Epilepsy

Epilepsy

The term “epilepsy” describes a disorder of the brain that causes a predisposition to suffer repeated epileptic seizures.

Epilepsy is not a psychiatric or mental illness, it is a physical problem caused by sporadic abnormal functioning of a group of neurons.

Since epileptic seizures that manifest intermittently are the only symptom, most people with epilepsy are fully capable of the rest of their time.

The term epilepsy derives from the Greek epilambaneim, which means ‘catch by surprise’ and refers to a set of diseases that are manifested by epileptic seizures caused by a problem in the brain. Generally, an epileptic seizure is triggered by an excess of electrical activity of a group of neurons (brain cells) hyperexcitable and can affect functions such as movement or behavior, or the level of consciousness (the notion of what happens around one).

The crises usually last just a few seconds or a few minutes, after which it ends, and the brain returns to normal functioning. The type of seizure depends on the part of the brain affected and the cause of the epilepsy.

The prevalence is estimated at around 8 patients per 1000 inhabitants. This means that about 400,000 people suffer from epilepsy and, although this disease can affect anyone at any time of their lives, in most cases it manifests in childhood and after 65 years. In the world, a total of 50 million inhabitants coexist daily with epilepsy and, although there are circumstances such as hormonal changes or lack of sleep that could accentuate it, this pathology affects all races and, in all countries, equally.

Some people may have more than one seizure due to high fever, diabetes, other illnesses, stress, alcohol, or drug use. These people do not have epilepsy because their crises are not due to brain diseases.

Each year more than 20,000 new cases are diagnosed, and it is one of the most common chronic neurological diseases, until it becomes the second reason for ambulatory neurological consultation after headaches. Despite this, today patients with epilepsy still must face a serious stigma derived from ignorance and social discrimination. However, approximately 70% of people with epilepsy can enjoy a full life, without crisis, thanks to the administration of antiepileptic treatments.

It is quite common for people to suffer at least one epileptic seizure throughout their life. It is estimated that between 2 and 5% of the population will experience an episode of epilepsy at some time; however, this does not imply that it is a patient with epilepsy. According to the International League Against Epilepsy (ILAE), to have epilepsy must have had more than one crisis. Also, keep in mind that some people may have more than one seizure caused by high fever, diabetes, other diseases, stress, alcohol, or drug use. And that’s

Some Epilepsy causes:

  • Diseases of other organs, such as diseases of the liver and kidneys, diabetes and alcoholism.
  • Genetics.
  • Problems before birth that affect brain growth.
  • Head injuries, especially from car accidents.
  • Brain tumors.
  • Brain infections, such as meningitis or encephalitis.
  • Another disease that damages or destroys brain tissue.
  • Cerebral hemorrhage, that is, the formation of a blood clot inside the brain.
  • Fever
  • Severe brain trauma.

Seizures fall into two main groups. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures are a result of abnormal activity on both sides of the brain. 

  • Generalized Onset: Generalized seizures affect both sides of the brain or large networks of cells on both sides from the beginning of the event. The networks can be on the surface of the brain or involve deeper areas. Generalized seizures don’t need to involve the entire brain, just part of both sides. 
  • Focal Onset: The term focal seizure has been used for years, but the lay public and many professionals still use the term partial seizures. In this 2017 Classification, focal seizures will replace partial seizures and refer to those that start in an area or network on one side of the brain. They may start on the surface of the brain or in deeper areas, and can be very localized or spread to larger areas. Sometimes more than one network is involved.
  • Unknown Onset: Seizures may be of unknown onset if the beginning of the seizure is not clear. As more information becomes available over time or through testing, the type of seizure may be changed to a generalized or focal onset seizure.

Generalized Motor Seizures : 

  • Tonic-clonic – No change (Years ago the term grand mal was used)
  • Clonic – No change
  • Tonic – No change
  • Myoclonic – No change
  • Myoclonic-tonic-clonc – New term
  • Myoclonic-atonic – New term
  • Atonic – No change
  • Epileptic spasms – New term

Generalized Non-Motor Seizures (Absence):

  • Typical Absence – No change (Years ago the term petit mal was used)
  • Atypical absence – No change
  • Myoclonic absence – New term
  • Eyelid myoclonia – New term

Partial (Focal) Seizures
Partial (focal) seizures refer to seizures beginning in one area of the brain. By observing which area of the body is affected by the seizure, physicians can identify where in the brain the seizure occurred. 
Partial seizures are further categorized as either:

  • Simple partial seizures – The seizure is localized to one area on one side of the brain, but may spread to other areas. Consciousness is not lost during a simple partial seizure.
  • Complex partial seizures – Seizures originating in one area of the brain that affect consciousness are labeled as complex partial seizures.
  • Partial seizures that secondarily generalize – Partial seizures may spread to other areas of the brain.

Treatment:
The first step is to go to the specialist to make sure that the patient has epilepsy before starting any treatment. The diagnosis of epilepsy requires that at least two unprovoked seizures have been suffered. Once the diagnosis is made it is advisable to start the treatment as soon as possible and follow it regularly.

The most common treatment uses antiepileptic drugs (AEDs), which manage to control seizures in approximately 70-80% of patients. Medications restore the chemical balance of neurons and attenuate abnormal electrical discharges.

Between 20-30% of people do not respond to simple pharmacological treatment (with only one medication) and several drugs must be combined. Even so some epilepsies do not respond to medication and it may be necessary to resort to surgery or vagus nerve stimulation (VNS) by implanting an electrode under the skin of the neck.

Although treatment improves the quality of life and in most cases manages seizures, epilepsy patients still have to cope with the social stigma derived from ignorance of the disease.

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