Epilepsy: Seizures Types, Symptoms, Causes, Diagnosed and Treatment

 

Seizures are the result of improper nerve cell signaling in epilepsy, a brain disease. Uncontrollably high electrical activity bursts that alter awareness, behavior, sensations, and muscular movements are known as seizures. Even though epilepsy cannot be cured, there are many options for treatment. Medication can be used to treat epilepsy in up to 70% of people.

A brain condition called epilepsy, sometimes referred to as a seizure disorder, is characterized by recurrent seizures. Various types of epilepsy exist. For some people, the reason is known. In certain cases, the reason is unknown.

Define Epilepsy:

Chronic epilepsy is a long-term condition characterized by repeated seizures brought on by abnormal electrical signals produced by damaged brain cells. Seizures are brought on by an uncontrollably high spike in electrical activity within brain cells. A seizure may cause changes to your awareness, sensations, emotions, behavior, and muscle control (your muscles may twitch or jerk).

Another term for epilepsy is a seizure disorder.

What is the Brain's Reaction to Epilepsy?

All areas of your body send and receive messages to and from the brain's cells. A continuous electrical impulse that travels from cell to cell transmits these messages. This rhythmic electrical impulse pattern is disturbed by epilepsy. Rather, in one or more regions of your brain, there are electrical energy bursts between cells that resemble an unpredictable lightning storm. Your awareness (including loss of consciousness), sensations, emotions, and muscle moves are all altered by this electrical disruption.

 What are the Different Types of Seizures?

Medical professionals classify epilepsies according to the type of seizure. The origin of a seizure, your awareness level at the time, and its presence or absence of muscle movements are the three main factors that determine which category a seizure falls into.

There are two major seizures:

Focal Onset Seizures:

One region, or network of cells, on one side of the brain is where focal onset seizures begin. There once was a term for this seizure: partial onset seizure. Two types of focal seizures are there:

In a focal onset aware seizure: you are aware and awake at the time of the seizure. Healthcare providers used to refer to this as a simple partial seizure. Among the symptoms could be:

• Changes in the senses that things taste, smell, or sound.
• Emotional changes.
• Jerking uncontrollably in the arms or legs.
• Getting tingling, feeling lightheaded, and seeing flashing lights.

Focal Onset Impaired Seizures Awareness: indicates that you are confused or that you lost consciousness or awareness during the seizure. This kind of seizure was once known as a complex partial seizure. Among the symptoms could be:

• A blank stare, or "staring into space."
• Repetitive movements with the hand or fingers, such as rubbing, biting, or blinking of the eyes.

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 Generalized Onset Seizures:

Widespread brain networks on both sides are simultaneously impacted by general onset seizures. Seizures with a broad focus fall into six types.

Absence seizures: Seizures known as absences result in a blank stare, sometimes known as "staring into space," which is a brief loss of awareness. Minor muscular movements could be present, such as blinking of the eyes, lip-smacking or chewing sounds, hand movements, or rubbing of the fingers. Children are more likely to experience absence seizures, which typically last for a few seconds (usually less than ten), and are frequently confused with daydreaming. Petit mal seizures was the previous term for this type of seizure.

Atonic seizures: The word "atonic" means "without tone." An atonic seizure is characterized by a lack of muscular control or weak muscles; parts of your body, such as your head or eyelids, may droop or drop, or you may fall to the ground during this brief seizure (usually lasting less than 15 seconds). This type of seizure is also referred to as a "drop seizure" or "drop attack."

Tonic refers to "with tone," so tonic seizures. When you have a tonic seizure, your muscular tone increases significantly. You may fall because of tense or stiff arms, legs, back, or entire body. During this brief seizure—which typically lasts less than 20 seconds—you might be alert or experience a little shift in awareness.

Clonic seizures: The term "clonus" refers to a fast, repetitive jerking or stiffening of a muscle. Muscles can jerk constantly for a few seconds to a minute, or they can tense up and then jerk for a few seconds to two minutes, which is known as a clonic seizure.

Seizures tonic-clonic: This particular type of seizure combines repetitive, rhythmic muscle jerking (clonic) with muscular stiffness (tonic). Healthcare professionals may refer to this seizure as a grand mal seizure, although they have also called it a seizure. Most people associate seizures with tonic-clonic seizures when they hear the word. You lose consciousness, fall to the ground, and your muscles stiffen and jerk for one to five minutes. You may bite your tongue, drool, and lose muscle control of your bowels or bladder, making you poop or pee.


Myoclonic seizures: The term "myo" refers to muscle, and "clonus" refers to shock-like, momentary jerks or twitches of the muscles. Typically, myoclonic seizures end after a few seconds.
Your type of seizure may shift to focal or generalized onset seizure depending on what your healthcare practitioner learns.

What Symptoms and Signs of Epileptic Seizures?

