example, myoclonic-astatic seizures;
5. tonic seizures;
6. tonic-clonic seizures – affect patients of all ages and are characterized by loss of consciousness, which can last up to 3 minutes. At the beginning of the attack, the patient screams, then tilts his head back and straighten his limbs. The eyeballs are pointing upwards and the hands are clenched.

Secondary generalized seizures – they begin together with focal symptoms and with an electroencephalographic examination.

The diagnosis of the above-mentioned seizures is not easy, because the focal symptoms appearing at the beginning of a secondary generalized seizure may be so subtle that they go unnoticed. Then the so-called mapping techniques.

PARTIAL (focal) seizures

Partial seizures originate in specific areas of the brain and may remain in partial form, and may spread to the rest of the cortex or develop into a generalized seizure. Patients with focal seizures do not have disturbances of consciousness, but paresis in various parts of the body may appear, e.g. Todd’s palsy, i.e. a paraparesis that resolves spontaneously within XNUMX hours. If the sensory cortex is paralyzed – sensory and sensory seizures appear. Patients also experience pain, numbness, and unpleasant smells and tastes.

Vegetative seizures – are characterized by pressure on the throat, chest, paling, redness and sweating. On the other hand, mental seizures are composed of various intellectual symptoms, e.g. intrusive thoughts, hallucinations.

Complex partial seizures can take the form of:

1. light-headedness in simple activities such as chewing or swallowing,
2. immobility,
3. nibbling or folding hands
4. supposedly intentional activities such as washing and undressing.

Alcohol consumption and poisoning can also lead to epileptic states. The most common epileptic state is tonic-clonic seizure. This ailment causes serious respiratory and circulatory disorders, which may result in brain hypoxia. Among patients with status epilepticus, the mortality rate is around 80%, therefore it is considered a life-threatening condition. In any case, the patient must be hospitalized.

Epilepsy requires neurological treatment and frequent visits to the neurologist. Remember that you can now make an appointment with this specialist quickly and conveniently via the halodoctor.pl portal.

Epilepsy – diagnosis

The basis for the diagnosis is a medical interview with the patient. It helps not only to recognize the ailment, but also to choose the appropriate treatment.

Additional tests ordered in the diagnosis of epilepsy are:

1. EEG tests – which are routine tests necessary when epilepsy is suspected. The record made during the robbery gets the greatest value. It is worth noting that a correct EEG recording does not exclude epilepsy in XNUMX%, it mainly applies to epilepsy with partial seizures. EEG recording during loss of consciousness is pathological, heals when the patient regains consciousness returns to the pre-seizure state (as opposed to an epileptic seizure);
2. computed tomography and magnetic resonance imaging – these are methods that allow faster and more accurate finding of the cause of epilepsy, its location and nature;
3. SPECT test – allows the assessment of cerebral flow with the use of radioactively labeled particles. This type of test is performed during a seizure where cerebral blood flow is significantly increased, and after a seizure (decreased flow). SPECT also helps in locating epileptic lesions;
4. PET (positron emission tomography) – with the help of oxygen and glucose it allows to determine the metabolism of the brain.

You can arrange and perform an MRI of the head privately. The test is available from the private MRI Diagnostics facility.

Treatment of epilepsy

Treatment of epilepsy is primarily aimed at helping the patient to function normally, or at least satisfactorily, in daily chewing. It is important to ease the seizures or get them to stop completely. All antiepileptic drugs work in two ways:

1. raise the seizure threshold,
2. limit the spread of focal discharges to other areas of the brain, thus counteracting the secondary, generalized discharges that characterize the generalized tonic-clonic convulsions.

The drug should be adjusted by the doctor to the appropriate type of attack, and if one preparation is not effective – the second is implemented. It is also important to take medication in specific doses and times (if the drug has a prolonged effect, it should be used every 12 hours). The effectiveness of therapy depends not only on the drug, but also on taking it as prescribed by a specialist.

The organization of the epilepsy care system in Poland does not keep up with the possibilities of medical knowledge. Existing regulations prevent doctors from personalizing treatment. Reimbursement of epilepsy treatment with so-called the first line is limited to only four classic substances with many side effects. All other drugs taken in the treatment of epilepsy belong to the newer generation preparations and are reimbursed only after the diagnosis of drug-resistant epilepsy. About 5-10 percent of patients do not respond to drug treatment and require neurosurgical treatment.

Surgical treatment is surgery on brain tissue, which is designed to reduce the frequency of epileptic seizures or make them less bothersome. However, there is no guarantee that surgery will completely relieve the patient from seizures. The new treatment for epilepsy is vagus nerve stimulation. It involves the implantation of a vagus nerve stimulator under the left collarbone, which inhibits the seizure activity of the brain. This device resembles a pacemaker. The vagus nerve stimulator is recommended for patients with aura, where the patient, feeling that a seizure is approaching, can prevent seizures by activating the pacemaker magnet. However, this method is very expensive.

Other neurosurgical methods in the treatment of epilepsy:

1. temporal lobectomy or extra-temporal resections – usually performed in partial seizures;
2. removal of one hemisphere of the brain (hemisphaerectomy) – usually in cases of cerebral palsy and in clinically severe seizures;
3. intersection of the corpus callosum (callosotomy) – performed in partial, generalized and tonic seizures.