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Tuesday, April 17, 2012

Epilepsy Temporal lobe epilepsy; Seizure disorder

Epilepsy was one of the first brain disorders to be described. It was mentioned in ancient Babylon more than 3,000 years ago. The strange behavior caused by some seizures has contributed through the ages to many superstitions and prejudices. The word epilepsy is derived from the Greek word for "attack." People once thought that those with epilepsy were being visited by demons or gods. However, in 400 B.C., the early physician Hippocrates suggested that epilepsy was a disorder of the brain -- and we now know that he was right.



What Is Epilepsy?

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions, muscle spasms, and loss of consciousness. During a seizure, neurons may fire as many as 500 times a second, much faster than normal. In some people, this happens only occasionally; for others, it may happen up to hundreds of times a day.
More than 2 million people in the United States -- about 1 in 100 -- have experienced an unprovoked seizure or been diagnosed with epilepsy. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. However, about 25 to 30 percent of people with epilepsy will continue to experience seizures even with the best available treatment. Doctors call this situation intractable epilepsy. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy.
Epilepsy is not contagious and is not caused by mental illness or mental retardation. Some people with mental retardation may experience seizures, but seizures do not necessarily mean the person has or will develop mental impairment. Many people with epilepsy have normal or above-average intelligence. Famous people who are known or rumored to have had epilepsy include the Russian writer Dostoyevsky, the philosopher Socrates, the military general Napoleon, and the inventor of dynamite, Alfred Nobel, who established the Nobel Prize. Several Olympic medalists and other athletes also have had epilepsy. Seizures sometimes do cause brain damage, particularly if they are severe. However, most seizures do not seem to have a detrimental effect on the brain. Any changes that do occur are usually subtle, and it is often unclear whether these changes are caused by the seizures themselves or by the underlying problem that caused the seizures.
While epilepsy cannot currently be cured, for some people it does eventually go away. One study found that children with idiopathic epilepsy, or epilepsy with an unknown cause, had a 68 to 92 percent chance of becoming seizure-free by 20 years after their diagnosis. The odds of becoming seizure-free are not as good for adults or for children with severe epilepsy syndromes, but it is nonetheless possible that seizures may decrease or even stop over time. This is more likely if the epilepsy has been well-controlled by medication or if the person has had epilepsy surgery.


Common causes of epilepsy include:
  • Stroke or transient ischemic attack (TIA)
  • Dementia, such as Alzheimer's disease
  • Traumatic brain injury
  • Infections, including brain abscess, meningitis, encephalitis, and AIDS
  • Brain problems that are present at birth (congenital brain defect)
  • Brain injury that occurs during or near bith
  • Metabolism disorders that a child may be born with (such as phenylketonuria)
  • Brain tumor
  • Abnormal blood vessels in the brain
  • Other illness that damage or destroy brain tissue
Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy



What Are the Different Kinds of Seizures?

Doctors have described more than 30 different types of seizures. Seizures are divided into two major categories -- focal seizures and generalized seizures. However, there are many different types of seizures in each of these categories.

Focal Seizures

Focal seizures, also called partial seizures, occur in just one part of the brain. About 60 percent of people with epilepsy have focal seizures. These seizures are frequently described by the area of the brain in which they originate. For example, someone might be diagnosed with focal frontal lobe seizures.
In a simple focal seizure, the person will remain conscious but experience unusual feelings or sensations that can take many forms. The person may experience sudden and unexplainable feelings of joy, anger, sadness, or nausea. He or she also may hear, smell, taste, see, or feel things that are not real.
In a complex focal seizure, the person has a change in or loss of consciousness. His or her consciousness may be altered, producing a dreamlike experience. People having a complex focal seizure may display strange, repetitious behaviors such as blinks, twitches, mouth movements, or even walking in a circle. These repetitious movements are called automatisms. More complicated actions, which may seem purposeful, can also occur involuntarily. Patients may also continue activities they started before the seizure began, such as washing dishes in a repetitive, unproductive fashion. These seizures usually last just a few seconds.
Some people with focal seizures, especially complex focal seizures, may experience auras -- unusual sensations that warn of an impending seizure. These auras are actually simple focal seizures in which the person maintains consciousness. The symptoms an individual person has, and the progression of those symptoms, tend to be stereotyped, or similar every time.
The symptoms of focal seizures can easily be confused with other disorders. For instance, the dreamlike perceptions associated with a complex focal seizure may be misdiagnosed as migraine headaches, which also may cause a dreamlike state. The strange behavior and sensations caused by focal seizures also can be istaken for symptoms of narcolepsy, fainting, or even mental illness. It may take many tests and careful monitoring by an experienced physician to tell the difference between epilepsy and other disorders.


