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Epilepsy
Epilepsy is a common chronic neurological condition that is characterized by
recurrent unprovoked epileptic seizures. An epileptic seizure is caused by
over-activity of the brain cells, which produces
a surge of electricity. This may be due to a variety of factors, such as brain
damage from birth injuries, head injury, stroke, brain tumours and alcoholism.
There is some evidence to suggest the condition sometimes has a genetic basis -
although it is rare for it to run in families.
What causes epilepsy?
In many instances, the cause of the condition is still unknown.
There are two type of seizures.
A partial seizure begins in one specific part of the brain, and may spread to
other areas.
A generalised seizure can start in both sides of the brain at once.
Partial seizures:
- Simple partial seizure - Confined to one particular area of the brain.
The person retains consciousness, but may be fearful, and experience
a strong sense of deja vu. Symptoms include jerking of an arm and
an unpleasant taste in the mouth.
- Complex partial seizure - The electrical disturbance spreads, disrupting
consciousness. The person may interact with the surroundings, but be
unaware of what they are doing and have no recollection of the event.
Symptoms may include repeatedly chewing, swallowing or scratching.
Afterwards the person is likely to be confused for some minutes.
Generalised seizures:
- Tonic clonic seizure - This leads to 'grand mal' convulsions in which the
person loses consciousness, falls to the ground, becomes stiff and shakes.
In some instances a tonic clonic seizure may occur after an initial partial
seizure - in which case the person may have some warning of what is about
to occur.
- Absence attack - A blank spell lasting a matter of seconds from which
recovery is almost immediate.
- Myoclonic seizures - Jerks caused by a sudden contraction of the muscles.
Can affect the whole body usually restricted to one or both arms and sometimes the head.
- Tonic seizures - All the muscles contract. The body stiffens and the person
will fall over if unsupported.
- Atonic seizures - All muscle tone is lost and the person simply drops to the ground.
Diagnosis
Usually it is easy for a doctor to tell whether a patient has epilepsy, but
sometimes other disorders can cause sudden changes in behavior that may be
confused with epilepsy. The patient's treatment depends on an accurate diagnosis.
Does the patient have epilepsy or some other disorder? If the diagnosis is epilepsy,
the choice of treatment also depends on accurately identifying the specific type
(or types) of seizure. Different types respond best to different seizure medicines.
Some types can even be made worse by particular medicines.
The doctor usually orders a variety of tests to help make the diagnosis. These include:
- A brain wave test, also called an EEG (electroencephalogram)
- Blood tests
- Either a CT scan (sometimes called a CAT scan), a special x-ray of the brain, or an MRI scan (magnetic resonance imaging)
Depending on the urgency of the situation, other tests also might be recommended,
such as a lumbar puncture (also called a spinal tap), EKG
(electrocardiogram, to check the heart), or a sleep test.
What is the treatment?
There are a wide range of anti-epileptic drugs to prevent seizures.
Which drug is prescribed will depend on the individual patient, and their particular
form of epilepsy. The drugs are effective, but can have side effects, including drowsiness and
dizziness. Some drugs may produce longer term side effects, such as acne and weight gain.
Treatments are available that can successfully prevent seizures for most people
with epilepsy. The first treatment almost always is one of the many seizure
medicines. If one treatment fails, others may be more successful.
For some people, the treatment of epilepsy consists of taking a pill once or
twice a day for a few years. No seizures, no side effects.
Others take many pills year after year. Lots of seizures, plenty of side effects.
They may move on to other kinds of treatment. Sometimes they work well and
sometimes they do not. People in this situation can get help from a team of
health professionals who not only will help them find the most effective treatment
to stop seizures, but also will help them to live as well as they can while the
search continues.
Anti-epileptic drugs should not be taken in tandem with some other medications.
They may also slightly increase the risk of malformations if taken during pregnancy.
For people who do not respond to drug treatment, surgery is a plausible solution.
The most common form of surgical treatment is to remove the hippocampus - a part
of the brain involved in memory which is particularly vulnerable to damage.
Other forms of surgery which may be considered include:
- Temporal lobectomy - a larger part of the temporal lobe is removed.
- Sub-pial resection - fine cuts are made in the motor areas of the brain.
- Hemispherectomy - the removal of the whole of one side of the brain
- Corpus callosotomy - cutting the fibres that connect the two halves of the brain.
An alternative to neurosurgery is a treatment called vagal nerve stimulation in
which a pacemaker device is placed under the skin to stimulate the vagus nerve
in the neck. This form of treatment does not usually cure the epilepsy, but can reduce seizure
frequency and severity.
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