Epilepsy is a group of neurological disorders characterized by epileptic seizures. Epileptic seizures are episodes that can vary from brief and nearly undetectable periods to long periods of vigorous shaking. These episodes can result in physical injuries, including occasionally broken bones. Epilepsy is one of the most common serious neurological disorders affecting about 39 million people as of 2015. However, there is no reason to lose heart. Stem cell therapy research is under progress to treat epilepsy, which would make us wait at least for a decade. Hence, Siddha Spirituality of Swami Hardas Life System is already available since the year 1990 to help such people. The methods are free and need no money and medicines. So let us know in detail about epilepsy, symptoms, causes, diagnosis, medications, surgery, and treatments.
Epilepsy facts & figures
As of 2015, about 39 million people have epilepsy. Nearly 80% of cases occur in the developing world. In 2015, it resulted in 125,000 deaths up from 112,000 deaths in 1990.
Epilepsy is more common in older people. In the developed world, the onset of new cases occurs most frequently in babies and the elderly.
In the developing world, onset is more common in older children and young adults, due to differences in the frequency of the underlying causes.
About 5–10% of people will have an unprovoked seizure by the age of 80, and the chance of experiencing a second seizure is between 40 and 50%.
The word epilepsy is from Ancient Greek ἐπιλαμβάνειν, “to seize, possess, or afflict”.
Epilepsy is a disorder of the brain defined by any of the following conditions:
- At least two unprovoked seizures occurring greater than 24 hours apart
- One unprovoked seizure and a probability of further seizures similar to the general recurrence risk after two unprovoked seizures, occurring over the next 10 years
- Diagnosis of an epilepsy syndrome
Epilepsy is characterized by a long-term risk of recurrent seizures. These seizures may present in several ways depending on the part of the brain involved and the person’s age.
The most common type of seizures is convulsive. Of these, one-third begin as generalized seizures from the start, affecting both hemispheres of the brain. This type is the absence seizure, which usually lasts about 10 seconds.
Focal seizures are often preceded by certain experiences, known as auras. They include:
- Sensory (visual, hearing, or smell)
- Motor phenomena
Jerking activity may start in a specific muscle group and spread to surrounding muscle groups in which case it is known as a Jacksonian March.
There are six main types of generalized seizures:
- Atonic seizures
They all involve loss of consciousness and typically happen without warning.
Tonic-clonic seizures occur with a contraction of the limbs followed by their extension along with arching of the back which lasts 10–30 seconds (tonic phase). A cry may be heard due to contraction of the chest muscles, followed by a shaking of the limbs in unison (clonic phase).
Tonic seizures produce constant contractions of the muscles. A person often turns blue as breathing is stopped.
In clonic seizures, there is shaking of the limbs in unison. After the shaking has stopped it may take 10–30 minutes for the person to return to normal. Loss of bowel or bladder control may occur during a seizure. The tongue may be bitten at either the tip or on the sides during a seizure.
In a tonic-clonic seizure, bites to the sides are more common. Tongue bites are also relatively common in psychogenic non-epileptic seizures.
Myoclonic seizures involve spasms of muscles in either a few areas or all over.
Absence seizures can be subtle with only a slight turn of the head or eye blinking. The person does not fall over and returns to normal right after it ends.
Atonic seizures involve the loss of muscle activity for greater than one second. This typically occurs on both sides of the body.
Epilepsy can have adverse effects on social and psychological well-being. These effects may include social isolation, stigmatization, or disability. They may result in lower educational achievement and worse employment outcomes.
Learning disabilities are common in those with the condition, and especially among children with epilepsy. The stigma of epilepsy can also affect the families of those with the disorder.
ADHD and epilepsy have significant consequences on a child’s:
- Social development
Epilepsy is also more common in children with autism.
