Epilepsy

Source:  Epilepsy    Tag:  is epilepsy hereditary



Epilepsy is one of the most common diseases or disorders in neurology. The cause of epilepsy and the symptoms are extremely diverse. Epilepsy is a chronic disorder of cortical cells, which for various reasons respond to outbreaks of synchronous electrical impulse, which is manifested by epileptic seizures.
What are seizures? 
Epileptic seizures are the visible symptom of described disorders, depending on where in the brain the disorder appears. During seizure can occur muscle spasms, sensory disturbances, disturbances of smell, sight and hearing, as well as some degree of consciousness disturbance. There are two basic categories of seizures: generalized (with full consciousness disturbance) and partial seizures (with or without partial disorder of consciousness). 


How an epileptic seizure looks like? 
Among generalized seizures the most common are large seizures (grand-mal) with complete loss of consciousness, muscle spasms whereby the person often turns, bites tongue and urinates and so called small seizures (apsans) that are common in childhood, and are reflected in short-term interruption of previous activities by staring in some object and brief absence. They are often revealed when the child starts school. 

Another large group are so called partial seizures. The basic difference between partial seizures with simple (elementary) symptoms and partial seizures with complex symptoms is that in the latter leads to disorder (narrowing) of consciousness. Appearance of seizures depends on the localization of epileptic focus. These damages of the motor cortex can provoke relatively frequent unilateral motoric symptom (ie motoric Jackson attacks) that manifests by breaking and convulsion of the muscles which cause a feeling of numbness or tingling in the affected limb of a patient.

Special clinical interest thing make complex partial epilepsy of temporal focus (called "psychomotor" epilepsy) whose clinical picture is very diverse, accompanied by defective or narrowing of consciousness quite often after a "hunch" or aura.


What are the causes of epilepsy? 
The causes of epilepsy can be numerous disorders of the central nervous system (congenital developmental disorders, infections, tumors, vascular diseases, degenerative disorders - congenital brain deterioration disease, metabolic disorders - traumas). In childhood, according the frequency, the most common cause is neonatal trauma, disorders of vascular development, congenital defects, head injury, infections, tumors or neoplasms. In adult age the most common causes are stroke, head injury, intoxication or excessive consumption of alcohol and / or drugs, tumors and infections. However, a significant number of epilepsies are so-called idiopathic (with a hereditary basis) and cryptogenic (with hidden, invisible damage). 


Is epilepsy a hereditary disease? 
Heredity plays an important role as a causative factor. However, inheritance is very complex and diverse, and the small number of epilepsies are inherited directly from parent to child. 

It is known that some idiopathic epilepsies are inherited. Idiopathic epilepsy is that in which not one single cause or damage that may lead to epileptic seizures is found. Development of science, genetic researches and new technical methods in the DNA analysis helped locate genes and their mutations (changes in the genes) in patients with some types of epilepsy, especially in childhood. Investigations were carried out in families in which several members of several generations had epilepsy. The first gene in patients with epilepsy was found in 1995.

Can epilepsy be caused by some other diseases? 
Causes of epileptic seizures can also be preventing of a sleep, hypoglycemia (low blood sugar), a longer and more intense physical effort, (insufficient supply of oxygen to the brain), and in rare cases, emotional stress. It should be noted that seizure does not mean someone has epilepsy, and that detailed neurological examination and treatment in order to establish the diagnosis of epilepsy is required. 

Posttraumatic epilepsy 
Posttraumatic epilepsy (PTE) usually occurs as a complication of severe, but sometimes easier head trauma, and if not treated with adequate medication (antiepileptic drugs) can cause further damage to the traumatized brain. 

Head injuries mainly occur in car accidents, falls from a height, hard or sharp blows to the head as a result of the injury. The occurrence of epilepsy after head trauma depends on the mechanism of injury and the intensity of the trauma. PTEs risk is higher in those patients who after head trauma have hemorrhage (in brain),posttraumatic loss of consciousness longer than 24 hours, and those with epileptic seizures within the first week after injury. The interval from head trauma to the occurrence of late PTE is from 1 week to 7 years and over.
EEG is of little predictive value for determining the risk of PTE's. 
By type of seizures half has grand mal seizures (large seizures), and other half has partial and partial -complex seizures (minor seizures). 
Much attention was given to attempt to prevent the occurrence of PTE's by treatment with various antiepileptic drugs immediately after head trauma, but unfortunately, without the expected favorable results. 

What is the "aura"? 
Aura means warning, premonition. Represents a wide variety of discrete symptoms, signs that precede seizure visible to the environment. 

It's difficult to enumerate them because there are many: a sense of sparks, strange smells and tastes, anger, sudden grief, strange beeps, nausea with vomiting, numbness of the hands, unmotivated movements, different strange feeling, a feeling that something is small or big but it does not fit the reality, the feeling that something has been seen or never seen, a sense of decay, sudden heart palpitations, etc. These symptoms small child doesn't know to signalize and warn surrounding people.

It is now known that these "little" symptoms actually presents or very mild seizure stopped with aura or, if one of the forms of visible seizures follows, represent its beginning. Which of these discrete symptoms will occur depends on the part of the brain from which the seizures originates and which is responsible for the functions that are manifested in the aura.

