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What is Epilepsy: A complete guide to this chronic disorder

We’ve all heard of people who can’t be around flashing lights because of their epilepsy, but what is epilepsy? In this article, we will look at what is epilepsy, the symptoms, causes, types, and treatments of epilepsy as well as how it affects our body.

What is Epilepsy

What is epilepsy?

Epilepsy is a chronic disorder that means the same thing as seizure disorders. It’s known for its unpredictable and unprovoked seizures. It comes in a wide range of types and varies from person to person. The word epilepsy itself doesn’t indicate anything about the cause or severity of someone’s seizures. Epilepsy is found in more than 50 million people worldwide. Of those 50 million, 80% live in developing countries and 6-10 million with epilepsy live in India.

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Epilepsy can be traced back to Assyrian texts in 2,000 B.C. However, there are multiple references to epileptic-like happenings throughout many ancient texts, especially in ancient Greek medical texts. Hippocrates, a famous Greek physician, includes tons of neurological things within his book On Sacred Disease. For example, he included the first known neurosurgery procedure that refers that the craniotomy should be performed on the opposite side of the brain as the seizures in order to spare the patients from the “phlegma” that in theory caused the disease.

In the 18th and 19th centuries is when medicine began to make important advances and did more research on epilepsy. At the beginning of the 18th century, the belief that epilepsy was an idiopathic disease that derived from the brain and other organs became to come into view. William Cullen and Samuel A Tissot set out to accurately describe the various types of epilepsies. However, many people from The Church had religious superstitions and believed that epilepsy was a divine punishment or possession- the Grand Mal Seizures are the classic example of “possession”. The 19th century carries with it many advances in epilepsy form the French medical school. The 20th century is marked by the inventions of electroencephalography (EEG) and anti-epileptic drugs, advancement in neurosurgery, and the outline of underlying pathophysiological mechanisms. The most recent epileptic advances involve advanced imaging techniques, the development of microsurgery, and research connecting the genetic factors and epileptic seizures.

What is epilepsy: disease or disorder?

Epilepsy is a disorder due to the disturbance that is caused by neurons sending wrong messages to the brain. Unlike a disease, epilepsy can’t be caught.

What is epilepsy: symptoms

Epileptic seizures can affect any process your brain can coordinate and do. The symptoms will vary depending on the type of seizure. However, an epileptic person tends to have the same type of seizures every time so the symptoms will be similar to each epileptic episode. Some signs of seizures and symptoms can include:

  • Temporary confusión
  • Loss of consciousness and/or awareness
  • A staring spell
  • Psychic symptoms like anxiety, fear, or déjà vu
  • Uncontrollable and jerking movements in the arms and legs

What is epilepsy: causes

Epilepsy has no known cause for about half of the people who suffer from it. However, the other half of the people can trace their epilepsy to several factors, including:

  • Genetic influence. Sometimes epilepsy runs in the family. Researchers have linked some specific types of epilepsy to specific familiar genes. Other genes may make someone more sensitive to certain environmental conditions that can cause seizures.
  • Brain conditions. Conditions such as a brain tumor, dementia, or stroke can cause epilepsy. The leading cause of epilepsy in people over the age of 35 is a stroke.
  • Developmental disorders like autism or neurofibromatosis– a condition where tumors grow on the nervous system. About 3 in 10 kids with autism also have epilepsy.
  • Head trauma. Something like a traumatic brain injury can easily cause epilepsy.
  • Prenatal injury. Before we are born, we are incredibly sensitive to brain damage by things like infection, poor nutrition, or oxygen deficiencies. This brain damage may cause epilepsy or cerebral palsy.
  • Infectious diseases like meningitis, viral encephalitis, and AIDS can cause epilepsy.

What is epilepsy: types

Based on how the abnormal brain activity begins, doctors will classify the seizures into two groups: focal or generalized.

