Epilepsy

Epilepsy is a neurological disorder of the CNS which gives rise to recurrent seizures, followed by episodes of unusual behaviour and, at times, loss of awareness and orientation. Seizures take place because of abnormal electric activity in the brain which clinically manifest as abnormal uncontrolled jerky movements of part or whole body followed by altered sensorium.

Seizures can be fatal to file if the patient is either travelling or driving during the episode.

Types of Seizures

Based on the abnormal activity present in the brain, the seizures can be classified into the following types:

  1. Focal seizures: When the seizures take place because of abnormal electrical activity in one part of the brain. These are further sub-divided into two categories, namely:
  • Focal seizures without loss of consciousness: This type of seizure is also called Simple partial seizure and doesn’t cause loss of consciousness but leads to jerky movements in the extremities and sensory symptoms like a tingling sensation, numbness and dizziness.
  • Focal seizures with impaired awareness: They have also termed complex partial seizures and are characterized by loss of consciousness or awareness among the patients. Patients generally become unresponsive and exhibit certain repetitive movements like rolling fingers of the hand, walking in a circular pattern and continuous staring at the surroundings.
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    1. Generalized seizures: Seizures appear to involve the entire area of the brain. It is further sub-divided into the following types:
    • Absence seizures. Also called “petit mal seizures”, they are more commonly seen in children and characterized by short loss of awareness and a blank stare over the surroundings and may cause repetitive movements like lip smacking or blinking lasting only for 5 to 10 seconds.
    • Tonic seizures. These cause sudden muscle stiffness around the legs, arms, or trunk, thereby making the person more prone to falling.
    • Atonic seizures. These are also called “drop seizures” and are characterized by loss of muscle control. The leg muscles are most commonly involved.
    • Clonic seizures. Clonic seizures are characterized by repeated, jerky muscle movements of the face, neck, and arms.
    • Myoclonic seizures. Myoclonic seizures cause spontaneous, quick twitching of the arms and legs. Sometimes these seizures cluster together.
    • Tonic-clonic seizuresTonic-clonic seizures used to be called “grand mal seizures.” Symptoms include:
      • • stiffening of the body
      • • loss of bladder or bowel control
      • • biting of the tongue
      • • loss of consciousness
     

    Causes

    • • Brain tumour
    • • High-grade fever
    • • Traumatic brain injury
    • • Lack of oxygen supply to the brain
    • • Brain scarring post-traumatic epilepsy
    • •Infectious conditions like HIV and AIDS and meningitis
     

    Diagnosis

    • • Diagnosis can be made based typical clinical history
    • • Neurological Examination: In order to determine the type of Epilepsy present in a patient, the doctor accesses motor abilities, sensory functions as well as mental functions (seizure semiology)

    Common investigations for seizure are:

    • • Electroencephalogram (EEG) to record the electrical activity of the brain
    • • Magnetic Resonance Imaging (MRI) or C.T. Scan to reveal abnormalities in the structure of the brain.
    • • Positron Emission Tomography (PET) helps visualize the metabolic activities of the brain and hence detect abnormalities.
    • • Video EEG
    • •High-density EEG
     

    Treatment

    • • Anti-epileptic drugs like levetiracetam, valproate, lamotrigine, carbamazepine, phenytoin etc
    • • Vagus nerve stimulation
    • • Deep Brain stimulation
    • • Responsive neurostimulation
    • • Transcranial magnetic stimulation
    • • Brain surgery
     

    Risk Factors

    • • Family history
    • • Age. Commonly seen in children but can occur at any age.
    • • Brain infections
     

    Complications

    • • Injuries like fractures while driving
    • • Drowning while swimming
    • • Depression and Anxiety
    • • Suicidal tendencies
    • • Pregnancy complications cause risks to both mother and baby.
    • •Sudden unexpected death in Epilepsy
     

    Outlook

    Epilepsy can be treated and controlled very effectively. Although there is no cure for Epilepsy, approximately 70% of patients recover completely with various treatment options available. The remaining others can undergo surgery after being advised by the doctor,