Generalized Seizures

Generalized seizures are a result of abnormal neuronal activity on both sides of the brain. These seizures may cause loss of consciousness, falls, or massive muscle spasms.
There are many kinds of generalized seizures. In absence seizures, the person may appear to be staring into space and/or have jerking or twitching muscles. These seizures are sometimes referred to as petit mal seizures, which is an older term. Tonic seizures cause stiffening of muscles of the body, generally those in the back, legs, and arms. Clonic seizures cause repeated jerking movements of muscles on both sides of the body. Myoclonic seizures cause jerks or twitches of the upper body, arms, or legs. Atonic seizures cause a loss of normal muscle tone. The affected person will fall down or may drop his or her head involuntarily. Tonic-clonic seizures cause a mixture of symptoms, including stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness. Tonic-clonic seizures are sometimes referred to by an older term: grand mal seizures.
Not all seizures can be easily defined as either focal or generalized. Some people have seizures that begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern.
Society's lack of understanding about the many different types of seizures is one of the biggest problems for people with epilepsy. People who witness a non-convulsive seizure often find it difficult to understand that behavior which looks deliberate is not under the person's control. In some cases, this has led to the affected person being arrested or admitted to a psychiatric hospital. To combat these problems, people everywhere need to understand the many different types of seizures and how they may appear.


Symptoms

Symptoms vary from person to person. Some people may have simple staring spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy.
Most of the time, the seizure is similar to the previous one. Some people with epilepsy have a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) before each seizure. This is called an aura.
For a detailed description of the symptoms associated with a specific type of seizure, see:

Signs and tests

The doctor will perform a physical exam, which will include a detailed look at the brain and nervous system.
An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.
To diagnose epilepsy or plan for epilepsy surgery:
  • You may need to wear an EEG recorder for days or weeks while you go about your everyday life.
  • You may need to stay in a special hospital where brain activity can be be watched on video cameras. This is called video EEG.
Tests that may be done include:
Head CT or MRI scan often done to find the cause and location of the problem in the brain.


What to Do if You See Someone Having a Seizure

If you see someone having a seizure with convulsions and/or loss of consciousness, here's how you can help:
  1. Roll the person on his or her side to prevent choking on any fluids or vomit.

  2. Cushion the person's head.
  3. Loosen any tight clothing around the neck.
  4. Keep the person's airway open. If necessary, grip the person's jaw gently and tilt his or her head back.
  5. Do NOT restrict the person from moving unless he or she is in danger.

  6. Do NOT put anything into the person's mouth, not even medicine or liquid. These can cause choking or damage to the person's jaw, tongue, or teeth. Contrary to widespread belief, people cannot swallow their tongues during a seizure or any other time.
  7. Remove any sharp or solid objects that the person might hit during the seizure.
  8. Note how long the seizure lasts and what symptoms occurred so you can tell a doctor or emergency personnel if necessary.

  9. Stay with the person until the seizure ends.
Call 911 or 108 ( or emergency medical contact)  if :
  1. The person is pregnant or has diabetes.
  2. The seizure happened in water.
  3. The seizure lasts longer than 5 minutes.
  4. The person does not begin breathing again or does not return to consciousness after the seizure stops.
  5. Another seizure starts before the person regains consciousness.
  6. The person injures himself or herself during the seizure.
  7. This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or jewelry stating that they have epilepsy or a seizure disorder.
  8. After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Be patient with the person and try to help him or her find a place to rest if he or she is tired or doesn't feel well. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.
  9. If you see someone having a non-convulsive seizure, remember that the person's behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures. You can help by following these guidelines:
  10. Remove any dangerous objects from the area around the person or in his or her path.
  11. Don't try to stop the person from wandering unless he or she is in danger.
  12. Don't shake the person or shout.
  13. Stay with the person until he or she is completely alert.


Treatment

Treatment for epilepsy may involve surgery or medication.
If epilepsy seizures are due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop.
Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures.
  • These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have.
  • Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects.
  • Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Never not stop taking or change medications without talking to your doctor first.
  • Many epilepsy medications cause birth defects. Women wishing to become pregnant should tell the doctor in advance in order to adjust medications.
Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy."
  • Surgery to remove the abnormal brain cells causing the seizures may be helpful for some patients.
  • Surgery to place a vagus nerve stimulator (VNS) may be recommended. This device is similiar to a heart pacemaker. It can help reduce the number of seizures.
Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.
Lifestyle or medical changes can increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:
  • New prescribed medications, vitamins, or supplements
  • Emotional stress
  • Illness, especially infection
  • Lack of sleep
  • Pregnancy
  • Skipping doses of epilepsy medications
  • Use of alcohol or other recreational drugs
Other considerations:
  • Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.
  • Persons with poorly controlled epilepsy should not drive. Each state has a different law about which people with a history of seizures are allowed to drive.
  • Also avoid machinery or activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.
See also: Seizures - first aid.

Support Groups

The stress caused by having epilepsy (or being a caretaker of someone with epilepsy) can often be helped by joining a support group. In these groups, members share common experiences and problems.
See: Epilepsy - support group

Expectations (prognosis)

Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s.
For many people, epilepsy is a lifelong condition. In these cases, the anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy. However, serious injury can occur if a seizure occurs during driving or when operating equipment.

Complications

  • Difficulty learning
  • Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia
  • Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure
  • Permanent brain damage (stroke or other damage)
  • Side effects of medications

Calling your health care provider

Call your local emergency number (such as 911) if:
  • This is the first time a person has had a seizure
  • A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do)
In the case of someone who has had seizures before, call 911 for any of these emergency situations:
  • This is a longer seizure than the person normally has, or an unusual number of seizures for the person
  • Repeated seizures over a few minutes
  • Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)
Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea or vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.
Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.
Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

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