Causes and risk factors
In most cases the cause is not known. However some of the common causes are head trauma, stroke or transient ischemic attack [TIA]. Diseases that predispose to cause epilepsy are dementia, infections like meningitis, AIDS, brain tumours, neurofibromatosis, Kidney failure, Liver failure. Congenital brain defects, developmental defect like autism can lead to epilepsy.
Clinical presentation
An epileptic seizure is characterised by staring spells, loss of consciousness, uncontrollable shaking movements of arm and legs. A seizure may be preceded by an aura consisting of a strange sensation. The types of seizures include partial or focal seizure and generalized seizure. Focal seizure – seizure that arises due to abnormal activity in one area of brain. They are of two types – simple focal seizure and dyscognitive focal seizure. Generalized seizure – seizures that arise due to abnormal activity in entire brain. They are of six types-Tonic-clonic seizure, Tonic seizure, clonic seizure, Myoclonic seizure, Absence seizure, Atonic seizure. The seizures last for less than 1 minute. However whole episode i.e. fatigue, tiredness, weakness, may last from 30 minutes to an hour up to regaining full consciousness. Some of the triggers for seizures include – sleep deprivation, overexertion, stress , fever, other illnesses, flashing bright lights, alcohol, associated with menstrual cycle or hormonal changes, low blood sugar , use of certain medications, use of certain specific foods such as caffeine etc.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. An EEG is recommended. Imaging studies such as CT scan, MRI scan is useful for further evaluation. Blood test for sugar, calcium and electrolytes level may be recommended. Kidney function test, Liver function test, Tests for infectious diseases will be advised.
Treatment
Anticonvulsant medications are the first line treatment for the epilepsy. The choice of medication will depend upon factors like age, seizure type, frequency of seizure, overall health and other medical history. Surgery for epilepsy is considered when seizure are not controlled even after trial of two or three medications. Neurostimulation is considered for those who are not fit for the surgery. It is of three types Vagus nerve stimulation, Anterior thalamic stimulation, Closed-loop responsive stimulation. Doctor may also advise Kiteogenic diet in cases of children to reduce the number of seizures. It consists of diet which is low in carbohydrate, high in fat and with adequate amount of protein.
Other Modes of treatment
The other modes of treatment can also be effective in treating epilepsy. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating epilepsy.
Facts and figures
Average incidence of epilepsy every year in US is 1, 50,000. The incidence of epilepsy is higher in young children and old adults.