Focal seizures show up when there is just one area of your brain with abnormal activity. Sometimes they are called partial seizures. Without a thorough examination, sometimes the symptoms of focal seizures are confused with other neurological disorders like narcolepsy or migraines. There are two types of focal seizures:

  • Focal seizures without loss of consciousness, previously known as simple partial seizures, means that some senses are altered. For example, emotions and the way things look, smell, taste, sound, or feel may change. There can also be some involuntary jolting of a body part, like a leg or an arm, with sensory symptoms like tingling, flashing lights, or dizziness.
  • Focal seizures with impaired awareness, once known as complex partial seizures,  means that there is a change or loss of consciousness and/or awareness. Someone having a focal seizure with impaired awareness may stare into space and not respond normally to their environment. They may also use repetitive movements like chewing, swallowing, hand rubbing, or walking in circles.

Generalized seizures appear in all area of the brain. There are six types known today: absence, tonic, tonic, clonic, myoclonic, and tonic-clonic.

  • Absence seizures, previously known as petit mal seizures, mean that the person stares into space or uses subtle movements like lip smacking and eye blinking. It can cause a brief loss of awareness. This type of seizure often occurs in children and can occur in clusters.
  • Tonic seizures affect the muscles in your back, arms, and legs and can cause you to fall to the ground due to the stiffening of your muscles.
  • Atonic seizures, also known as drop seizures, cause you to suddenly fall down due to a loss of muscle control.
  • Clonic seizures affect the arms, neck, and face. They show up by repeated jerking muscle movements.
  • Myoclonic seizures are little sudden twitches in your legs and arms.
  • Tonic-Clonic seizures, also known as grand mal seizures, are the most dramatic type of epileptic seizure a person can have. They can cause immediate and abrupt loss of consciousness, stiffening and shaking of the whole body, and sometimes a lack of bladder control and tongue biting.

What is epilepsy: how epilepsy affects the brain

Neurons are nerve cells that control the way we feel, think and move. Our neurons typically communicate using chemical and electrical signs, signals, and messages to each other that cause depolarization. When the signals are disrupted, damaged, or there are too many messages sent at once, is when a seizure begins.

Sometimes these neurons send out abnormal messages. If only a single neuron acts abnormal and sends out an unusual message, nothing will happen. But if lots of neurons, from the same area of the brain, being to send out unusual and abnormal messages together, for example, to have a seizure, then seizures can happen. There are three requirements for the unusual message to cause a seizure. First, each neuron has to be excited. Second, the message must be long enough to cause the other neurons to act in an identical way. Third, all of the neurons must be connected to other neurons within a few synapses. Once these conditions are met, the unusual seizure message spreads quickly. If the unusual message causes disrupted activity, this affects only a part of the brain which makes it a focal seizure. If the disrupted activity speaks to the whole brain, it becomes a generalized seizure. The part of the brain where the disruption (the neurons giving unusual messages) begins is known as the epileptic focus and is what doctors look for when finding out the causes of the seizures.

Because our brain has many different functions- such as memory, movement, moods, and all of our senses, a seizure can temporarily or seriously affect each and every one of these.

What is epilepsy: how epilepsy affects the body

Epilepsy doesn’t just affect our brain, but also our body and organs. Some examples include:

  • The heart is affected by an abnormal heartbeat. With enough seizures over time, people can develop regular abnormal heartbeats. Some doctors believe that sudden unexpected death in epilepsy (SUDEP)  is actually caused by an irregular heartbeat.
  • The lungs don’t always know how to keep rhythm and the breathing may become disrupted and labored. This is because the autonomic nervous system regulates our breathing. However, seizures disrupt this system and cause our breath to temporarily stop.
  • The reproductive system. Those with epilepsy commonly have up to two to three times more reproductive problems than those without epilepsy.
  • While epilepsy itself doesn’t weaken bones, the drugs many people take for epilepsy will weaken the skeletal system.
  • The effects seizures on the digestive system can involve abdominal pain or irritable bowels as well as loss of bowel control.
  • The entire muscular system can be affected because some seizures cause our muscles to tighten suddenly while others cause our muscles to go completely limp.

