INTRODUTION TO EPILEPSY

The word "epilepsy" comes from the Greek word epi meaning "upon, at, close upon", and the Greek word Leptos meaning "seizure". From those roots we have the Old French word epilepsie, and Latin word epilepsia and the Greek words epilepsia and epilepsies.


WHAT IS IT?

Epilepsy is a common serious neurological condition where there is a tendency to have seizures that start in the brain. Epilepsy is usually only diagnosed after a person has had more than one seizure.

Not all seizures are due to epilepsy. Seizures can happen for many different reasons, such as diabetes or a heart condition. Here, when we use the term 'seizure' we mean epileptic seizure.

It is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Some people have “absence seizures.” This causes you to lose awareness and stare blankly until the brain returns to normal patterns.

Having one seizure doesn’t mean you have epilepsy. Your doctor might test for epilepsy if you have more than one seizure or other symptoms like traumatic brain injury.


WHAT ARE ITS SYMPTOMS?

The main symptoms of epilepsy are repeated seizures. There are some symptoms which may indicate a person has epilepsy. If one or more of these symptoms are present a medical exam is advised, especially if they recur:

▶A convulsion with no temperature
▶Short spells of blackout or confused memory
▶Intermittent fainting spells during which bowel or bladder control is lost. ▶This is frequently followed by extreme tiredness.
▶For a short period the person is unresponsive to instructions or questions.

▶The person becomes stiff suddenly for no obvious reason
▶The person suddenly falls for no clear reason
▶Sudden bouts of blinking without apparent stimuli
▶Sudden bouts of chewing, without any apparent reason
▶For a short time the person seems dazed, and unable to communicate
▶Repetitive movements that seem inappropriate
▶The person becomes fearful for no apparent reason, he/she may even panic or become angry
▶Peculiar changes in senses such as smell, touch and sound
▶The arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements.

The following conditions need to be eliminated as they may present similar symptoms, and are sometimes misdiagnosed as epilepsy:

▶A high fever with epilepsy-like symptoms
▶Fainting
▶Narcolepsy (recurring episodes of sleep during the day and often disrupted nocturnal sleep)
▶Cataplexy (a transient attack of extreme generalized weakness often precipitated by an emotional response such as surprise, fear, or anger; one component of the narcolepsy quadrad)
▶Sleep disorders
▶Nightmares
▶Panic attacks
▶Fugue states (a rare psychiatric disorder characterized by reversible amnesia for personal identity)
▶Psychogenic seizures (a clinical episode that looks like an epileptic seizure, but is not due to epilepsy. The EEG is normal during an attack, and the behavior is often related to psychiatric disturbance, such as a conversion disorder)
▶Breath-holding episodes (when a child responds to anger there may be vigorous crying and subsequent apnea and cyanosis - the child then stops breathing and skin color changes with loss of consciousness).

WHAT CAUSES IT?

In many cases, the cause is unknown. In more than half of epilepsy cases, doctors will not be able to identify a cause. These epilepsy cases, called idiopathic epilepsy, make up 60 to 70 percent of epilepsy cases.

The four most common causes of epilepsy are:

▶Brain infection. Infections such as AIDS, meningitis, and viral encephalitis have been shown to cause epilepsy.
Brain tumor. Tumors in the brain can interrupt normal brain cell activity and cause seizures.

▶Head trauma. Head injuries can lead to epilepsy. These injuries may include sports injuries, falls, or accidents.
Stroke. Vascular diseases and conditions, such as stroke, interrupt the brain’s ability to function normally. This can cause epilepsy.

Other epilepsy causes include:

▶Neurodevelopmental disorders. Autism and developmental conditions like it may cause epilepsy.

▶Genetic factors. Having a close family member with epilepsy increases your risk for developing epilepsy. This suggests an inherited gene may cause epilepsy. It’s also possible specific genes make a person more susceptible to environmental triggers that can lead to epilepsy.

▶Prenatal factors. During their development, fetuses are particularly sensitive to brain damage. This damage might be the result of physical damage, as well as poor nutrition and reduced oxygen. All of these factors could cause epilepsy or other brain abnormalities in children.

WHAT ARE THE RISK FACTORS?

