Epilepsy

What is epilepsy?

Epilepsy causes brief absence seizures, involuntary movements, repetitive reflexes such as sucking movements, loss of consciousness, and so on. It can originate in one area of the brain (focal seizure) or the brain as a whole (generalized seizure). Seizures are sometimes accompanied by loss of consciousness and/or loss of bowel control. Their frequency can vary from only just one over a ten year period to several per day.

• Focal epileptic seizures: these seizures originate in the neural networks in just one half of the brain. They may sometimes spread to the other side of the brain at which point they become generalized seizures.
• Generalized epileptic seizures: these kinds of seizures begin at a specific point in the neural network and electrical impulses are sent out quickly and bilaterally, in other words, to both hemispheres.

Symptoms 

Seizures (absence seizures, muscle contractions, etc.) are the main symptom and may vary depending where in the brain the epileptic seizure begins.

For example, in tonic-clonic seizures (GTCS), it is common to observe twitching, muscle contractions, jerking, etc. These movements are called “myoclonus” and may be symmetric or asymmetric and are accompanied by rolling of the eyes. They are followed by a spasm with clenching of the teeth, laboured breathing and an epileptic shout.

Who is affected by epilepsy? 

Epilepsy affects the entire population, regardless of age, from whilst still in the womb right up to people in their nineties. It is estimated that 8 in 1000 people have the condition.

Related factors:

• Infectious and viral processes (meningitis)
• Traumatic brain injury
• Tumours
• Stroke, etc.

In some cases the cause of epilepsy may be unknown, as although we can see an epileptic seizure occurring in the brain, current technologies do not reveal what causes them. Epilepsy may also be genetic. 

It is the second most common neurological disorder (after stroke) seen in accident and emergency departments. An estimated 3,000 patients are seen in our centre every year. 3% of the population will attend a medical centre at some point during their lifetime to determine whether their symptoms are caused by epilepsy.

Diagnosis 

Diagnosis requires:

• Taking a case history, which includes personal and family history of the illness
• A medical examination: a general examination, cardiovascular examination (electrocardiogram)
• Mental health assessment
• General blood test, urine and cerebrospinal fluid (CSF) tests
• Genetic testing
• Electroencephalogram and video-encephalogram
• Cranial neuroimaging (CT or MRI)
• Neuropsychological tests

Typical treatment

• Drugs: there is a wide range of effective anti-epileptic drugs
• Clinical trials: involving new treatments and aimed at the 30 % of patients who do not respond to the current pharmacological treatment available.
• Epilepsy surgery: for patients with symptomatic epilepsy when the brain lesion is easily identifiable.

Prevention 

It is advisable to avoid all situations that may create:

• Traumatic brain injury
• Connate anoxia
• Infectious diseases (such as tuberculosis or meningitis)
• Secondary prevention of stroke

When faced with a seizure, a series of recommendations should be followed to avoid injury to the person having the seizure.