What is epilepsy: diagnosis of epilepsy

A person is diagnosed as epileptic when they have two unprovoked seizures that were not caused by a known and reversible medical condition like low blood sugar or alcohol withdrawal. Common ways a doctor diagnosis epilepsy after reviewing the symptoms and medical history is to run some tests. This may include:

  • Blood tests to check for infections and genetic conditions.
  • Lumbar puncture (spinal tap) is a needle that is placed into the lower back and spinal cord. The cerebral spinal fluid- the fluid that bathes the spinal cord and brain- that is removed is looked at for infections or any other problems.
  • A neurological exam to test behavior, mental function, motor skills, and be able to diagnose and determine the type of epilepsy.
  • Neuropsychological tests are tests given by doctors to look at your thinking, speech, and memory skills to see what areas of the brain are affected.
  • An electroencephalography (EEG) is the most common test for diagnosing epilepsy because it records the electrical activity in our brains. The EEG is able to see the changes in our normal brain wave pattern.
  • High-density EEG to see more precisely which areas of the brain are being affected by the seizures. A high-density EEG is the same as an EEG, but the electrodes are closer together, about half a centimeter apart than a normal EEG.
  • Computerized tomography scan (CT scan) which uses X-rays to look at the cross-sectional images of the brain. It can show brain abnormalities that could be causing the seizures like tumors or cysts.
  • Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to show a highly detailed view of the brain. An MRI can detect brain lesions or abnormalities that could be the root cause of the seizures.
  • Functional MRI (fMRI) involves measuring the blood flow to specific parts of the brain when they are working. For example, looking at the areas of speech and movement before surgery so doctors can avoid injuring those places of the brain while operating.
  • Curry analysis takes the EEG data and puts it into an MRI of the brain to show where the seizures are taking place.
  • Positron emission tomography scan (PET Scan) injects a small amount of low-dose radioactive material into a vein to help see the active areas of the brain and be able to see abnormalities.
  • Single-photon emission computerized tomography scan (SPECT Scan) is used if the MRI and the EEG didn’t show the brain location where the seizures are originating. Like the PET Scan, it injects radioactive material into a vein to create a 3D map of the activity of the blood flow during seizures.
  • Statistical parametric mapping (SPM) compares the areas of the brain that have an increased metabolism during seizures. This can tell doctors where seizures began, in theory.
  • Magnetoencephalography (MEG) measures the magnetic fields that are produced by brain activity to help show possible areas of where the seizures start.

What is epilepsy: treatments

Typically, doctors begin to treat epilepsy with medication. If that doesn’t work, then they may try to fix epilepsy with surgery or therapy.

Many people can become one seizure-free by taking an anti-seizure/antiepileptic medication. Other people can have a decreased frequency or intensity of seizures by taking a combination of medications.

Epilepsy surgery involves removing the area of the brain that’s causing the seizures. Doctors will only perform the surgery if the area of the brain is small and well-defined, and if it doesn’t interfere with functions that we need every day like language, speech, motor, hearing, or vision. Even with surgery, many people will still need to take some sort of medication to prevent the seizures after a successful surgery.

There are some therapies that seem to work for some people, as well. The vagus nerve stimulation is like a little pacemaker that goes underneath the skin of the chest. The wires from the stimulator are connected to the vagus nerve in the neck. The idea is that it sends bursts of energy to our brain via the vagus nerve. Although it’s not clear how it stops seizures, it can usually reduce seizures by 20%-40%. Some younger people with epilepsy may be able to use the Ketogenic diet in order to reduce their seizures. It is a strict diet low in carbohydrates and high in fats.

What is epilepsy: Prognosis

Epilepsy is the fourth most common neurological disorder. However, the prognosis of it depends on each person and their seizures. Around 80% of people with epilepsy require ongoing treatment to prevent further seizures. Age, family history, infections, and other present disorders will affect how likely it is that the seizures will get better or even stop.

