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It is a chronic brain disorder that can affect people of any age. It is characterised by recurring convulsions caused by excessive electrical impulses in groups of brain cells. The consequences can be neurological, cognitive, psychological and social.
In 2005, epilepsy was defined as “a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures”. Epilepsy is therefore diagnosed when patients experience two or more seizures, separated by a period of time that can last from 24 hours to 10 years.
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.
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.
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:
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 requires:
It is advisable to avoid all situations that may create:
When faced with a seizure, a series of recommendations should be followed to avoid injury to the person having the seizure.
Migraine is a type of chronic headache characterised by repeated episodes of intense pain that can prevent those affected from going about their daily life.
According to the WHO, it ranks 7th in the list of most debilitating illnesses as it can result in years of inactivity, in suffering and a lack of productivity.
Migraine is the result of activation or irritation of the trigeminal nerve fibres. This nerve has three branches that transmit sensation in the head. The fibres of the first branch surround the blood vessels found in the membranes known as the meninges.
The meninges are made up of different layers of tissue that lie over the brain and it is in these structures where we feel the pain. It is the membrane covering it, not the brain itself, where the pain is felt.
During a migraine, the meninges become inflamed as a consequence of inflammatory substances being released from the trigeminal fibres. This inflammation, or non-infectious “meningitis” is responsible for producing the pain and means that it increases or worsens when upon moving the head. For this reason, resting and staying still brings relief.
A migraine attack may last from 4 to 72 hours. This type of headache may occur any number of times, from once a year to several times in succession.
This condition is three times more common in women than men. It generally starts before thirty years of age and no later than fifty.
There is often a family history of migraine. It can be triggered by various stimuli such as food and drink (cheese, red wine, chocolate), intense odours, bright lights, changes in the weather, changes in sleep patterns, hormonal changes and stress.
The symptoms a patient describes must be taken into account when making a diagnosis. A detailed physical and neurological examination should then be carried out, which should be normal in a person with migraine.
After this first stage, the health professional will decide whether additional examinations are necessary to confirm it is migraine and not another illness.
Certain conditions require further medical investigation such as when:
Although there is no cure for migraine, the right treatment can relieve the pain and prevent it occurring.
The first group includes anti-inflammatories, paracetamol, ergotamine and its derivatives, and drugs generically known as triptans. Preventative treatment is advisable when migraines are very frequent and do not respond well to symptomatic treatment.
The choice of a symptomatic or preventative treatment should be decided and monitored by a doctor. It is very important not to self-medicate to avoid chronic headaches that may be triggered by abusing analgesic medication. If used often or in large doses, both prescription and non-prescription medications can cause other problems.
One way to prevent migraine is to try to avoid the things that trigger it. However, some trigger factors are outside our control, such as migraine caused by menstruation or certain weather conditions.
Keeping a regular schedule and avoiding certain food and drink that may cause migraine, as well as getting enough sleep, are important to prevent it. It is important to have a balanced lifestyle with regular mealtimes and bedtimes.
Frequent and gentle exercise also helps reduce the illness.
You can find more information on the blog Midolordecabeza.org
Strokes are a medical condition caused by an alteration in blood circulation to the brain. This alteration is due to an artery becoming blocked (ischemic stroke) or the rupture of a blood vessel (haemorrhagic stroke), preventing blood from reaching the brain and therefore temporarily or permanently altering brain functions. When blood flow is impeded, the affected part of the brain does not get the nutrients and oxygen it needs. As a result, brain cells can die, causing severe after-effects.
For this reason, if a person is suspected of having a stroke, the Emergency Medical Service should be notified immediately by calling 112. Acting quickly is essential in order to minimise or eliminate possible after-effects.
Strokes can be grouped into two broad categories depending on the reasons behind them:
When blood flow is temporarily interrupted (for between one and 24 hours), this is known as a Transient Ischemic Attack (TIA); however, if the duration is longer or the brain scanner detects necrosis (neuronal death), it is considered an ischemic stroke. TIA is a predictor of vascular disease and, in the case of stroke, is a warning that the person is at risk. In fact, 40% of people who suffer a stroke have previously suffered a TIA.
In the event of the sudden onset of one or more of the following symptoms, action should be taken quickly by calling 112:
Anyone can suffer a stroke, regardless of age and physical condition, although they are more common in the elderly. About 75% of cases occur in people over 65, although they increasingly affect young adults due to their lifestyle habits (between 15 and 20% are under 45). Strokes can also affect children: in Catalonia alone, 900 children live with a disability as a result of a stroke.
This disease can also be known by other names, such as apoplexy, cerebral vascular accident, seizure and thrombosis. In Catalonia, more than 13,000 people are admitted each year for a stroke and, unfortunately, they are not always reached in time to save the patient.
To determine the cause of a stroke it is necessary to perform a brain scan (CT). The scan can be completed by reviewing the condition of the cerebral and cardiac vessels, taking into account risk factors and chronic diseases presented by the patient. However, it is not always possible to discover the origin.
Knowing the cause of a stroke allows us to establish the most appropriate treatment to prevent it from happening again. Depending on the aetiology (cause), it can be classified as:
If a stroke is suspected, a neuroimaging test (a CT or MRI) should be performed as soon as possible, which will tell us about:
Specialists may request other tests such as a chest x-ray (performed upon admission as a first assessment), a doppler or transcranial duplex (to see whether there is a possible intracranial occlusion or stenosis, and where it is located), blood tests (to find out the status of risk factors, immunological and coagulation study, serologies, hormones, renal function, etc.) or a cardiological study (if a cardioembolic stroke is suspected).
After diagnosis, specialists may ask to repeat the tests to detect any changes by comparing the images, or request other tests.
Stroke treatment should be applied immediately, as rapid action can lessen the effects. However, a rehabilitation period is usually needed to eliminate or reduce possible after-effects.
After suffering a stroke, the risk of having another is higher, so it is necessary to take medication to reduce the risk, always following medical guidelines. The first year after suffering a stroke is when there is the highest risk of relapse.
Suffering a second stroke may have a fatal outcome. In survivors, it leads to an increase in the degree of disability and risk of dementia, as well as a higher rate of institutionalisation.
The impact may be different for each patient. Symptoms will be more or less severe depending on the area and volume of the brain affected, as well as the general state of health prior to the event.
In the case of a transient ischemic attack (TIA), which does not usually leave after-effects, or ischemic strokes, if the patient responds well to treatment, recovery is virtually immediate. At other times, the recovery is longer term and takes weeks or months, leaving some sort of after-effects.
There may also be a worsening of the patient due to neurological causes or complications such as fever, infections or others. In more severe cases, it can lead to death.
Once the patient is discharged, the primary care team takes responsibility for the patient, and will monitor risk factors and other chronic diseases. In complex cases, patients will need to visit specialists, such as neurologists.
The return home after hospital discharge will vary depending on the severity of the incident and the patient's family situation. Similarly, reintegration into daily life will depend on the after-effects experienced by each patient.
Neurology, General Hospital
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