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Epilepsy :

 

What is Epilepsy ?

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Epilepsy is a neurological condition, which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition like alcohol withdrawal or extremely low blood sugar.

The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures, what type they are, or how severe they are.


What is Seizure ?

A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders that can affect the brain. Some seizures can hardly be noticed, while others are totally disabling.


Does Single Seizure means, I will get epilepsy?

About half of the people who have one seizure without a clear cause will have another one, usually within 6 months. You are twice as likely to have another seizure if you have a known brain injury or other type of brain abnormality. If you do have two seizures, there's about an 80% chance that you'll have more.

If your first seizure occurred at the time of an injury or infection in the brain, you are more likely to develop epilepsy than if you had not had a seizure in that situation.

More seizures are also likely if your doctor finds abnormalities on a neurological examination; a set of tests of the functioning of your nervous system that is performed in the doctor's office.

Another thing that can help your doctor predict whether you will have more seizures is an EEG, electroencephalogram , a test in which wires attached to your scalp record your brain waves. Certain patterns on the EEG are typical of epilepsy. If your brain waves show patterns of that type, you are about twice as likely to develop epilepsy as someone who does not have those patterns.


Symptoms of the Seizure

A seizure is usually defined as a sudden alteration of behavior due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below


Early seizure symptoms (warnings)

  • Smell
  • Taste
  • Jamais vu
  • Racing thoughts
  • Dizziness
  • Lightheadedness
  • Strange feelings Fear/Panic
  • Tingling feeling
  • Sound
  • Deja vu
  • Visual loss or blurring
  • Stomach feelings
  • Headache
  • Nausea
  • Pleasant feeling
  • Numbness

   Sometimes seizures come with no warning

 

Seizure symptoms

  • Black out
  • Confusion
  • Convulsion
  • Drooling
  • Electric Shock Feeling
  • Eyes rolling up
  • Falling down
  • Hand waving
  • Inability to move
  • Lip smacking
  • Out of body experience
  • Staring
  • Swallowing
  • Smell
  • Visual loss or blurring
  • Tongue biting
  • Twitching movements
  • Breathing difficulty
  • Chewing movements
  • Difficulty talking
  • Deafness/Sounds
  • Eyelid fluttering
  • Fear/Panic
  • Foot stomping
  • Loss of consciousness
  • Heart racing
  • Incontinence
  • Making sounds
  • Shaking
  • Stiffening
  • Sweating
  • Spacing out
  • Teeth clenching/grinding
  • Tremors

 

After-seizure symptoms (post-ictal)

  • Bruising
  • Depression and sadness
  • Exhaustion
  • Frustration
  • Injuries
  • Nausea
  • Shame/Embarrassment
  • Thirst
  • Writing difficulty
  • Confusion
  • Difficulty talking
  • Fear
  • Headache
  • Memory loss
  • Pain
  • Sleeping
  • Urge to urinate/defecate
  • Weakness

 

Who gets Epilepsy ?

Epilepsy can develop in any person at any age. 0.5% to 2% of people will develop epilepsy during their lifetime. People with certain conditions may be at greater risk.

 

When are people most likely to get epilepsy?

New cases of epilepsy are most common among children, especially during the first year of life. The rate of new cases gradually declines until about age 10, and then becomes stable. After age 55 or 60, the rate starts to increase, as people develop strokes, brain tumors, or Alzheimer's disease. (All of these disorders can cause epilepsy.)

 

Facts About Epilesy

  • Up to 5% of the world's population may have a single seizure at some time in their lives.
  • It is likely that around 50 million people in the world have epilepsy at any one time.
  • Children and adolescents are more likely to have epilepsy of unknown or genetic origin.
  • Brain injury or infection can cause epilepsy at any age.
  • Recent studies show that up to 70% of children and adults with newly diagnosed epilepsy can be successfully treated.
  • About 10% of children with epilepsy have seizures that do not respond to treatment. The proportion of adults is higher, up to 15%.

 

What are the Risk Factor ?

Risk factors for epilepsy include

  • Babies who are small for their gestational age
  • Babies who have seizures in the first month of life
  • Babies who are born with abnormal brain structures
  • Bleeding into the brain
  • Abnormal blood vessels in the brain
  • Serious brain injury or lack of oxygen to the brain
  • Brain tumors
  • Infections of the brain: abscess, meningitis, or encephalitis
  • Stroke resulting from blockage of arteries
  • Cerebral palsy
  • Mental handicap
  • Seizures occurring within days after head injury ("early posttraumatic seizures")
  • Family history of epilepsy or fever-related seizures
  • Alzheimer's disease (late in the illness)
  • Fever-related (febrile) seizures that are unusually long
  • Use of illegal drugs such as cocaine

 

Is epilepsy inherited ?

