Epilepsy

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures caused by abnormal electrical activity in the brain. Seizures vary in type and severity and can occur at any age. Epilepsy is one of the most common neurological disorders, affecting about 1% of the world's population.

Causes of epilepsy:

The causes of epilepsy fall into several categories, but in many patients the cause is unknown (idiopathic epilepsy). Possible causes include the following

Genetic factors:

• Some types of epilepsy are caused by genetic mutations. These genetic mutations affect the function of nerve cells, making them more prone to epileptic seizures. Genetic causes of epilepsy can run in families, but a family history of epilepsy does not necessarily mean that a person will develop the disease.

Brain damage:

• Traumatic brain injury (TBI) caused by an accident, fall or violence can cause epilepsy. This is called post-traumatic epilepsy and can develop immediately after the injury or years later.

Stroke :

• Stroke is the main cause of epilepsy in older people. Stroke occurs when blood flow to the brain is disrupted, damaging brain tissue and causing epileptic seizures.

Infections:

• Infections that affect the brain, such as meningitis, encephalitis and HIV, can inflame and damage brain cells and cause epilepsy.

Developmental disorders:

• Some conditions that affect brain development, such as autism spectrum disorders and neurofibromatosis, can increase the risk of epilepsy.

Tumors:

• Brain tumors, whether cancerous or benign, can disrupt the brain's electrical activity and trigger epileptic seizures.

Prenatal injury:

• Prenatal damage to the brain, such as oxygen deprivation (hypoxia), maternal infection or maternal malnutrition, can increase the risk of epilepsy in the child.

Metabolic or nutritional disorders:

• Conditions such as low blood sugar (hypoglycemia), dehydration and electrolyte imbalances can cause epileptic seizures, especially in vulnerable individuals.

Types of seizures:

Epileptic seizures can be divided into two main categories depending on where and how they start in the brain

1.Focal (partial) seizures:

Seizures start in a specific part of the brain. These can be further divided into

• Focal seizures (formerly known as simple partial seizures): the person is conscious but may experience unusual sensations, movements or emotions.
• Focal disorientation seizures (formerly known as complex partial seizures): consciousness changes or is disturbed, and the person appears confused or unresponsive.

2. Generalized seizures:

Involve both sides of the brain from the onset and usually affect consciousness. Types include:

 Absence seizures (small seizures): Characterized by short periods of staring or dizziness. These seizures usually last only a few seconds and are more common in children.

 Tonic-clonic seizures (large seizures): the best known type with convulsions, muscle rigidity and loss of consciousness. The patient may cry, collapse or become immobilized.

 Myoclonic seizures: short, shock-like contractions of a muscle or group of muscles. 

 Atonic seizures: sudden loss of muscle tone, resulting in collapse or falling.

Tonic seizures: sudden stiffening of muscles.

 Clonic seizures: repeated jerking movements.

Diagnosis of epilepsy:

A diagnosis of epilepsy usually requires a comprehensive evaluation that includes

History: a detailed history, including when the seizures started, seizure frequency and possible triggering factors.

Neurological examination: to determine the presence or absence of neurological problems.

Electroencephalography (EEG): EEG records the electrical activity of the brain and can detect abnormal patterns associated with seizures. Imaging studies:

Magnetic resonance imaging (MRI) or computed tomography (CT): can be used to look for structural brain abnormalities such as tumors, strokes or malformations.

Blood tests: Can help rule out conditions such as metabolic abnormalities that trigger epileptic seizures.

Epilepsy treatment:

Epilepsy is not always curable, but it can often be effectively managed with treatment. Treatment options include the following

Medication:

Anti-epileptic drugs (AEDs) are the most common treatment for epilepsy and can control seizures in about 70% of patients. Common AEDs include phenytoin, carbamazepine, valproate, levetiracetam and lamotrigine. The choice of medication depends on the type of seizure, the age of the patient and other factors.

Surgery:

If seizures cannot be controlled with medication (drug-resistant epilepsy), surgical treatment may be preferred. The surgery aims to remove or replace the part of the brain where the seizures started. Temporal lobectomy is one of the most common epilepsy surgeries.

Vagus nerve stimulation (VNS):

VNS involves implanting a device that sends electrical impulses to the vagus nerve in the neck. This stimulation can reduce the frequency and severity of seizures.

Ketogenic diet:

This high-fat, low-carbohydrate diet may be recommended for children with difficult-to-treat epilepsy. The ketogenic diet changes brain energy metabolism and helps reduce epileptic seizures.

Reactive nerve stimulation (RNS):

A device implanted in the brain detects abnormal electrical activity and provides electrical stimulation to prevent seizures from occurring.

Seizure triggers:

Certain factors and conditions can trigger seizures in people with epilepsy. Common triggers include

• lack of sleep
• Stress
• Alcohol or drug use
• Flashing lights or patterns (photosensitive epilepsy)
• Fever or illness
• Hormonal changes (e.g. during menstruation)
• Forgetting to take medication

First aid during a seizure :

It is important to know how to help a person when they have a seizure:

• Make sure the person is protected from danger by staying calm and moving nearby objects away from them.
• Have the person lie on their side to secure their airway, especially if they are having a tonic-clonic seizure.
• Do not hold the person or put anything in their mouth.
• Time the seizure: call an ambulance if the seizure lasts longer than 5 minutes or if the person has more than one seizure without regaining consciousness.

Prognosis:

The prognosis for epilepsy depends on the type of epilepsy, its cause and response to treatment. Many people with epilepsy can successfully control their seizures with medication and other treatments and lead a relatively normal life. In some children, especially those with absence seizures or benign epilepsy, epilepsy can go into remission. However, epilepsy is a lifelong condition and may require ongoing management.