These risk factors give you a higher chance of developing epilepsy:

▶Age. Epilepsy can begin at any age, but more people are diagnosed at two distinct phases in life: childhood and after age 60.
▶Brain infections. Infections, such as meningitis, inflame the brain and spinal cord and can increase your risk for developing epilepsy.

▶Childhood seizures. Some children develop seizures not related to epilepsy during their childhood years. Very high fevers may cause these seizures. As they grow older, some of these children may develop epilepsy.
▶Dementia. People experiencing a decline in mental function may also develop epilepsy. This is most common in older adults.
▶Family history. If a close family member has epilepsy, you are more likely to develop this disorder.
▶Head injuries. Previous falls, concussions, or injuries to your head may cause epilepsy. Taking precautions during activities such as bicycling, skiing, and riding a motorcycle can help protect your head against injury and possibly prevent a future epilepsy diagnosis.
▶Vascular diseases. Blood vessel diseases and strokes can cause brain damage. Damage to any area of the brain may trigger seizures and eventually epilepsy. The best way to prevent epilepsy caused by vascular diseases is to care for your heart and blood vessels with a healthy diet and regular exercise. Also, avoid tobacco use and excessive alcohol consumption.


WHAT ARE ITS EFFECTS ON THE BODY?

Due to the unpredictability of seizures, there can also be a great emotional toll.

DO'S AND DON'TS  WHEN SOMEONE IS HAVING A FIT

HOW CAN IT BE TREATED?

Even mild seizures may require treatment because they can be dangerous during activities such as driving or swimming. Treatment with medications or sometimes surgery can control seizures for about 80 percent of people with epilepsy. Some children with epilepsy may also outgrow their condition with age.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away.

There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help.

▶Blood tests. Your doctor will take samples of your blood to test for possible infections or other conditions that might explain your symptoms. The test results might also identify potential causes for epilepsy.

▶CT scan. A computed tomography (CT) scan takes cross-sectional pictures of your brain. This allows doctors to see into each layer of your brain and find possible causes of seizures, including cysts, tumors, and bleeding.

▶fMRI. A functional MRI (fMRI) lets your doctors see your brain in very close detail. An fMRI allows doctors to see how blood flows through your brain. This may help them understand what areas of the brain are involved during a seizure.

COMMON ANTI-EPILEPTIC DRUGS

Here is a list of the most commonly prescribed anti-epileptic drugs (AEDs).

▶acetazolamide (brand name Diamox)
▶acetazolomide modified release (Diamox SR)
▶carbamazepine (Tegretol)
▶carbamazepine modified release (Tegretol Retard)
▶clobazam (Frisium)
▶clonazepam (Rivotril)
▶ethosuximide (Emeside - Zarontin)
▶gabapentin (Neurontin)
▶lacosamide (Vimpat)
▶lamotrigine (Lamictal )
▶levetiracetam (Keppra)
▶oxcarbazepine (Trileptal phenobarbital)
▶perampanel (Fycompa)
▶phenytoin (Epanutin)
▶pregabalin (Lyrica)
▶primidone (Mysoline)
▶rufinamide (Inovelon)
▶sodium valproate (Epilim - Episenta)
▶sodium valproate modified release (Epilim Chrono)
▶tiagabine (Gabitril )
▶topiramate (Topamax)
▶valproic acid (Convulex)
▶vigabatrin (Sabril)
▶zonisamide (Zonegran)

Anti-seizure medications may have some side effects. Mild side effects include:

▶Fatigue
▶Dizziness
▶Weight gain
▶Loss of bone density
▶Skin rashes
▶Loss of coordination
▶Speech problems
▶Memory and thinking problems

WHAT ARE THE COMPLICATIINS?

Having epilepsy increases your risk for certain complications. Some of these complications are more common than others.

The most common complications include:

▶Car accidents. Many states do not issue driver’s licenses to people with a history of seizures until they have been seizure-free for a specified period of time. A seizure can cause loss of awareness and affect your ability to control a car. You could injure yourself or others if you have a seizure while driving.