What is epilepsy: Social Stigma

What is the social stigma around epilepsy? Some people with epilepsy feel a social stigma, almost a shame, for having epilepsy because it leaves them out of certain things. Sometimes a child with epilepsy will be told they can’t participate in a school activity (which is illegal) or not invited to a birthday party. Furthermore, many healthcare and car insurance providers may not like to take on someone with epilepsy because they may not have the proper coverage, but they also pose a big risk factor. For example, there is a high risk of someone with epilepsy and frequent seizures crashing their car. However, that does not mean that they are a less safe driver than someone without epileptic seizures.

What is epilepsy

How to support someone with epilepsy

Make sure that someone with epilepsy:

  • Takes their medication correctly.
  • Getting enough sleep
  • Exercising
  • Wearing a medical alert bracelet in order to be treated correctly by medical personnel in case of emergency.
  • Let them live as independently as possible. For example, continuing to work.
  • Become educated about epilepsy!
  • Find a doctor that everyone likes
  • Find an epilepsy support group for both yourself and them.

Have you or anyone you know had epilepsy? How did they handle it? Let us know in the comments below!

Brain seizures: When The Brain Has Too Much Energy

Brain seizures: Some of us have to deal with them every single day, whilst others can be witnesses of someone having a  brain seizure. Most commonly, people having to experience someone suffering from a brain seizure are overwhelmed when their loved ones jerk uncontrollably and subsequently lose consciousness. Not only are the witnesses clueless about which steps to take, but also the patients if his/her seizure occurs for the first time. This article will give you a guide on what brain seizures are, their symptoms, treatments and what steps to take in order to increase the quality of life of the patient. 

What are brain seizures?

What are brain seizures?

Brain seizures are changes in the brain’s electrical activity. This change can cause dramatic, noticeable symptoms or it may not cause any symptoms. Patients that experience brain seizures possess abnormal neural activity which is uncontrolled and happens spontaneously.

The brain function, however, is often not abnormal. The involuntary change in neural activity is considered epilepsy, in which the brain seizures are the symptoms. Though, brain seizures can also be induced in a normal brain under a variety of conditions different species, from humans to flies. Brain function is not abnormal but cognitive aspects might be threatened by many brain seizures.

Brain Seizures Types

Generally, we differentiate between three different types of seizures. Usually, they are dependent on the number of brain cells showing abnormal activity. This is crucial in order to select a suitable treatment for the patient, as different medications have to be used for each seizure type.

  1. Generalized onset brain seizures: In this case, there is no identifiable onset meaning a starting point in the brain cannot be determined. The seizure starts and spreads too quickly making a reliable decision about the trigger impossible. For this reason, treatment using surgery to suppress the symptoms is not available.
  2. Focal onset brain seizures: Whereas in generalized onset seizures the location is not known, in this type of brain seizure, doctors are able to determine the starting point of the seizures. Focal brain seizures can start in one area of the brain or in a specific group of cells either in the left or right hemisphere. Furthermore, patients can have full or impaired awareness during their fit.
  3. Unknown onset brain seizures: If the nature of the seizure cannot be determined, they belong to this group. This is mostly at the beginning or if the patient lives alone without witnesses observing the person with the seizure. As more information is obtained, the seizure is later classified as generalized onset brain seizure or focal onset brain seizure.

How is a brain seizure caused?

Aspects of the brain affected by different brain seizure

The emergence of a brain seizure can be down to several reasons, but determining the exact cause has proven to be challenging. At least half of all patients display idiopathic seizures meaning the cause is unknown. Nevertheless, depending on the age of the patient, determining the trigger of a brain seizure can be narrowed down.

Generally, genetics plays a large role whether someone will experience a seizure in their lives or not. Pinpointing the specific genes which are responsible for the symptoms though is a struggle. This diagnosis is mostly very vague as the relationship between the genes in the brain and the nature of seizures is poorly understood.

What is known on the other hand is a prevalence of about 3 out of 10 patients having a change in brain structure which leads to some sort of brain seizure. Mostly this is the case for children born with alterations in brain regions.  For the elderly, incidence such as a stroke is usually the cause of developing recurrent seizures.