Recurring seizures are epilepsy's primary symptom. However, the kind of seizure you have will determine the symptoms you experience.
Signs and symptoms of seizures consist of:

• Temporary unconsciousness or lack of awareness.
• Loss of muscle tone, jerking, and uncontrolled moving muscles.
• Staring blankly or "staring into space"
• Temporary confusion, slowed thinking, problems understanding and talking.
• Changes to taste, smell, hearing, vision, and feelings of tingling or numbness.
• Problems understanding or talking.
• Upset stomach, waves of heat or cold, goosebumps.
• Mouth-smacking, chewing, hand-rubbing, and finger motions.
• Psychic symptoms, such as déjà vu, anxiety, dread, or dread.
• Faster breathing and/or heart rate.

Causes:

Around 50% of epileptics have no known etiology for their condition. In the other half, the condition can be linked to several things, such as:

Genetic influence. Epilepsy can run in families in certain instances. There most likely is a genetic component in these cases. Certain genes have been connected by researchers to particular forms of epilepsy. However, some persons suffer from non-hereditary genetic epilepsy. A child may experience genetic changes that are not inherited from their parents.

Genes account for a small portion of the causation of epilepsy in most cases. A person may be more susceptible to environmental conditions that cause seizures if they have specific genes.

Head trauma. Epilepsy can be caused by head trauma from a car accident or other traumatic injury.

Elements throughout the brain. Epilepsy can be caused by brain tumors. Another possible cause of epilepsy is abnormal blood vessel formation in the brain. Seizures can occur in people with blood vessel disorders such as cavernous and arteriovenous malformations. Furthermore, stroke is a major cause of epilepsy in persons older than 35.

Infections. Epilepsy can be brought on by viral encephalitis, meningitis, HIV, and some parasite infections.

Injury before birth: Babies are sensitive to brain damage before birth, which can result from a variety of factors. These might include poor nutrition, low oxygen levels, or an infection in the mother. Both cerebral palsy and epilepsy may arise from this brain damage.

Conditions for development: Developmental problems can occasionally lead to epilepsy. Epilepsy is more common in individuals with autism than in those without the disorder. Additionally, studies have shown that attention-deficit/hyperactivity disorder (ADHD) and other developmental conditions are more common in individuals with epilepsy. There may be a genetic component to having both conditions.

Seizures Triggers:

Environment-related factors can cause seizures. Although they don't cause epilepsy, seizure triggers can provoke seizures in those who already have the condition. The majority of people with epilepsy lack reliable triggers that reliably set off a seizure. Still, they are frequently able to identify the conditions that facilitate a seizure. Among the potential seizure causes are:

• Alcohol.
• Lights that flash.
• Usage of illegal drugs.
• Taking anti-seizure medications over what is prescribed or missing doses.
• Insufficient sleep.
• Throughout the menstrual cycle, hormones change.
• Stress.
• Dehydration
• Skipped meals.
• Illness.

How Are Seizures Diagnosed?

Even once symptoms start, it may take some time to fully understand the magnitude of the seizure; nevertheless, diagnostic testing and a thorough medical evaluation can help. Diagnostic tests and a physical examination are used to diagnose seizures. In the course of the examination, the doctor asks when the seizures started and gets the child's and family's whole medical history. Neurological issues may be the cause of seizures, requiring further health care.

Among the diagnostic tests that could be performed are:

• Blood examinations

• Electrodes are affixed to the scalp to capture the continuous electrical activity of the brain during an electroencephalogram (EEG).

• Large magnets, radiofrequency technology, and a computer are used in magnetic resonance imaging (MRI), a diagnostic technique that produces finely detailed images of the body's organs and structures.

• A computed tomography scan, often known as a CT or CAT scan, is a diagnostic imaging technique that creates horizontal or axial images of the body—sometimes referred to as slices—by combining X-rays and computer technology. Any aspect of the body, including the bones, muscles, fat, and organs, can be seen in great detail on a CT scan. Compared to standard X-rays, CT scans provide more detail.

• A lumbar puncture, often known as a spinal tap, involves inserting a specific needle into the spinal canal in the lower back. This area encompasses the spinal cord. It is thus possible to monitor the pressure inside the brain and spinal canal. To find out if there's an infection or other issues, a tiny amount of cerebral spinal fluid (CSF) can be taken out and tested. The liquid that surrounds your child's brain and spinal cord is called CSF.

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Treatment:

One can control seizures. Using antiseizure medications appropriately can help up to 70% of epileptics become seizure-free. After two years without seizures, stopping antiepileptic medication may be considered, although this decision should be made after considering relevant clinical, social, and personal issues. The two most reliable indicators of seizure recurrence are an abnormal electroencephalography (EEG) pattern and a confirmed seizure etiology.

How is the Treatment for Epilepsy Administered?

Anti-seizure medication, surgery, and special diets are used to treat epilepsy. These treatments are typically used in conjunction with each other.

Epilepsy Medication:

is the first line of treatment for epilepsy; it does not cure the condition; it only lessens the frequency and severity of seizures. About 60% to 70% of epilepsy people can reduce their seizure frequency with anti-seizure drugs.

Antiseizure medications are absorbed by the stomach and then go through the bloodstream to the brain, where they affect neurotransmitters to reduce the electrical activity that causes seizures. Depending on the type of seizure you have, your doctor may prescribe a single medication or a combination of medications.

