Epilepsy

epilepsy summary

Epilepsy is a neurological disease that affects many people. About 1-2% of the world’s population have seizures, and in childhood and old age these incidences are higher. In Brazil, it is estimated that 1.8 to 3.6 million people have epilepsy. For about 30% of cases, the causes of epilepsy are not known. However, for another part, some factors can influence such as genetic causes, environmental factors, head trauma, infections, brain tumors, vascular malformations and intoxication, especially by drugs of abuse, such as LSD and cocaine. A particularly common cause in children is fever. Although frightening for parents, this condition rarely causes brain damage.

Symptoms vary according to the region of the brain affected. In this regard, seizures can be divided into simple partial, complex and generalized (absence, atonic, myoclonic, tonic-clonic). Diagnosis is made with neurological examinations and brain imaging. It is important that the patient is properly treated, as some complications such as falls and seizures in sequence (status epilepticus) can compromise the patient’s quality of life, with irreversible brain damage.

Treatment is with antiepileptic drugs such as phenobarbital and valproic acid. Surgeries are also indicated in some cases, especially for patients refractory to drug treatments. Some medicinal plants can help control crises, such as marcela and lemon balm . It is important to mention that the patient with epilepsy should avoid the use of herbal medicines containing ginkgo biloba . Homeopathic treatment can be done with some medicines like Bufo Rana and Cuprum Metallicum.

It is important that the patient correctly follows the doctor’s instructions and regularly takes medications. Relatives and friends should be aware so they can help in case of a seizure. The patient should also observe which factors can trigger epilepsy, such as sleep deprivation or contact with intense light (video games, computers) so that he can modify his life habits.

Definition

Epilepsy is a disease characterized by seizures caused by electrical discharges in part or all of the brain. The epilepsy disease is defined when the patient has more than one episode of convulsive crisis without this crisis being associated with external factors such as drugs, medications or traumas.

There are several types of seizure depending on the part of the brain affected and the symptoms generated. Thus, epilepsy can be of the following type:

– Epilepsia focal simples (Epilepsia Jacksoniana)

– Complex focal epilepsy

– Generalized grand mal or tonic-clonic epilepsy

-Petite Mal type epilepsy or absence seizure

Epidemiology

– In February 2017, the WHO estimated that around 50 million people worldwide were affected by epilepsy. It can be noted that this is less than 1% of the world’s population. According to WHO, this condition can be treated in about 70% of cases, but about three quarters of those affected in developing countries do not receive the treatment they need, according to 2017 data.

Causes

In about 30% of cases of epilepsy, the causes are not known and the condition is called essential epilepsy. In the rest of cases, some causes may be:

– Genetic causes: some cases of epilepsy are hereditary. Scientists estimate that more than 500 genes may be linked to epilepsy. Although genetic baggage seems to be closely associated with the type of seizure developed, it is important to emphasize that not only heredity will make the individual be epileptic or not. Environmental and social factors are important for the onset of the disease.

– Head trauma: trauma suffered by the skull, such as in accidents and falls, can trigger seizures.

– Vascular accidents and heart attacks: cerebrovascular accidents (CVA) are responsible for about 50% of cases of epilepsy in patients over 65 years of age.

epilepsy fever- Dementia: Dementia states, such as Alzheimer’s, are important causes of epilepsy in the elderly.

– Infections: diseases such as meningitis, AIDS and viral encephalitis can trigger epileptic seizures.

– Prenatal damage: infections, damage caused by lack of oxygen or poor nutrition can damage the brain of fetuses. Some cases of childhood epilepsy are associated with cerebral palsy and other neurological disorders.

– Poisoning: neurotoxic agents can lead to the onset of seizures. Some agents that are toxic to the brain include drugs of abuse (cocaine, heroin, LSD), alcohol, heavy metals, pesticides, and chemical solvents.

Vascular epilepsy – High fever: very high temperatures trigger convulsive crises, especially in children. Although this is a particularly frightening situation, convulsive crises caused by high fever do not leave sequelae in the brain.

– Developmental disorders: Conditions such as autism and Down Syndrome are associated with epilepsy.

– Brain tumors: some tumors that cause epilepsy are astrocytomas, gangliomas, meningiomas, glioblastoma, etc.

– Vascular malformations: cavernomas, arteriovenous malformations, sequelae of ischemia, etc.

It is believed that these factors produce a hyper excitability of brain neurons, causing them to propagate many electrical impulses and initiate the seizure.

Groups of risk

Anyone can have a seizure during their lifetime, however, for this to be characterized as epilepsy, these seizures need to be recurrent. Some factors can increase the risk of developing seizures. Therefore, some groups and risk factors are:

– Men have a slightly higher risk of developing seizures than women.