When suffering from epilepsy, an imbalance in the brain’s chemistry is frequently observed. This refers to the neurotransmitters being present in the wrong concentrations (too little or too much in the brain). In general, everybody has got two kinds of neurotransmitters with opposing functions: Neurotransmitter of excitatory and inhibitory qualities, with the former increasing the firing rate and the latter reducing the activity of the neurons. The balance of both kinds has to be maintained and if not given, can result in hyperactivity of the neurons causing epilepsy.

The best-studied neurotransmitter is GABA, or gamma-aminobutyric acid, which possesses inhibitory qualities counterbalancing neuronal excitation. GABA’s counterpart glutamate, the principal excitatory neurotransmitter, plays a crucial role in the initiation and spread of brain seizures. This was demonstrated by During and Spencer in 1993 when they tested the concentration of these two neurotransmitters in the hippocampus before and during a seizure. Before seizures, the glutamate concentration in this brain area was found to be higher than in the control group, whereas the concentration of GABA was observed to be lower. During the seizure, GABA concentrations increased in both groups, however in the control group a greater increase was found. Consequently, drugs to treat epilepsy revolve around these two neurotransmitters, by either reducing the concentration of glutamate or by increasing GABA content in the synapses in order to reduce hyperactivity of the neurons.

Brain Seizures Symptoms

Clinicians group the symptoms into two categories, generalized and partial or focal seizures, in order to find out if a patient suffers from epilepsy.
The different types are:

Generalized brain seizures (produced by the whole brain)

  • “Grand Mal”: The most known form where the patient loses consciousness and collapses. The body stiffens and violent jerking begins usually lasting for about 30-60 seconds. Afterwards, the patient goes into deep sleep.
  • Absence: Individuals experiencing an absence seizure stare into space for a few seconds. They are most common in children and a brief loss of consciousness is reported.
  • Myoclonic: These seizures are brief, shock-like jerks or twitches of a muscle or a whole muscle group. This usually does not last for a long time (only about 1-2 seconds) and the person experiencing it retains full consciousness.
  • Clonic: This type of seizures is very similar to the myoclonic seizure with the difference of a more regular and sustained jerking.
  • Tonic: The muscle tone, the muscle’s normal tension at rest, is highly increased leading to tense feelings in arms, legs or body in general. Awareness usually does not change much and the symptoms subside within 20 seconds.
  • Atonic: Atonic seizures are substantially the opposite of tonic seizures. Instead of the muscles becoming stiff, a person experiencing an atonic seizure will feel their muscles going limp. For instance, a person standing might fall to the ground when suffering an atonic seizure. As tonic seizures, they do not last for a long time either.

Partial or Focal brain seizures

Focal brain seizures are known to originate from a specific brain region causing a variety of symptoms depending on the brain area affected. Generally, doctors differentiate between seizures causing a (partial) loss of consciousness and the ones where consciousness is preserved.

Symptoms of focal seizures with impaired awareness (once called complex partial seizures) could be the following:

  • Staring into space
  • Response to the environment is abnormal or impaired
  • Execution of repetitive movements (hand rubbing, chewing, walking in circles, etc…)

Symptoms of focal seizures without loss of consciousness (once called simple partial seizures):

  • Change of emotions
  • Difference in perception
  • Involuntary jerking of a body part
  • Sensory symptoms (eg. tingling, dizziness and flashing lights)

Note: If an individual experiences seizures repeatedly (once a week or even once every single day), their symptoms will most likely remain similar.

Brain seizures: Diagnosis and what to expect when visiting a doctor?

If a person suffers from a brain seizure (or thinks they have suffered one), the first stop will be consulting your general practitioner. Make an appointment and if the seizure was witnessed by someone, ask this person to join.

Depending on the type of seizure, most likely you were unconscious which makes it difficult for you to describe what happened. However, the doctor will ask you a series of questions, also called the medical interview, in which he will ask you about your general health and incidences before, during and after the seizure. Especially for the medical interview, it is advisable to have someone near you answer questions which you might not be able to answer.

The doctor will most likely be able to diagnose a brain seizure based on the answers of the patient. However, to obtain a clearer idea of the clinical picture of the patient, more tests will be necessary.