Which types of seizures are there? 
The most common cerebral seizures are epileptic, psychogenic (affective, hysterical) and ischemic (due to a sudden reduction of blood supply). 

Psychogenic seizures are caused by activation or release of certain brain structures due to emotional imbalance. They are very common and, although relatively harmless, can look dramatic. At children are called affective respiratory attacks since it comes to the cessation of breathing, which occurs during crying. At adults they occur with very varied symptoms and usually are theatrical and in front of witnesses, usually caused by numerous life problems.

Ischemic seizures are very common. They are caused by a sudden reduction in blood flow to the brain. By far the most common cause is fainting which usually occurs when getting up suddenly especially if the person has temperature, flu, uncomfortable standing, staying in the area with an unpleasant smell, taking blood tests etc.

Epileptic seizures are by definition sudden cerebral seizures of different clinical picture which are the result of abnormal electrical discharge from different parts of the cerebral cortex or from front part of the brain stem.

Partial seizures
Partial seizures emerge from a limited place in different areas of the cortex. That place is called an epileptic focus or focal point. 
Simple partial seizures affect one side of the body or parts of that side, opposite to the one which they break out and can occur in the form of muscle spasms (convulsions) or in the form of impaired sensation (paresthesia). A person does not lose consciousness, but, given the fact that it is often disturbed function of speech during the seizure, we may have impression of loss of consciousness. 
A complex partial seizures or psychomotor emerge from the so-called limbic system in which for epilepsy the most important structure is hippocampus, and is located at the bottom of the cerebral mass and surrounds part of the central structures of the brain. Seizures are very diverse, mostly in the form of a special form of narrowed consciousness called puzzle-headed or in a stronger form twilight state in which the person is disoriented in its personality, time and space with numerous diverse motor automatisms like squelch, movement of undressing and dressing, unduly departure, leaving the room, opening doors and windows. Very often appear illusions, hallucinations, deja vu, never seen before, restlessness, anger, aggression, etc. 
Partial seizures that secondarily generalize are those who start as a partial, then, after a shorter or a longer time are converted to a form of generalized seizures, usually in a large seizure (grand mal). 
I. primary generalized seizures 
Primarily generalized seizures are those in which an abnormal electrical discharge begins in front part of the brain stem and extends symmetrically from one side to the center of consciousness, and on the other side of the whole cortex. 
Primary grand mal (major seizures or primary generalized seizures with loss of consciousness). This is the most severe epileptic seizure, although this does not necessarily mean the most severe form of the disease in epileptic patients. The patient loses consciousness, has a symmetrical arm and leg spasms, chokes, falls on the ground, there is often froth at the mouth, tongue bite and incontinence. After the seizure deep sleep or coma follows, depending on many factors, but particularly on the duration of seizures. 
Apsans is a brief loss of consciousness with the disruption of activities including breathing. It lasts max. 20 seconds. Upon termination, patient continues to do what he had previously been doing (breathing, writing). It occurs excusively to children, and the number of seizures per day can be hundreds which significantly interferes with daily activities. It is caused very easy by deep breathing (hyperventilation) with eyes closed. 
Myoclonisms are involuntary muscle twitches. They occur as muscle twitches all over the body, generalized myoclonism or as snatch/jerk of each muscle group, segmented myoclonism (eyelid blinks, head jerks). A special form of myoclonism are infantile spasms in infants with West's syndrome. 
Atonc or astatic seizures indicate sudden loss of tone of the entire body, most commonly with a dramatic fall and frequent trauma. 


II Unclassified seizures 
Unclassified seizures are those for which we are not sure if they are epileptic or epileptic which at this point are not classified. 

III status epilepticus
Epileptic status is a long duration of epileptic seizure, more than half an hour, or a long duration of frequent brief seizures. It is important because sometimes is life threatening, and always at some extent, it damages the brain. 

If a person suffers a seizure, has she epilepsy? 
Epilepsy is not the same as an epileptic seizure. The diagnosis of epilepsy should be based on several indications which are connected into a single unit. First and foremost is that epileptic seizure is one symptom, and epilepsy is a disorder mainly chronical code at which epileptic seizures repeat. Just like headache is a symptom, and the disease can be a migraine, inflammation of the brain, brain tumor, etc. 

Given that in the beginning of the disease, after the first or several attacks, we can not say with certainty whether disease is going to be chronical, additional details important for diagnosis must be determined. In the first place, it is the exclusion of other possible causes of epileptic seizure, determining the circumstances under which the attack occurred, such as neurological and general status, age of patients at the end the EEG.


When a seizure can occur, and it's not epilepsy? 