Epilepsy can have both genetic and acquired causes, with the interaction of these factors in many cases. Established acquired causes include:
- Serious brain trauma
- Problems in the brain as a result of a previous infection
Epilepsies caused by genetic, congenital, or developmental conditions are more common among younger people, while brain tumors and strokes are more likely in older people.
Genetics is believed to be involved in the majority of cases, either directly or indirectly. Some epilepsies are due to a single gene defect. Most are due to the interaction of multiple genes and environmental factors.
Epilepsy may occur as a result of a number of other conditions including:
- Head trauma
- Previous infections of the central nervous system
- Genetic abnormalities
- As a result of brain damage around the time of birth
Some evidence links epilepsy and celiac disease and non-celiac gluten sensitivity, while other evidence does not. There appears to be a specific syndrome which includes coeliac disease, epilepsy, and calcifications in the brain.
The epilepsy diagnosis is typically made based on observation of the seizure onset and the underlying cause. An electroencephalogram (EEG) to look for abnormal patterns of brain waves and neuroimaging (CT scan or MRI) to look at the structure of the brain are also usually part of the workup.
Cases of epilepsy may be organized into epilepsy syndromes by the specific features that are present. These features include the age that seizure begins, the seizure types, EEG findings, among others.
Identifying an epilepsy syndrome is useful as it helps determine the underlying causes as well as what anti-seizure medication should be tried.
The ability to categorize a case of epilepsy into a specific syndrome occurs more often with children since the onset of seizures is commonly early.
Some childhood epilepsy syndromes are included in the unknown cause category in which the cause is presumed genetic, for instance, benign rolandic epilepsy.
An electroencephalogram (EEG) can assist in showing brain activity suggestive of an increased risk of seizures. It is only recommended for those who are likely to have had an epileptic seizure on the basis of symptoms.
In the diagnosis of epilepsy, electroencephalography may help distinguish the type of seizure or syndrome present. In children, it is typically only needed after a second seizure.
Diagnostic imaging by CT scan and MRI is recommended after a first non-febrile seizure to detect structural problems in and around the brain. MRI is generally a better imaging test except when bleeding is suspected, for which CT is more sensitive and more easily available.
For adults, the testing of electrolyte, blood glucose, and calcium levels are important to rule out problems with these as causes. An electrocardiogram can rule out problems with the rhythm of the heart.
In children, additional tests may be required such as urine biochemistry and blood testing looking for metabolic disorders.
Epilepsy is usually treated with daily medication once a second seizure has occurred, while medication may be started after the first seizure in those at high risk for subsequent seizures. Supporting people’s self-management of their condition may be useful.
Epilepsy First aid
Rolling a person with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs.
Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten.
Efforts should be taken to prevent further self-injury. Spinal precautions are generally not needed.
If a seizure lasts longer than 5 minutes or if there are more than two seizures in an hour without a return to a normal level of consciousness between them, it is considered a medical emergency is known as status epilepticus. This may require medical help to keep the airway open and protected; a nasopharyngeal airway may be useful for this.
At home, the recommended initial medication for the seizure of a long duration is midazolam placed in the mouth. Diazepam may also be used rectally. In the hospital, intravenous lorazepam is preferred.
If two doses of benzodiazepines are not effective, other medications such as phenytoin are recommended. Convulsive status epilepticus that does not respond to initial treatment typically requires admission to the intensive care unit and treatment with stronger agents such as thiopentone or propofol.
Two medications at once are recommended only if a single medication does not work. In about half, the first agent is effective; a second single agent helps in about 13% and a third or two agents at the same time may help an additional 4%. About 30% of people continue to have seizures despite anticonvulsant treatment.
There are a number of medications available including phenytoin, carbamazepine, and valproate. Low-quality evidence suggests that phenytoin, carbamazepine, and valproate may be equally effective in both focal and generalized seizures.
Controlled release carbamazepine appears to work as well as immediate release carbamazepine, and may have fewer side effects.
In the United Kingdom, carbamazepine or lamotrigine are recommended as first-line treatment for focal seizures, with levetiracetam and valproate as second-line due to issues of cost and side effects.