▶Drowning. People with epilepsy are 15 to 19 times more likely to drown than the rest of the population. That’s because people with epilepsy may have a seizure while in a swimming pool, lake, bathtub, or other body of water. They may be unable to move or may lose awareness of their situation during the seizure. If you swim and have a history of seizures, make sure a lifeguard on duty is aware of your condition. Never swim alone.

▶Emotional health difficulties. Unfortunately, the emotional toll of epilepsy may be too great for some people to bear alone. Depression, anxiety, and suicidal thoughts and actions are possible complications.

▶Falling. Certain types of seizures affect your motor movements. You may lose control of your muscle function during a seizure and fall to the ground, hit your head on nearby objects, and even break a bone.

▶Pregnancy-related complications. Women with epilepsy can get pregnant and have healthy pregnancies and babies, but extra precaution is needed. Some anti-seizure medications can cause birth defects, so you and your doctor need to carefully evaluate your medicines before you plan to get pregnant.

Less common complications include:

▶Status epilepticus. Severe seizures, ones that are prolonged or happen very frequently, can cause status epilepticus. People with this condition are more likely to develop permanent brain damage.

▶Sudden unexplained death in epilepsy (SUDEP). Sudden, unexplained death is possible in people with epilepsy, but it is rare. Only two to 18 percent of people with epilepsy die from SUDEP.

Doctors do not know what causes SUDEP, but one theory suggests heart and respiratory issues may contribute to the death.


WHEN TO SEE A DOCTOR?

A seizure can be very scary, especially if it’s happening for the first time. Once you have been diagnosed with epilepsy, you will learn to manage your seizures in a healthy way.

However, a few circumstances may require you to seek immediate medical help. These circumstances include:

▶Injuring yourself during a seizure
having a seizure that lasts more than 5 minutes
▶Failing to regain consciousness or not breathing after the seizure ends
▶Having a high fever in addition to the seizures
▶Having diabetes
▶Having a second seizure immediately after a first
▶A seizure caused by heat exhaustion


HOW CAN IT BE PREVENTED?

Epilepsy may not be preventable for some people. However, you can take certain precautions. These include:

▶Protect against head injury. Accidents, falls, and injuries to the head may cause epilepsy. Wear protective headgear when you’re bicycling, skiing, or engaging in any event that puts you at risk for a head injury.
▶Guard against prenatal injury. Taking good care of yourself while you’re pregnant helps protect your baby against certain health conditions, including epilepsy.
▶Be vaccinated. Childhood vaccinations can guard against diseases that might lead to epilepsy.

HOW COMMON IS IT?

Approximately 50 out of every 100,000 people develop epilepsy each year in industrialized nations.

Epilepsy in USA - according to The Epilepsy Foundation over 3 million Americans are affected by epilepsy and seizures. About 200,000 new cases of seizures and epilepsy occur in the USA each year. 10% of all Americans will experience a seizure some time during their lifetime.

Epilepsy in UK - according to Epilepsy Action 460,000 people in the United Kingdom have epilepsy.

Epilepsy worldwide - according to The National Society for Epilepsy (UK) about 50 million people have epilepsy globally.


THE EPILEPSY-DEPRESSION CONNECTION

Chances are good that if you have epilepsy, you could also be depressed. The epilepsy-depression link has been the subject of many studies.

Researching epilepsy and depression helps doctors know how to treat symptoms of both conditions.

Studies published in the Journal of Neurology, Neurosurgery & Psychiatry and Epilepsy & Behavior suggest that between 30 and 55 percent of people with epilepsy also have depression.
Women with epilepsy are more likely than men to experience depression. In fact, more women than men are diagnosed with depression in general. According to evidence published in
Neurology , hormonal changes could be a reason that depression is more likely in women.

Of all of the medical conditions that people with epilepsy could also have, depression is at the top of the list.

There are many possible causes of depression in people with epilepsy. One of the most common is brain injury. The area of the brain responsible for mood may be affected in people whose epilepsy is cause by brain injury. This may lead to a variety of mood changes, including depression. This is a physical cause that links the two conditions.

WHAT'S THE TAKEAWAY?

It’s important to remember that depression and epilepsy are both manageable medical conditions. You may be at a higher risk for depression if you have epilepsy. But there are steps you can take to overcome your challenges and live a happy, productive life.