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EPILEPSY

Epilepsy is a chronic neurological disorder that produces a rapid discharge of nerve impulses causing recurrent seizures. The affected individual may behave in an unusual manner, he may experience muscle spasms, loss of sensation over the hands and feet and loss of consciousness.

Epilepsy is basically classified into two types, namely:

  • Generalized seizures that affect the whole brain
  • Focal seizures or partial seizures that affect only a part of the brain

Seizures usually last from a few seconds to minutes. However, mild seizures last for a few seconds, which makes it difficult to differentiate mild seizures over other neurological disorders. This can be achieved only by proper diagnosis and treatment of seizures that helps in minimizing further complication of the seizures.

Seizures are observed among all age groups; however, the incidence of seizures is higher in children and older adults. This condition occurs more in men when compared to women.

Causes

Seizures usually arise due to:

  • High fever
  • Genetic changes
  • Head injury or trauma
  • Sudden alcohol withdrawal (chronic alcoholism)
  • Brain infections
  • Stroke
  • Decreased oxygen supply
  • Low blood sugar levels
  • Developmental disorders

Types of seizures and associated symptoms

According to the International Classification of Epileptic Seizures, seizures are classified as:

Generalized seizures

These seizures affect the whole brain and are generally classified into six types, namely:

  • Tonic seizures- These seizures cause muscle stiffness
  • Clonic seizures- These seizures cause continuous muscle movements of the face, neck and hands
  • Atonic seizures- These seizures cause loss of balance which may lead to sudden fall due to the loss of muscle control
  • Myoclonic seizures-These seizures cause continuous twitching (contraction) of the muscle of the hands and feet
  • Tonic-clonic seizures- These seizures cause biting of the tongue, muscle stiffness, loss of control of the bladder and loss of consciousness
  • Absence seizures- These seizures usually cause blank stare and cause biting of the lips and tongue. This type of seizures is also known as petit-mal seizures.

Partial Seizures

These seizures are also known as focal seizures and it may last for a few seconds. Partial or focal seizures are classified into two types, namely:

  • Simple seizures-These seizures cause twitching of the muscles, dizziness and a change in the perception of sense organs. It does not cause loss of consciousness.
  • Complex seizures-These seizures cause performing repetitive actions, unresponsiveness and loss of consciousness.

Risk factors

Some of the risk factors of epilepsy include:

  • Age: The prevalence of epilepsy is greater among children and geriatrics when compared to adult population
  • Family history: Individuals with a family history of epilepsy are at an increased risk of developing epilepsy when compared to others
  • Head injuries: Individuals with head injuries and patients with dementia are at greater risk of developing seizures
  • Brain infections: Certain brain infections such as meningitis and other viral and bacterial infections may cause seizures
  • Stroke: Decreased blood supply to the brain caused due to stroke may cause brain tissue necrosis, thereby increasing the risk of epilepsy
  • Childhood seizures: Children suffering from high fever may suffer from epilepsy. However, the risk of epilepsy increases the duration of the seizure episode

Diagnosis

The diagnosis of epilepsy includes neurological examination, blood tests and image scans. Neurological examination helps in determining the mental function, motor abilities and behavioural pattern of the individual. Blood and culture tests help in determining the cause of infection and the suitable choice of drug treatment for epilepsy.

The other image scans performed to diagnose epilepsy are:

  • Electroencephalogram (EEG): The test is performed to monitor the brain’s electrical activity by placing small discs with thin wires over the scalp. The nerve impulses produced are then recorded on the electroencephalograph that helps in the diagnosis of the cause of seizures.
  • Brain scan: Image scans such as magnetic resonance imaging (MRI) scan and computed tomography (CT) scan is performed to detect the presence of underlying factors such as a tumour, injury, blood clot, brain tissue necrosis and so on.

Treatment

Depending on the severity of the condition, epilepsy is treated either through medication therapy or surgery.

Medication

Anti-epileptic drugs are used in the treatment of seizures. The dose and the duration of the medicine depend on the intensity of the condition. However, do not stop taking the medicine even if there is a decrease in the severity of the condition as the doctor prescribes maintenance dose to prevent recurrence of seizures.

Surgery

The doctor may recommend a surgery if seizures are not treated through medicines. The surgical procedure depends on the nature and severity of the seizure. Some of the surgical procedures performed to treat seizures are:

  • Stimulation of the vagus nerve: This procedure involves deep brain stimulation, by implantation of a probe to stimulate the vagus nerve. The probe is then connected to an implanting device through a thin wire that is attached to the chest. Thus, it helps in controlling the nerve impulses produced by the brain.
  • Removing the focal point: This procedure involves removal of tissue or a small portion of the brain that produce seizures. This surgery is only performed when seizures are reported to be produced from a fixed region of the brain.
  • Isolation of the focal point: This procedure involves making a series of cuts over the brain to prevent the spread of tremors. This surgery is performed when the affected tissue is of major importance.

Management and Coping

Seizures can be effectively managed by use of medicines and lifestyle modifications in day-to-day life. Regular use of medicines is the most vital aspect of managing epilepsy.

Adequate sleep during night is essential to prevent seizures, as lack of sleep affects the normal function of the brain that triggers seizures.

A regular exercise keeps away depression and keeps the body and mind healthy. This helps lower the risk of developing seizures.

It is advised to maintain a healthy diet and avoid the use of alcohol, as it promotes healthy living and prevents neurological and emotional outbursts.

By Neurosurgeons

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