It may seem obvious that heredity (genetics) plays an important role in many cases of epilepsy in very young children, but it can be a factor for people of any age. For instance, not everyone who has a serious head injury (a clear cause of seizures) will develop epilepsy. Those who do develop epilepsy are more likely to have a history of seizures in their family. This family history suggests that it is easier for them to develop epilepsy than for others with no genetic predisposition.

 

Brothers and sisters of children with epilepsy more likely to develop it.

Their risk is slightly higher than usual, not because they will "catch" it (that can't happen) but because there may be a genetic tendency in the family that makes seizures and epilepsy more likely. Even so, most of them will not develop epilepsy. Epilepsy is more likely to occur in a brother or sister if the child with epilepsy has primary generalized seizures. Depending on the type of epilepsy and the number of family members who are affected, only about 4% to 10% of the other children in the family will have epilepsy.

 

If I have epilepsy, will my children also have it?

Less than 2 people out of every 100 (2%) develop epilepsy at some point during their lifetime. The risk for children whose father has epilepsy is only slightly higher. If the mother has epilepsy and the father does not, the risk is still less than 5%. If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of inheriting epilepsy is higher for some types.

 

Will I always have epilepsy ?

About 80% of people with epilepsy treated with seizure medicines remain free of seizures for at least 2 years. Many never have any more seizures. The chances of becoming completely seizure-free are best if there is no known brain injury or abnormality, and if the person has a normal neurological examination and EEG.

Of adults, 50-60% will be seizure-free after using their first seizure medicine. Another 11-20% will gain seizure control using the second medication, leaving 20-30% who are still having seizures.

Among those who are young when their epilepsy is diagnosed, 20% are "smooth sailors"-they start on medication and never have another seizure after medication is stopped, even when they reach adulthood. About 50-60% of children become seizure-free with the first medication used, but 30% never stop taking seizure medicines. About 10% have a really difficult time with "intractable seizures."

The more time that passes without seizures, the greater is the chance of staying seizure-free. Over 50% of children outgrow their epilepsy. Twenty years after the diagnosis, three-quarters of people will have been seizure-free for at least 5 years, although some may still need to take daily medication.

 

Will I have to take seizure medicines for the rest of my life?

Many people who are seizure-free for 2 to 4 years can stop taking their medications, under their doctor's supervision, without having further seizures. However, about 30% of children and 30% to 65% of adults will have seizures again. You need to discuss this with your doctor and agree on a plan for stopping gradually over weeks or months, not all at once.

Whether it will be safe for you to stop taking your seizure medicine depends partly on whether you drive a car or engage in other activities that would be dangerous if you had another seizure. If your answer is "yes," you will need to be more cautious.

 

I've been taking seizure medicine but I'm still having seizures. Will I always have them?

Some people with seizures that cannot be controlled with tolerable doses of seizure medicine (who have what doctors call "intractable epilepsy") do eventually become seizure-free. The longer that you continue to have seizures after the diagnosis of epilepsy is made, however, the lower the chance that your seizures will stop.

Your doctor will want you to try different medications or combinations of them. The more medicines that fail to control your seizures, however, the less likely it is that another medication regimen will fully succeed. Other kinds of treatments, such as vagus nerve stimulation or epilepsy surgery, may be very helpful for some people who continue to have seizures while taking seizure medicines.

 

How serious are seizures ?

The life expectancy of people who have epilepsy is the same as for anybody else if they are otherwise pretty healthy. Some people whose epilepsy is caused by stroke or a brain tumor may die sooner from those conditions, of course.

A long-lasting convulsive seizure (called "tonic-clonic status epilepticus") is a medical emergency. If not stopped within about 30 minutes, it may cause permanent injury or death. In addition, people with epilepsy can also die from inhaling vomit during or just after a seizure. This can be prevented if someone will turn the person onto one side when the seizure begins and ensures that the vomit completely comes out of the mouth. In general, seizures are hardly ever fatal, even if the person loses consciousness.

People who are not seizure-free need to be careful about possible accidents during a seizure. Death from drowning is more common among people with epilepsy. It can even occur in a tub with only a few inches of water, so people who have seizures probably should stick to showers instead of baths. If you have epilepsy, your doctor-and the agency in your state or province responsible for licensing drivers-will help you decide whether it is safe for you to drive. You should also be careful on train or subway platforms and when walking near busy streets. However,with some planning, you should be able to lead a life that is both active and safe.

 

What about Sudden Unexplained Death in Epilepsy (SUDEP)?

SUDEP is a rare condition in which young or middle-aged people with epilepsy die without a clear cause. It accounts for less than 2% of deaths among people with epilepsy. The risk is about 1 in 3,000 per year for all people with epilepsy. Although, it can be as high as 1 in 300 for those who have frequent, uncontrollable seizures and take high doses of seizure medicines. SUDEP is extremely rare in children.

