Epilepsy is a group of related disorders characterized by a tendency for recurring seizures. There are different types of epilepsy and seizures. Epilepsy drugs are prescribed to control seizures, and rarely surgery is necessary if medications are ineffective. Epilepsy is a disorder of the brain’s electrical system. Abnormal electrical impulses cause brief changes in movement, behavior, sensation, or awareness. There are around 180,000 new cases of epilepsy each year. About 30% occur in children. Children and elderly adults are the ones most often affected.
There is a clear cause for epilepsy in only a minority of the cases. Typically, the known causes of seizure involve some injury to the brain. Some of the main causes of epilepsy include: low oxygen during birth, brain tumors, genetic conditions that result in brain injury, infections such as meningitis, stroke, abnormal levels of substances such as sodium or blood sugar, and head injuries that occur during birth, childhood, or adulthood. In up to 70% of all case of epilepsy in adults and children, no cause can ever be discovered.
Although the underlying causes of epilepsy are usually not known, certain factors are known to provoke seizures in people with epilepsy. Avoiding these triggers can help you avoid seizures and live better with epilepsy: missing medication doses, heavy alcohol use, cocaine or other drug use, and lack of sleep. There are three different types of epilepsy and seizures. The first one being, generalized seizures affect all areas of the brain, sometimes referred to as grand mal seizures.
The person affected may call out or make some sound, often stiffening for several seconds then having rhythmic movement with the upper and lower extremities. The return to consciousness is gradual and the person may be confused for quite some time minutes to hours. Secondly, a partial or focal seizure only part of the brain is involved, so only part of the body is affected. Depending on the part of the brain having abnormal electrical activity, symptoms may vary. If the part of the brain controlling movement of the hand is involved, then only the hand may show rhythmic or Jerky movements.
If other areas of the brain are involved, symptoms might include strange sensations like a full feeling in the stomach or small repetitive movements such as picking at one’s clothes or smacking of the lips. Sometimes the person with a partial seizure appears dazed or confused. This may represent a complex partial seizure. The term complex is used by doctors to describe a person who is between being fully alert and unconscious. Lastly, absence or petit mal seizures are most common in childhood. Impairment of consciousness is present with the person often staring blankly.
Typically, these seizures are brief, lasting only seconds. Some people may have many of these in a day. Evaluating patients with epilepsy is aimed at determining what type of seizures they are having and their cause. Various seizure types respond best to specific treatments. An important part of the diagnostic rocess is the electroencephalogram (EEG), because it is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain.
During an EEG, electrodes are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to brain waves. Because 30 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary. Some monitors allow the patient to stay at home and continue his or her normal activities.
Prolonged EEG- video monitoring is another diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy. Treatment for epilepsy includes drug herapy, surgery, and ketogenic diet. Many drugs are available to treat epilepsy, several of which have only recently been released.
Although generic drugs are safely used for most medications, anticonvulsants are one category where doctors proceed with caution. Most doctors prefer to use brand name anticonvulsants, but realize that many insurance companies will not cover the cost. As a result, it is acceptable to start taking a generic anticonvulsant medication, but if the desired control is not achieved, the patient should be switched to the brand name drug. The choice of drug is most ften based on factors like the patient’s tolerance of side effects, other illnesses he or she might have, and the medication’s delivery method.
Although the different types of epilepsy vary greatly, in general, medications can control seizures in about 70% of patients. Secondly, another treatment of epilepsy could be surgery. Most patients with epilepsy do not require surgery. However, if seizures are not controlled after a trial of two or three medications then re-evaluation is suggested. This information is critical in deciding if epilepsy surgery is an option. Of the 30% of patients whose eizures cannot be controlled with drugs, approximately one third may be candidates for epilepsy surgery.
However, only about 3,000 epilepsy surgeries are performed annually. Before surgery is considered, a comprehensive presurgical exam is performed. This evaluation is performed to ensure that the operation will likely improve the seizures and will not cause damage to essential functions such as speech and memory. The evaluation requires prolonged EEG-video monitoring and other tests to pinpoint the exact location of the injured brain cells causing the seizures. The location of the damaged cells determines whether the surgery can be erformed and what technique should be used.
Lastly, an alternate treatment could be the ketogenic diet being a high-fat, low-carb plan, has received much attention lately and is effective for treating certain types of epilepsy. Specifically, it is used most frequently in children with seizures that have not responded to medical therapy. However, the diet requires careful planning and may be difficult to follow, so it is usually not recommended in older children or adults. The diet is usually started in the hospital, and when successful, it is most often maintained for two to three years.
A relatively new treatment involves electrical stimulation of the vagus nerve. This treatment requires minor surgery to implant a stimulator. The stimulator is placed under the skin in the upper chest, like a pacemaker. The treatment appears to be effective for seizures that do not respond well to medications alone. The degree of effectiveness of the vagus nerve stimulator is approximately the same as medication. Vagus nerve stimulation decreases seizure numbers by half or more in 40% to 50% of taking medications after the stimulator has been placed, although many people can take fewer drugs.