The primary physician will ask a neurologist to take a look at the inside of the individual’s brain. Every single brain is different and finding the most suitable treatment for a patient is far from straightforward. The following tests are used when attempting to diagnose brain seizures in detail:

  • Blood tests: The most common blood test is the CBC (Complete Blood count) in which the doctor determines important parameters in your blood, e.g the number of red blood cells, white blood cells, hemoglobin, etc. Therefore a blood test serves to determine the appropriate medication for infections, allergies, and other abnormalities are revealed.
  • Metabolic tests: This test assesses the functioning of your organs, more specifically your body’s ability to metabolize. The evaluation is also done via a blood sample and includes an assessment of the content of important molecules in your blood. The sodium, potassium and blood sugar levels are evaluated. Not only will this help determine an electrolyte imbalance, but also reveal any malfunction of the kidney or the liver. The importance of looking at these organs is to find out whether a disease could trigger the brain seizures, which was found to be the case for instance in patients with diabetes. In this case, doctors focus on treating the symptoms of the illness causing the brain seizures (in this case diabetes) rather prescribing drugs targeting the brain seizures directly.
  • An EEG (electroencephalography) test: The term might sound familiar to most of us, but what is this exactly and how can it help doctors make a more accurate diagnosis? An EEG can reveal the electrical activity of the brain and in which regions abnormal/normal activity is present. The specialists can make conclusions if the brain seizures come from a single area or are more widespread looking at the EEG pattern.
  • CT and MRI scan: Computer Tomography (CT) and Magnetic Resonance Imaging (MRI) are two techniques that will look into your brain. The aim here is to find physical abnormalities that cause the seizures. Although for a lot of people suffering from brain seizures the test results will be negative, it is still an important procedure. In cases where brain seizures are very frequent and strong, determining the exact cause is crucial since the possibility to undergo surgery could be an adequate treatment option.

What to do and not to do when faced with a brain seizure?

If we see our loved-ones suffering from a seizure, it would be normal to be frightened and expect the worst. However, most brain seizures are not dangerous and the person regains his/her normal state within a few minutes without permanent damage. Fact is: Once a seizure is going, you cannot simply force the person to stop jerking, however, you can protect the person inflicting damage to his own body.

The DO’S!

  • Make sure other people are not standing too close to the person having a seizure
  • Remove sharp or hard objects from the surroundings
  • Do not stop the movements of your friend
  • Take a look at his/her watch to record the seizure duration
  • To keep the airway clear, put the person on his/her side
  • And most importantly: Keep calm!

The DONT’S!

  • Do not restrain the person as you might injure him or get injured yourself
  • No offering of food or drinks to the sufferer: A sip of water might be a trigger for choking
  • Do not insert anything into his/her mouth! They will not swallow their tongue
  • No CPR (unless the patient is not breathing after the seizure)

Tips to reduce brain seizures

Since the underlying trigger for a brain seizure is often unknown, it is crucial to reduce the odds of a brain seizure to a minimum. Take the following provisions:

  • Reduce stress by getting enough sleep (it is best to adhere to a regular sleeping schedule)
  • Physical activity or yoga may help feeling more relaxed, as well as deep breathing
  • Limit noise sources and make sure the room is well illuminated when watching TV or when playing video games
  • When going for a run you should do it in the park, rather than in high-traffic areas or unpaved trails
  • But most importantly: Stick to your medication your doctor prescribed you unless he/she tells you otherwise!

Have you witnessed a brain seizure or are you suffering from this condition? Please feel free to comment below.

Long-terms benefits follow brain surgery for certain forms of epilepsy

Long-terms benefits follow brain surgery for certain forms of epilepsy

Brain surgery for certain difficult forms of epilepsy often reduces or eliminates seizures for more than 15 years after the procedure, according to new research by neurologists at Henry Ford Hospital.

Drugs are not effective in controlling seizures in 30 out of 100 people with epilepsy, and resective surgery is the most common alternative treatment. During resective surgery, the portion of the brain responsible for the seizures is removed, usually reducing their frequency and sometimes eliminating them.