A few common conditions are: 
1. febrile convulsions ( in young children in whom one or a few real grand mal seizures appear, and then, after child's fourth year of life, usually cease to appear.  Febrile seizures are very frequent, about 5 times more common than epilepsy and therefore represent an important chapter in pediatric epileptology.   Although febrile seizures are definitely not epilepsy, some common features among them can not be completely negated, and many of them now belong to the epileptic syndromes.)
2. inflammation of the brain  (meningitis and encephalitis) -  often cause an epileptic seizure during the inflammation because of imflammational and chemical stimulation of the cerebral cortex. 
3. brain contusion ( at injuries often has epileptic seizure as one of the symptoms which later occurs no longer unless the scar and damage incurred in a later period do not cause epilepsy.)
4. stroke ( often has accompanying epileptic seizure whose outcome is similar to that of cerebral contusion.)
5. metabolic disorder -  can cause epileptic seizures (lack of calcium and other electrolytes, low blood sugar, severe levels of damage of the kidneys and liver). 

What is electroencephalography, and what is its role in epileptology? Electroencephalographic recording of the brain brings a record which is called an electroencephalogram (EEG). Normal and abnormal electrical potentials of the cortex are recorded.  Is the most important laboratory method of examination in the epileptology, but is important in the diagnosis of many other diseases, and in the analysis of sleep disorders. EEG is a painless, simple and cheap method of examination. In epileptology is important as confirmation of a diagnosis of epilepsy and to determine the form of epileptic seizures and epilepsy. Wrong opinion is often found in patients that with the EEG examination can successfully be diagnosed or excluded any morbid conditions of the brain. Disadvantages of EEG are in the fact that the boundaries of normal and abnormal are very wide especially in children, which represents difficulties in interpretation, and that EEG may be normal in patients with epilepsy, and in various forms abnormal in healthy human ie child. Particularly because of the difficulty in interpreting often leads to false evaluation findings, and worry of the patient about his health, which he estimates through such a finding. 


How is epilepsy diagnosed? 

For the diagnosis of epilepsy, it is necessary to: 
1. Take a detailed medical history     
    - To find out whether there is similar illness in the family 
    - To examine which diseases person suffered before seizure and whether  
      she had head trauma 
    - Get as much information as possible about the seizure and the 
      circumstances in which seizure started (a description of what preceded 
      seizure and what happened during seizure: At what time seizure began - 
      the time of day, how long it lasted? How the child looked after seizure ie 
      was it tired, sleepy, did it fall asleep, whether it had a stronger headache 
      and whether it has vomitted) 
2. Make a detailed clinical neurological examination 
3. Do EEG. 

In some cases, it will be necessary to do other diagnostic tests – CT, MRI and biochemical laboratory tests.
Anamnesis (medical history, description of seizure) which gives an answer about the seizure type, and EEG which confirms the existence or origin of abnormal brain activity are the most important in determining the existence of epilepsy and its classification. 

First Aid in case of grand mal seizure 
- Remove all object near patient which could hurt him during the seizure 
- Put some soft and flat object under the patient's head (pillow, handbag, 
  appropriately folded clothes) 
- unbutton collar shirt of a patient, loosen his tie, eventually loosen strap 
  trousers 
- After the cessation of seizures put the patients in lateral position (lower leg 
  extended, the lower arm behind the body) 
- Do not put anything in your patient's mouth (spatula, spoon, etc.) in order to  
  prevent tongue bite, do not try to force to open the patient's mouth 
- Do not give any liquid to patient during seizure - until complete return of 
  consciousness 
- It is not advisable to hold patient during seizure, or try to physically stop 
  the cramps 
- Find in the patient's clothing document on possible illnesses (in some 
  countries there are identification cards or bracelets for patients with 
  epilepsy) 
- Check the exact time of seizure - as orientation on the length of its duration 
- Always wait untill the patient regains consciousness 
- Offer him help or - if required - to call for professional medical help 

 


Tips 
Here are a few tips that can facilitate everyday problems and make life more comfortable. Make sure that these tips are useful to people who do not have seizures, and use them depending on the type of seizures and problems that you have. 

In the bathroom:
doors open to the outside, do not lock them (hang the label "busy") 
it is safer taking a shower than having a bath 
sing while showering 
take a shower with warmish water (avoid too hot water) 
check whether drainage and ventilation of bathroom are correct 
Patients who have many seizures should take extra safety precautions when taking a shower (special pads, chairs with belts, etc.) 
Avoid using electrical appliances (hair dryer, electric shaver) in the bathroom or near water 


In the kitchen: 
Whenever possible, cook and use of electrical appliances in someone's presence 
use plastic plates, cups and glasses 
Use rubber gloves when handling a knife or wash the dishes 
Avoid frequent use of sharp knives (use a pre-cut or semi-cooked food as much as possible) 
If possible, use a microwave oven 

At work: 

inform the people that you work with about the possibility of the appearance of your seizures, and how they can help you in that moment (show them where is your pillow and how to put you on the pillow, whom to call, etc.) 
Avoid stress and overtime 
wear protective clothing in accordance with the type of seizures and your job 
keep in the closet spare clothes so you can change if necessary 


In the house: 
change the flooring and furniture with soft materials 
top the sharp edges of furniture or get furniture with rounded corners 
put a buckler around the place with open flame, heaters and radiators 
Avoid smoking and lighting fire if you're alone 
do not transfer lighted candles and heated dishes 
Avoid heaters that can tip over 
Take special care when ironing and using other electrical appliances 
Avoid climbing on a chair or ladder, especially if you are alone in the house