Understand the fundamentals of epilepsy and how the nervous system functions. Learn what neurologists do, the definition of seizures, and how this condition is evaluated medically.
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Epilepsy: Overview and Definition
When asking what is epilepsy it is best defined as a chronic disorder of the central nervous system characterized by recurrent and unprovoked seizures. A seizure is a sudden rush of electrical activity in the brain. Under normal conditions the billions of nerve cells in the brain communicate with each other through tiny electrical signals that fire in an orderly pattern. In a person with this condition these signals become abnormal and fire simultaneously or excessively. This disruption causes temporary changes in movement behavior sensation or awareness.
It is not a mental illness nor is it a sign of low intelligence. It is a neurological condition that affects people of all ages races and backgrounds. While a single seizure does not signify epilepsy a diagnosis is usually made 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 condition is broadly classified based on the origin of the seizures within the brain. Focal onset seizures begin in one specific area of the brain while generalized onset seizures involve both sides of the brain simultaneously. The underlying causes vary significantly. For about half of the people diagnosed the cause is idiopathic meaning no specific cause can be identified. In other cases the condition is symptomatic and can be traced to various factors.
These include genetic influence where specific genes make a person more sensitive to environmental conditions that trigger seizures. Head trauma from car accidents or sports injuries is a common cause. Brain conditions such as tumors or strokes are leading causes in adults over age thirty five. Infectious diseases like meningitis AIDS and viral encephalitis can also damage brain tissue and lead to permanent seizure disorders.
The main sign of the disorder is a seizure but the presentation of seizures epilepsy symptoms varies widely depending on where in the brain the disturbance begins and how far it spreads.
Focal seizures may result in subtle symptoms such as a sudden wave of joy or anger or a change in sensation like a strange smell or taste. The person may appear to be staring into space or have repetitive movements like hand rubbing or lip smacking. Generalized seizures often produce more dramatic symptoms.
Absence seizures cause a brief loss of awareness often mistaken for daydreaming. Tonic clonic seizures previously known as grand mal seizures are the most intense type. They involve a loss of consciousness body stiffening and violent shaking. Other types involve sudden loss of muscle tone causing the person to collapse or sudden jerking movements of the arms and legs.
Many individuals experience warning signs before a seizure occurs. This phenomenon is known as an aura and is actually a small partial seizure that acts as a warning for a larger event. An aura might manifest as visual changes such as flashing lights or wavy lines or physical sensations like dizziness numbness or a rising feeling in the stomach.
Identifying triggers is a crucial part of managing the symptoms. While seizures can happen randomly certain factors can increase the likelihood of an event. Common triggers include missed medication lack of sleep stress and alcohol consumption.
For a small percentage of patients known as photosensitive specific visual patterns or flashing lights can induce a seizure. Hormonal changes in women and low blood sugar or poor nutrition can also lower the seizure threshold making the brain more susceptible to abnormal electrical activity.
Diagnosis and Imaging
The process of diagnosing epilepsy begins with a thorough medical history and neurological examination. Since doctors are rarely present to witness the seizure they rely heavily on the description of the event provided by the patient and anyone who observed it. The physician will ask detailed questions about what happened before during and after the episode.
They will check for symptoms of infection or neurological deficits that might suggest a structural problem in the brain. Blood tests are routinely performed to rule out other conditions that can cause seizures such as diabetes or kidney failure. Genetic testing may also be recommended to provide more information about the condition and how to treat it particularly if there is a family history of the disorder.
The most common diagnostic tool is the electroencephalogram or EEG. This non invasive test records the electrical activity of the brain using small sensors attached to the scalp with a paste. If a person has epilepsy the EEG often shows changes in normal brain wave patterns even when they are not having a seizure. To increase the chances of detecting these abnormalities doctors may monitor the patient for prolonged periods or while they are asleep. Imaging tests are used to look for structural causes.
Magnetic resonance imaging or MRI uses powerful magnets and radio waves to create a detailed view of the brain which can detect lesions or tumors. Computed tomography or CT scans may be used in emergency situations to rule out bleeding or acute injury. Functional MRI and positron emission tomography scans help doctors see how the brain is working and identify the exact location of the seizure focus.
The majority of people with the condition can control their seizures with medication. These are called anti epileptic drugs or AEDs. The goal of medication is to stop seizures from happening with the fewest side effects possible. Finding the right medication and dosage can be complex. Doctors consider the type of seizure the age of the patient and other medical conditions when prescribing. Common side effects include fatigue dizziness and weight gain while more severe reactions can include depression or skin rashes.
It is critical that patients take their medication exactly as prescribed as missing doses is a major cause of breakthrough seizures. For about seventy percent of patients proper medication management allows them to live seizure free. The cost of these medications varies globally often ranging from a few hundred to several thousand dollars a year depending on whether generic or brand name drugs are used.
When medications fail to control seizures the condition is termed drug resistant or refractory. In these cases surgery may be an option. The most common procedure involves removing the small part of the brain where the seizures originate provided it does not control vital functions like speech or movement. For those who are not candidates for resection therapies like Vagus Nerve Stimulation or VNS are available.
This involves implanting a device under the skin of the chest that sends regular bursts of electrical energy to the brain via the vagus nerve. Another option is the ketogenic diet which is a high fat low carbohydrate diet. This rigorous diet forces the body to burn fats instead of carbohydrates which alters brain metabolism and can significantly reduce seizure frequency primarily in children.
Long-Term Care
For the majority of patients epilepsy is a chronic condition that requires lifelong management rather than temporary treatment. Long term care strategies focus on minimizing the impact of seizures on daily life and maximizing independence. Regular follow up with a neurologist is essential to monitor medication levels and adjust dosages as age or weight changes.
For those with drug resistant epilepsy long term monitoring units may be utilized to better characterize seizure patterns. Cognitive issues can arise over time particularly with memory and processing speed often due to the cumulative effect of seizures or medication side effects. Rehabilitation services including cognitive therapy and occupational therapy help individuals develop strategies to cope with these deficits and maintain employment or education goals.
Safety is a paramount concern in the long term management of the disorder. Sudden Unexpected Death in Epilepsy or SUDEP is a rare but fatal complication where a healthy person with the condition dies and no other cause is found. The risk is highest in those with frequent uncontrolled generalized tonic clonic seizures. Preventive strategies include strictly adhering to medication schedules and identifying lifestyle triggers such as sleep deprivation or stress.
For patients with severe or frequent seizures continuous supervision or the use of seizure alert devices and monitors can provide critical safety nets at night. Psychosocial support is also vital as the unpredictability of the condition can lead to anxiety and social isolation requiring ongoing counseling and community support networks.
Send us all your questions or requests, and our expert team will assist you.
Epilepsy is a condition where the brain has a tendency to cause repeated seizures due to abnormal electrical activity.
No, a seizure is a single event. Epilepsy means there is an ongoing risk of repeated seizures.
Yes, epilepsy can affect people of any age. It can begin in childhood or later in life.
No, some forms have no visible brain damage and may be genetic or idiopathic.
Yes, it is considered chronic, although some people may experience long periods without seizures or achieve remission.
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