– Although epilepsy can happen at any time of life, elderly people over 65 years of age and children are at greater risk, especially those younger than 5 years of age.

stroke and epilepsy – People with a family history of epilepsy.

– People who have suffered head trauma, such as car accidents and falls.

– Patients who have already had a stroke or heart attack .

– Patients with brain infections such as meningitis .

– Patients with brain malformations, including vascular malformations.

– Patients with brain tumors .

– Addicts to psychoactive chemicals such as LSD and cocaine.

– Autistic people and people with Down Syndrome.

Symptoms

The symptoms of epilepsy vary according to which neurons are in a state of hyperarousal. The results can be temporary confusion, absenteeism, uncoordinated muscle movements and complete loss of consciousness.

When seizures occur only in part of the brain, they are called partial seizures and can be divided into:

– Simple focal seizures: in this case, the patient does not lose consciousness. However, this may report changes in emotions or sensory issues such as taste, smell, vision and hearing. This crisis can also result in involuntary limb movements and vertigo.

epilepsia_sintomas- Complex focal seizures: in these cases, there is loss of consciousness and the patient may exhibit non-purposeful movements, such as walking in circles and chewing intensely.

When neuronal hyperexcitation is not limited to a certain brain region, there is what we call generalized seizures and can be classified as

– Myoclonic seizures: it is characterized by movements of the arms and legs.

– Absence seizures (Petit Mal): causes a brief loss of consciousness with sudden body movement. Absence seizures are short-lived, between 3 to 30 seconds, and can happen 50 to 100 times a day.

– Atonic seizures: are characterized by falls and loss of body muscle tone.

– Tonic-clonic seizures (Grand Mal): this is the most intense type of generalized seizure. In it, the patient presents loss of consciousness, stiffening of the muscles, uncoordinated movements and loss of bladder control.

Diagnosis

Before diagnosing epilepsy, it is necessary to investigate whether there are biological or toxic anomalies that could provoke seizures. For this, the doctor may request a blood test to check for poisoning, protein and enzyme levels, anemia , malnutrition, diabetes , etc.

If no cause is revealed, it will be necessary to resort to complementary tests that will confirm or not the disease. The doctor may perform a neurological examination to check body movements and how the patient’s intellectual capacity is affected by seizures.

Detailed brain scans may be needed for the doctor to check for any abnormalities such as the brain. These tests include:

– Electroencephalogram (EEG). The EEG allows, thanks to the electrodes, to measure the brain waves and identify the patterns (from the English pattern ). People with epilepsy often have different brain wave patterns than people without the condition.

– Magnetic Resonance Imaging (MRI). Magnetic resonance imaging (MRI) can reveal brain anomalies that can be the cause of epileptic seizures, such as tumors, hemorrhages and cysts, as revealed by the Mayo Clinic in a book.

– IQ, memory and language tests.

– Positron emission tomography.

– Functional MRI, to check the blood flow in the brain.

– Single photon emission computed tomography ( SPECT ). A method for creating a brain blood flow map during epileptic seizures.

Complications

The patient with epilepsy may have some complications during life. Some concern complications in the patient’s daily activities, such as falls, increased risk of being involved in car accidents, and drowning when showering or swimming. The patient may also kick, scratch, or injure himself during seizures.

In addition, women with epilepsy may experience life-threatening complications during pregnancy for both the baby and the mother, and certain seizure medications are not advised during pregnancy.

Other particularly important conditions for the epileptic patient are:

– Status epilepticus: in this condition, the patient has a continuous state of seizure lasting more than 5 minutes or has frequent epileptic seizures with loss of consciousness without recovering it during the seizures. Patients with status epilepticus are at increased risk of permanent brain damage and death.

– Sudden death: people with difficult-to-treat epilepsy are at risk of sudden death during a seizure. This rate is less than 1 case in 1000, but it is more common in patients who are not controlled by any treatment and in those who have generalized tonic-clonic seizures.

Treatments

In general, treatment for epilepsy aims to reduce neuronal excitability and the firing of electrical impulses in the brain.
Many patients on anticonvulsant drugs can live a normal life without experiencing any further seizures. Other patients have a reduction in the frequency and intensity of seizures. Some of the drugs used for the treatment of epilepsy are:

– phenobarbital

– valproic acid

– lamotrigine

– topiramate

– carbamazepine

A drug treatment also used in epilepsy is levetiracetam.

It is important to note that these medications, like any other, can have side effects. Some of the most common ones are:

– fatigue ;

– dizziness;

– weight gain;

– skin rash;

– lack of coordination and speech problems;

– depression .

Treatment is generally effective, but for this to happen it is essential that the patient regularly takes their medication.

