Epilepsy
Committed to the Welfare of a Special Child
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Epilepsy |
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| Facts about Epilepsy - Genesis - Types of seizures - Factors in seizures - Causes - Diagnosis - EEG - Management - Restrictions Epilepsy & Learning Disabilities
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The abnormal discharges may involve a small part of the brain only manifesting as partial or focal seizure or a much more extensive area in both cerebral hemispheres manifesting as generalised seizures. The presence or absence of warning or n Aura and a typical sequence of the events during an attack reflect the point in the brain from where the attack begins. Epileptic seizures can take a wide variety of forms but are broadly divided into generalised, and focal or partial seizures. Partial or Focal seizures affect part or a whole limb and may and may not become generalised, and focal or partial seizures. Partial or Focal seizures affect part or a whole limb and may not become generalised. If there is no alteration in consciousness it is known as simple partial ore Jacksonian seizures and if consciousness is altered or lost it is known as complex partial seizures, commonly known as psychomotor or temporal lobe epilepsy. Generalised seizures affect the whole body and consciousness is lost. However, by far the most common are Generalised Seizures (involving the whole of brain) commonly known as "Grand Mal" or "Tonic-Clonic" seizures are major seizures They are
According to the causes, epilepsy is divided into primary or idiopathic and secondary. Primary means no cause is demonstrate with all available investigations including latest Neuroimaging studies like Computerised Axial Tomography (CT scans), and Magnetic Resonance Imaging (MRI Scans). Secondary are those where seizures are manifestation of demonstrate structural diseases of the brain or they could definitely be attributed to causes like birth injuries, deficiency of sodium, sugar or calcium in the body, brain infections, head injuries and vascular insufficiency. About 40-50% of the cases are Primary or Idiopathic. Epilepsy is essentially a clinical diagnosis, e.g. form history and physical examination. Detailed account of the attack from patient and the eye witness is more important than the results of all the investigations as regards confirmation of the diagnosis. It often gives clues to the basic cause also. Thus every effort must be made to obtain this. Investigations are done to confirm the diagnosis and determine the cause. Depending on the age of the onset of the first seizure and associated symptoms and signs, the doctor decides the number and priority of the investigations. They include
EEG is done to increase the certainty of the diagnosis and
to ascertain the type of the seizure. It helps to determine proper
medication and prognosis. However, EEG is not required in all cases and
management of epilepsy in a given case can be done without the help of EEG
if not available.
It consists of following steps :
The general practitioner or family doctor and family members play a key role to help the patient achieve this. Commonly used anti-epileptic drugs:
These drugs suppress he
neuronal hyperexcitability responsible for seizures and gradually may cool
down the potentially hyperexcitable epileptic focus so that over the years
after the last attack, they could be withdrawn gradually. In few cases
recurrence of seizures is still a possibility, so a plan for withdrawal of
drugs should be done strictly under medical supervision.
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Resonance to the single drug or combination of the drugs is variable and depends on.
The treatment of every patient is highly individualised and strictly under medical supervision. The choice of the drug, the dosage of the drug, total duration of the treatment after the last attack and mode of withdrawal of the drugs are highly individualised. As the cost of the drugs like Carbamazepine and Sodium valproate is high and since the duration of the treatment is in years, economic constraints become an important factor for the choice of the drug. A record of attacks and drug therapy must be maintained. It is important to follow the doctor's instructions on periodic follow up examinations. This helps the physicians to monitor the patient's progress and detect any side effects of the drugs that may develop. Common side effects are nausea, drowsiness, weight loss or weight gain. These must be reported to the doctor. There is a general belief that these antiepileptic drugs dull the intelligence due to long term use and often this is the major reason to discontinue treatment. The drugs do have mild effect on cognitive function but the advantages outweigh the side effects. The selected cases it may be necessary to estimate the concentration of the drug in serum so that the optimal efficiency of the drug is combined with minimum side effects. This is known as serum level estimation or therapeutic drug monitoring. In chronic patients total seizure control may not be possible and in such cases one may have to strike balance between seizures and side effects of the drugs. This should be accepted by the patient and the relatives. A person with epilepsy can do every thing except
E-Cell Epilepsy Information
Centre ...see presentation
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The brain is the control center for the body like a
computer of the highest generation. It is made up of millions of tiny
nerve cells or neurons and supporting glial cells. Each neuron is
connected to thousands of other neurons and in turn to the different
parts of the body via nerves. Each neuron has electrical voltage
difference across its cell membrane. (This inherent electrical activity
can actually be detected, measured and recorded by
electroencephalogram-EEG). A seizure occurs when there is sudden
"surge" or "excess" or "chaos" in the normal
electrical activity in groups of neurons (epileptic focus) possibly due
to change in metabolism. This abnormal electrical discharge spreads to
other areas of the brain. This chaotic state of excessive excitability is
ultimately brought under control by inherent inhibitory influences.