Epilepsy: Symptoms, Treatment and Complications

Contents 

In this article, we will take a look at:

• What is epilepsy?
• How does epilepsy occur?
• Who is prone to epilepsy?
• Symptoms of epilepsy
• Diagnosis of epilepsy
• Complications of epilepsy
• Treatment for epilepsy

You can click on any of the links above to navigate to the section of your interest.

What is epilepsy?

Epilepsy is a condition that is more commonly known as a seizure disorder where a patient has recurrent seizures. A seizure is a neurological condition that occurs when there is abnormal electrical activity in areas of the brain, affecting the brain cells (neurons). This affects the motor, sensory and/or mental functions of the patient. The term epilepsy indicates that a patient has recurring seizures due to any cause irrespective of the type of seizure.

In case no other cause for the seizures has been detected, the epilepsy is then called primary epilepsy or idiopathic epilepsy. Seizures can be of the following types depending on the areas of the brain that they affect:

Focal Seizures (Partial Seizures)

Focal seizures occur when the abnormal electrical activity is limited to a particular area of the brain. A focal point can be detected where the seizure activity begins. Partial seizures have two types of manifestations: Seizures occurring with retained awareness mean that the patient does not suffer from loss of awareness of self and surroundings. This is otherwise known as a simple partial seizure. Seizures accompanied by a loss of awareness were previously known as complex partial seizure.

Generalised Seizures

Generalised seizures spread throughout both the left and right hemispheres of the brain and are of the following types:

Absence Seizures: The patient loses consciousness but does not experience convulsions (violent uncontrollable thrashing of the limbs). It usually appears as a blank stare and appears that though the patient is simply caught up in daydreaming. This type of seizure was previously known as petit mal seizure.

Tonic-Clonic Seizures also known as Convulsive Seizures:

The patient experiences loss of consciousness accompanied by tonic-clonic symptoms.

Atonic Seizures occur in children but are rare and also commonly known as drop attacks.

Tonic Seizures are seizures wherein the patient does not convulse but only experiences muscle rigidity.

Clonic Seizures are those where the patients experience convulsions alone.

Myoclonic Seizures usually occur as a part of childhood epilepsy and only involves a certain muscle group.

How does epilepsy occur?

The messages that are transmitted from the brain to the rest of the body and vice versa occur through the nervous system which is formed primarily of neurons. These neurons communicate and transmit messages through electrical impulses across the brain.

During a seizure, the electrical activity in the brain goes haywire and the neurons start firing randomly. When a patient experiences seizures repeatedly over a period of time, he or she is said to suffer from epilepsy.

The brain comprises of different areas that control different functions of the body. This means that the seizure activity could originate in one part of the brain and either be limited to this area or spread through the brain and affect other areas as well.

here are various causes for epilepsy, however in most of the cases, no specific cause is known. Among the known probable causes for epilepsy are:

• History of a previous trauma such as a car crash resulting in head injury
• Existing neurological conditions such as the presence of a tumour or infections in the brain
• Other viral infections that can eventually affect the brain such as AIDS or viral encephalitis
• Developmental disorders in children such as neurofibromatosis
• Head injury that might have occurred prior to birth

Who is prone to epilepsy?

Various studies have shown that quite a few factors can be linked with epilepsy that leaves a person at a higher risk for developing the condition. Some of these are:

• Epilepsy is more common in people on either end of the age spectrum- young children and old people who eventually fall prey to diseases such as strokes or Alzheimer’s can experience epilepsy.
• Epilepsy occurs more often in people who have suffered from a trauma that caused head injury, anywhere between days to weeks, following the trauma. It can also occur after the tissues are healed, due to the scarring caused initially.
• Epilepsy is more common in the Hispanic population.

What are the symptoms of epilepsy? How is epilepsy diagnosed? 

The various symptoms of epilepsy are as listed below:

Seizures - The seizures can be of any of the types mentioned above

If a patient experiences convulsive body movement that are not accompanied by a fever

Muffled memory with black outs

Loss of consciousness, usually accompanied by loss of bowel and bladder control, especially in tonic-clonic and tonic seizures

The patient takes time to gain awareness of their surroundings and respond, following a seizure episode.

If the patient is suffering from absent seizures, they suddenly start staring blankly into space, tense up and do not respond to others but after a few seconds they become normal.

In case of atonic seizures, the patient just falls down for no reason and gets up and continues to walk, and is seen commonly in children.

Patient may express repetitive gestures such as rapid blinking or chewing movements.

The patient experiences aura- especially in temporal lobe seizures where they sense a change in smell or hear sounds. Temporal lobe seizures can be accompanied by auditory hallucinations.

Diagnosis 

Diagnosing epilepsy is an exclusion process that involves ruling out other neurological and non-neurological conditions that mimic the symptoms. The tests conducted to diagnose epilepsy are:

• Thorough neurological examination to assess the higher mental functions, motor and sensory abilities.
• Blood tests to look for genetic conditions and infections that can cause seizures.
• Electroencephalogram, simply known as an EEG is a device that monitors the electrical activity of the brain. Abnormal wave patterns indicate the presence of seizures. The doctors might provoke seizures to confirm their presence by stressing the brain.
• A high-density EEG helps the doctors zero in on the areas of the brain that are affected by the seizures.
• CT scan reveals the presence of any tumours or cysts or even bleeding in the brain that may cause the seizures.
• MRI scan can further examine the brain along with a functional MRI if surgery is required.
• PET scan

Tests such as Statistical Parametric Mapping (SPM), Curry Analysis and Magnetoencephalography (MEG) help doctors find out the region of onset of the seizures.

Complications of Epilepsy 

In case the limbic region of the brain gets affected during the seizure episode, then the patient experiences emotional disturbances and de-motivation. The limbic cortex comprising the hippocampus, hypothalamus and amygdala are collectively known as the emotional cortex.

The complications include personality changes, mood swings, dependence, and obsessions. Other complications include memory loss and aggressive behaviour.

Complications that usually occur resulting from episodes of tonic clonic seizures include: Aspiration that occurs because the patient vomits during the seizure and the vomit enters the lungs, causing suffocation. The patients may fracture their skull or even dislocate their shoulders due to the severe limb thrashing. The tongue and lips can get chewed on and lasting injuries can occur.

Status epilepticus is a medical emergency situation where continued seizures occur without a break for the patients to regain awareness even for a few seconds. This may result in permanent brain damage.

Continued seizures can lead to problems of the heart such as arrhythmias, infarctions and cardiomyopathy. Pulmonary oedema is another complication.

Sudden unexplained death in epilepsy (SUDEP) is a very rare condition seen in a few patients who are on anti-convulsants and no apparent cause of death can be detected even during an autopsy.

Treatment for epilepsy 

Medical treatment for epilepsy includes treatment using anticonvulsant medications and anti-seizure medications such as benzodiazepines. Children who are on medication have been shown to be completely cured and epilepsy-free in their adult lives.

Usually the medication works very effectively and the patients don’t suffer from further episodes but if they do and the medications aren’t effective, surgery is recommended as the next line of treatment.

The surgery involves removing the part of the brain, the exact region, where the seizure activity occurs. This does not cause any damage such as loss of vital functions which include your motor, language, speech, hearing, and vision. The surgery may need to be followed up by continued treatment with medicines.

Vagus Nerve stimulation is a therapeutic alternative used to stimulate the vagus nerve and is functionally similar to a pacemaker.

Another such method is deep brain stimulation that involves using electrodes to send electrical impulses directly into the brain to control the seizure activity.