Surgery
For drug-refractory patients, an alternative is surgery. It consists of removing the affected part of the brain (as long as it is a small part and that it does not affect the overall functioning of the brain) or implanting electrodes that regulate electrical impulses.
According to the Mayo Clinic , surgery is most often performed when diagnostic tests show that the seizures originate in a small, well-defined area of ​​the brain that doesn’t interfere with vital functions such as speech, language, motor function, vision, and hearing.

Other additional therapies include vagus nerve stimulation and the ketogenic diet. According to the Mayo Clinic , this diet seems to work for some children with epilepsy.

In vagus nerve stimulation, an implant is placed under the skin of the patient’s chest. Electrical impulses stimulate the vagus nerve and this stimulation reduces seizures by 30 to 40%.

ketogenic diet

The ketogenic diet is a diet rich in lipids (90-92%), low in carbohydrates (2%) and normal amounts of protein (8-10%). Many patients are able to remain seizure-free on this type of diet. Before adopting this diet, talk to a doctor and a nutritionist so that he can adjust the ideal amounts of vitamins, nutrients and minerals in each case.

The ancient Greeks already knew that food could control epilepsy. In the 1920s to 1950s, the ketogenic diet was widely used, particularly in children, before losing its importance with the advent of anti-epileptic drugs.

The ketogenic diet is indicated for some epileptic patients who do not respond to medication.

However, only one third of patients do not respond to drug treatment. A better understanding of the signaling pathways that inhibit certain areas of the brain, therefore, could help find therapies to control diseases such as epilepsy.

In general, in case of convulsive crises, it is not advised to administer medication to the patient, as there is a risk of disturbing his previous examination. It is therefore necessary to administer anticonvulsants if the person has successive seizures (Status Epilepticus or status epilepticus ). In this case, the doctor may administer:

– phenobarbital

– diazepam

– high dose clonazepam.

Herbal medicine

Medicinal plants are an auxiliary treatment in the control of seizures. It is important that, before using any medicinal plant, the doctor is aware of the patient’s choice. Some of the medicinal herbs that can have a beneficial effect on epilepsy are:

– Marcela

– Marapuá-do-Campo

– Arabic acacia

Tanchagem _

– fennel

– Lemongrass

– Velame do Campo

Patients with seizures should avoid using ginkgo biloba. According to a study carried out in Germany, components of this plant reduce the effectiveness of anticonvulsant drugs. Studies show that ginkgo biloba induces the liver to manufacture enzymes that more quickly metabolize drugs for epilepsy. In addition, the seed of the plant produces a neurotoxin that triggers seizures.

therapy tips

The patient should be instructed to:

– recognize the signs of an epileptic seizure

– take care of your treatment take your pills correctly and regularly

– recognize triggering behaviors (alcohol, insomnia , intense light stimulation: television, video games, computers).

It is also important that the patient wears a bracelet indicating that he is an epileptic so that other people can help him if he has a seizure.

Tips to help a person in the middle of an epilepsy crisis

When an epileptic is in full seizure, it is essential to take the following precautions:

– protect the patient from falling objects and traumatism, removing, if possible, any and all dangerous objects from their path.

– Loosen the patient’s clothing, such as ties and collar.

– do not attempt to hold or immobilize the convulsing patient.

– do not try to make the patient regain consciousness by screaming or shaking.

– measure the seizure time. This may help future treatments.

– when the person is unconscious, put him on his side so that he does not choke on his own tongue.

– comfort the patient as soon as he is regaining consciousness.

– remain calm during the patient’s convulsive crisis.

Never place any object (towel, napkin) in the patient’s mouth while the patient is convulsing. This false idea does not soften anything and can cause suffocation.

Encourage your friends and family to learn more about epilepsy and try to overcome other people’s prejudices and negative reactions. The epileptic patient can lead an independent and quality life as long as he follows the treatment correctly and receives support from acquaintances.

Prevention

It is important for the patient to know which factors trigger convulsive crises and do everything possible to avoid them. To do this, try to change lifestyle habits such as:

– excessive consumption of alcohol and other drugs, especially those with brain-stimulating effects (LSD, heroin, cocaine, etc.). If you work with exposure to chemical solvents, pesticides or heavy metals, use adequate protection;

– overload and fatigue , with sleepless nights;

– intense light stimulation: television, videogames and computers, night parties.

– Have a healthy diet in order to avoid cerebrovascular problems, such as strokes and heart attacks . Associated with this, avoid sedentary lifestyle and do physical activity regularly.

For young children, it is essential to administer antipyretics (medicines that reduce fever ) when the body temperature is above 38.5°C. A higher temperature can provoke seizures in children.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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