What is Epilepsy?
An epileptic seizure is a transient paroxysm of uncontrolled discharges of neurons causing an event that is discernible by the person experiencing the seizure and/or by an observer. The tendency to have recurrent attacks is known as epilepsy; by definition, a single attack does not usually constitute epilepsy.
Epileptic seizures or epileptic attacks are a symptom of many different diseases, and the term epilepsy is loosely applied to a number of conditions. An epileptic patient will show recurrent epileptic seizures that occur unexpectedly and stop spontaneously.
This disorder is chronic neurological disorder which affects people of all ages.
● Nearly 50 million people worldwide suffer from epilepsy.
●People with epilepsy responds to the treatment 70% of the time. Despite this, Nearly 75% of affected people in developing countries do not get the treatment they need.
Incidence Rate Of Epilepsy
Epileptic seizures are common. The incidence (the number of new cases per given population per year) has been estimated at between 20 and 70 cases per 100,000 persons, and the cumulative incidence (the risk of having the condition at some point in life) at 2–5%. The incidence is higher in the first two decades of life but falls over the next few decades, only to increase again in late life, due mainly to cerebrovascular diseases. Currently, the elderly are the group in the populations with the highest incidence of epilepsy. Most studies of the prevalence of active epilepsy (the number of cases in the population at any given time) in developed countries cite figures of 4–10 per 1000 with a rate of 5 per 1000 population most commonly quoted. In developed countries, annual new cases are between 0.4 and 0.7 per 1000 general population.
Causes Of Epilepsy
Epileptic seizures are produced by abnormal discharges of neurons that may be caused by any pathological process which affects the cortical layer of the brain.
The likely etiology of epilepsy depends on the age of the patient and the type of seizure. The commonest causes in young infants are hypoxia or birth asphyxia, intracranial trauma during birth, metabolic disturbances and congenital malformations of the brain or infection. In young children and adolescents, idiopathic seizures account for the majority of the epilepsies, although trauma and infection also play a role. In this age group, particularly in children aged between 6 months and 5 years, seizures may occur in association with febrile illness.
Signs and Symptoms Of Epilepsy
The Signs and Symptoms of a seizure will depend on the location of the focus and the pathways involved in its spread. An international seizure classification scheme based on the clinical features of seizures combined with EEG data is widely used to describe seizures. The seizures are divided into two main groups according to the area of the brain in which the abnormal discharge originates. If it involves initial activation of both hemispheres of the brain simultaneously, the seizures are termed ‘generalised’. If a discharge starts in a localized area of the brain, the seizure is termed ‘partial’ or ‘focal’.
The diagnosis of epilepsy is clinical and depends on a reliable account of what happened during the attacks, if possible both from the patient and from an eyewitness. Investigations may help and the EEG is usually one of them.
Key points on the diagnosis and management of epilepsy
● Diagnosis is to be done urgently by a specialist with an interest in epilepsy
● EEG is used to support diagnosis
● Initiation of appropriate treatment to be recommended by a specialist
● Treatment individualised according to seizure type, epilepsy syndrome, co-medication and co-morbidity, the individual’s lifestyle and personal preferences
● The individual with epilepsy, and their family and/or carers, to participate in all decisions about care, taking into account any specific need
● Comprehensive care plans to be agreed
● Comprehensive provision of information about all aspects of condition
● Regular structured review at least once a year
● Patient to be referred back to secondary or tertiary care if: – Epilepsy inadequately controlled – Pregnancy considered or pregnant – Antiepileptic drug withdrawal considered
● MRI, magnetic resonance imaging; EEG, electroencephalogram.
Treatment of Seizures
●Convulsive seizures may look frightening but the person is not in pain, will usually have no recollection of the event afterward and is usually not seriously injured.
●Emergency treatment is seldom necessary.
●During the treatment process patient should be made as comfortable as possible, preferably lying down (ease to the floor if sitting), cushioning the head and loosening any tight clothing or removing the neckwear.
●During seizures, people should not move unless they are in a dangerous place, for example, on a road, by a fire or hot radiator, at the top of stairs or by the edge of the water.
●No attempt should be made to open the person’s mouth or force anything between the teeth. This usually results in damage, and broken teeth may be inhaled, causing secondary lung damage. When the seizure stops, people should be turned over into the recovery position and the airway checked for any blockage.
●Drugs used include intravenous lorazepam or diazepam. Other alternative medicines include midazolam in cases where the person has not responded to first-line drugs.