The person is often found dead in bed and doesn't appear to have had a convulsive seizure. About a third of them do show evidence of a seizure close to the time of death. They are often found lying face down.

No one is sure about the cause of death in SUDEP. Some researchers think that a seizure causes an irregular heart rhythm. More recent studies have suggested that the person may suffocate from impaired breathing, fluid in the lungs, and being face down on the bedding.

 

Safety Precautions

The best known way to lessen the risk of SUDEP is to control seizures. Therefore:

  • Take all seizure medicines regularly, as prescribed.
  • Avoid heavy alcohol use and recreational drugs.
  • Get regular sleep and avoid fatigue.

 

Certain Facts about Epilepsy

1.   Epilepsy is not infectious/contagious

2.   Epilepsy is not a curse

3.   People with epilepsy are not "epileptics.

4.   A seizure disorder is epilepsy.

5.   People with epilepsy usually are not mentally handicapped.

6.   Seizures do not cause brain damage.

7.   People with epilepsy are not violent or crazy.

8.   People with epilepsy are seldom brain-damaged.

9.   Epilepsy is not necessarily inherited.

10. Epilepsy is not a life-long disorder.

11. Epilepsy should not be a barrier to success

 

Types of Seizures :

Primary generalized seizures

Primary generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures.

 

Partial seizures

Partial seizures begin with an electrical discharge in one limited area of the brain. Some are related to head injury, brain infection, stroke, or tumor, but in most cases the cause is unknown.

 

Primary Generalized Seizures

Absence seizures
Atypical absence seizures
Myoclonic seizures
Atonic seizures
Tonic seizures
Clonic seizures
Tonic-clonic seizures

 

Partial Seizures

Simple partial seizures
Complex partial seizures
Secondarily generalized seizures

 

Temporal Lobe Epilepsy

The temporal lobes, one on each side of the head, just above the ears, are the sites of one of the most common forms of epilepsy. Complex partial seizures with automatisms (unconscious actions), such as lip smacking or rubbing the hands together, are the most common seizures in temporal lobe epilepsy.

Seventy-five percent of patients also experience simple partial seizures which may include such features as: a mixture of thoughts, emotions, and feelings that are hard to describe; sudden emergence of old memories or feelings of strangeness in familiar surroundings; hallucinations of voices, music, smells, or tastes, and feelings of unusual fear or joy. While partial seizures dominate, approximately half the people with temporal lobe epilepsy have generalized tonic-clonic seizures as well.

The seizures characteristic of temporal lobe epilepsy often begin in the deeper parts of the temporal lobe (part of the limbic system) which control emotions and memory. Memory problems may develop over time in people with this syndrome. Treatment is with medication or surgery, or in some cases, VNS therapy

 

Sleep and Epilepsy

We all know that we think more clearly, react more quickly, and generally perform better after a good night's sleep. And while a good night's sleep plays a key role in the overall well-being and health of all people it is even more vital in people with epilepsy. One reason why is because a lack of sleep or poor quality of sleep can in turn increase frequency of seizures. The reasons why sleep deprivation provokes seizures are unclear. However, what we do know is that the sleep-wake cycle is associated with prominent changes in brain electrical activity, so seizures and the sleep-wake cycle are often clearly related. We also know that most types of seizures are affected by sleep, although the degree varies greatly from type to type and patient to patient. Further, there are hormonal changes during sleep that could possibly be related to seizures. Finally, the effects of seizures and seizure medicines on the quality of your sleep can make the relationship even more complicated. In this section we will explore all the different aspects of the sleep-epilepsy connection. Let's get started with an introductory look at how sleep and epilepsy are connected.

 

Seizure Provoking Factors

Missed medication
Lack of sleep
Illness (both with and without fever)
Severe psychological stress
Heavy alcohol use
Use of cocaine and other recreational drugs such as Ecstasy
Over-the-counter or prescription medications or supplements that decrease the effectiveness of seizure medicines
Nutritional deficiencies: vitamins and minerals The menstrual cycle

 

DURING EPILEPTIC SEIZURE/ ATTACK

Do's...

  • Protect the person from injury - (remove harmful objects from nearby)
  • Cushion his head
  • Look for an epilepsy identity card
  • Aid breathing by gently placing them on one side once the seizure has finished
  • Stay with the person until recovery is complete
  • Be calm and reassuring
  • Loosen or remove his tie, scarf or anything around his head or neck
  • Call the ambulance or shift the patient to the nearest Hospital

 

Don't...

  • Restrain the person's movements
  • Put anything in the person's mouth
  • Try to move him unless he is in danger
  • Give him anything to eat or drink until they are fully recovered