The choice of an anti-seizure medication depends on:

•  Seizure type
• Your prior response to anti-seizure medications
•  Other medical conditions you have
•  The potential for interaction with other medications you take
•  Side effects of the anti-seizure drug (if any)
• Your age
•  General health
•  Cost

Typical drugs for epilepsy include:

• Keppra (levetiracetam) 
• Lamotrigine (Lamictal)
• Topamax, meaning topiramate
• Acid valproic (Depakote)
• Carbamazepine (Tegretol)
• Ethosuximide (Zarontin)

These drugs are often used once or twice a day and come in tablet, liquid, or injectable form. The lowest amount that your doctor will first recommend can be increased or decreased until it begins to function. It is necessary to take these drugs regularly and according to prescription.

The following are a few possible adverse effects:

• Fatigue
• Dizziness
• Skin rash, 
• Poor balance, 
•  Memory problems
• Depression and liver or other organ inflammation are common yet serious side effects.

Although everyone's experience with epilepsy is unique, most patients find that anti-seizure medications help. Children with epilepsy may be able to stop taking their medication and having seizures.

Advice on Diets:

The two most common diets that are commonly recommended for individuals with epilepsy are the modified Atkins diet and the ketogenic diet, which are low in carbs, moderate in protein, and high in fat. For children who are not candidates for surgery and for whom medication proved ineffective, diets are typically recommended. For some epileptics, low-glycemic index diets may help reduce seizures.

 Surgery and Devices:

If anti-seizure drugs are unable to manage your seizures and if they are severe and debilitating, your healthcare professional may discuss surgery. If anti-seizure medication therapies are unable to control your seizures after more than two attempts, epilepsy surgery may be a safe and effective course of treatment. If anti-seizure drugs fail to control your seizures, you must undergo evaluation at an epilepsy center to see whether you are a candidate for epilepsy surgery.

Surgical resection (removal of defective tissue), disconnection (cutting fiber bundles connecting brain areas), stereotactic radiosurgery (targeted destruction of abnormal brain tissue), and neuromodulation device implantation are among the surgical alternatives. Over time, these devices might reduce seizures by stimulating your brain with electrical impulses.

What Is Included in the Diet?

Approximately 90 percent of the calories in the ketogenic diet are made up of fat. Amounts of protein are provided to aid in growth promotion. The diet has a very small amount of carbohydrates. This extremely low-carb, high-fat diet induces the production of ketones in the body. The body produces ketones when fat is broken down. When the body does not receive enough carbs, they are produced as a source of energy. If your child eats too many carbohydrates, then his/her body may not create ketones. Ketones are essential for the diet to be successful.

Prevention:

Is epilepsy preventable?
While there are many uncontrolled and unpreventable causes of epilepsy, you can lower your risk of having certain conditions that may precede epilepsy, such as:

• Wear a helmet when biking, keep your floors clear of debris and electrical lines to minimize falls, avoid heights, and wear a seatbelt whenever you drive to reduce your risk of traumatic brain injury (from impacts to the head).
• Eat a balanced diet (like the Mediterranean diet), keep your weight in check, and get regular exercise to reduce your risk of stroke.
• Seek therapy to address your substance abuse. 

Prognosis / Outlook:

Does Epilepsy have a Therapy?

An epilepsy cure does not exist. However, there are many ways to treat epilepsy.


Will Seizures Be a Constant in My Life?

With the right care, 70% of patients experience no seizures for a few years. It is believed that the remaining 30% of people suffer from drug-resistant epilepsy. To find out if they qualify for epilepsy surgery, these individuals ought to visit an epilepsy center.

For What Length of Time Must I Take Anti-epileptic Medication?

Your response to treatment and the type of epilepsy you have will determine this. Some may be able to quit taking their medicine if they don't have seizures for several years. This choice is made by your healthcare provider. When reaching this decision, they will take into account several variables, such as the lack of brain lesions on your MRI, the results of your EEG, and your medical background. For some people, medicine may be necessary for life.

How can I Manage My Seizures?

To help manage your seizures:

• As directed by your healthcare professional, take your medications exactly as directed. Inform your healthcare provider as soon as possible if you miss a dosage.
• Make sure you get enough sleep, which is usually seven to nine hours every night.
• Control your stress. In the parts of your brain that are more prone to seizures, stress causes the release of specific brain chemicals. 
• Try yoga, meditation, deep breathing techniques, biofeedback, or other relaxation techniques to lower your stress levels.
• Engage in regular exercise, ideally for 30 minutes five days a week.

Reference:

• (National Institute of Neurological Disorders and Stroke. Epilepsy Information Page).

         Accessed 3/11/2022.

• (Epilepsy Foundation. Driving and Independence).

        Accessed 3/11/2022.

• https://www.who.int/news-room/fact-sheets/detail/epilepsy

• https://www.nhs.uk/conditions/epilepsy/living-with/

         Living with epilepsy. (2020).

• (American Association of Neurological Surgeons. Epilepsy).

         Accessed 3/11/2022.