Slowly stopping medications may be reasonable in some people who do not have a seizure for two to four years; however, around a third of people have a recurrence, most often during the first six months. Stopping is possible in about 70% of children and 60% of adults.
Surgery may be an option for people with focal seizures that remain a problem despite other treatments. These other treatments include at least a trial of two or three medications.
The goal of surgery is total control of seizures and this may be achieved in 60–70% of cases. Common procedures include cutting out the hippocampus via an anterior temporal lobe resection, removal of tumors, and removing parts of the neocortex.
Some procedures such as a corpus callosotomy are attempted in an effort to decrease the number of seizures rather than cure the condition. Following surgery, medications may be slowly withdrawn in many cases.
Neurostimulation may be another option in those who are not candidates for surgery. Three types have been used in those who do not respond to medications:
- Vagus nerve stimulation
- Anterior thalamic stimulation
- Closed-loop responsive stimulation
There is tentative evidence that a ketogenic diet (high-fat, low-carbohydrate, adequate-protein) decreases the number of seizures and eliminate seizures in some; however, further research is necessary. It is a reasonable option in those who have epilepsy that is not improved with medications and for whom surgery is not an option.
About 10% stay on the diet for a few years due to issues of effectiveness and tolerability. Side effects include stomach and intestinal problems in 30%, and there are long-term concerns about heart disease.
Less radical diets are easier to tolerate and may be effective. It is unclear why this diet works. In people with coeliac disease or non-celiac gluten sensitivity and occipital calcifications, a gluten-free diet may decrease the frequency of seizures.
Alternative medicine, including acupuncture, psychological interventions, routine vitamins, and yoga, have no reliable evidence to support their use in epilepsy. The trials were of poor methodological quality and it was not possible to draw any definitive conclusions.
Epilepsy and driving
Those with epilepsy are at about twice the risk of being involved in a motor vehicular collision and thus in many areas of the world are not allowed to drive or only able to drive if certain conditions are met.
In some places, physicians are required by law to report if a person has had a seizure to the licensing body. However, in other countries, the requirement is only that they encourage the person in question to report it themselves.
Countries that require physician reporting include Sweden, Austria, Denmark, and Spain.
Countries that require the individual to report include the UK and New Zealand and the physician may report if they believe the individual has not already.
In Canada, the United States and Australia the requirements around reporting vary by province or state. If seizures are well controlled most feel allowing driving is reasonable.
In the United Kingdom, a full national private pilot license requires the same standards as a professional driver’s license. This requires a period of ten years without seizures while off medications. Those who do not meet this requirement may acquire a restricted license if free from seizures for five years.
Seizure prediction refers to attempts to forecast epileptic seizures based on the EEG before they occur. As of 2011, no effective mechanism to predict seizures has been developed. Kindling, where repeated exposures to events that could cause seizures eventually causes seizures more easily, has been used to create animal models of epilepsy.
Gene therapy is being studied in some types of epilepsy. Medications that alter immune function, such as intravenous immunoglobulins, are poorly supported by evidence. Noninvasive stereotactic radiosurgery is, as of 2012, being compared to standard surgery for certain types of epilepsy.
Epilepsy in dogs
Epilepsy occurs in a number of other animals including dogs and cats and is the most common brain disorder in dogs. It is typically treated with anticonvulsants such as phenobarbital or bromide in dogs and phenobarbital in cats. Imepitoin is also used in dogs.
Stem cell therapy for epilepsy
Currently, there are no FDA approved stem cell therapies for epilepsy.
In the coming years, large scale human studies using stem cell therapy for the treatment of epilepsy will hopefully be carried out. Such studies will look at the safety and effectiveness of such treatment.
These studies will be necessary to obtain FDA approval- so that patients can receive stem cell therapy in the clinic setting.
Experts in the field are hopeful for significant advances in the next 10 years.
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