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Epilepsy is a neurological disorder that is represented by seizures of different kinds1. Seizures can be displayed in diverse physical ways like muscle spasms, body jerking, unconsciousness, disruptions, and changes in behavior. Seizures take place due to irregular brain or electrical activity.
According to WHO, “Epilepsy is one of the most common neurological disorders affecting about 50 million people around the world. More than 1 million cases are recognized every year in India.”
Types of Seizures and Their Symptoms
Seizures are recurring episodes caused by epilepsy. These can be classified into two types based on the region or hemisphere of the brain where the abnormal electrical impulse is taking place.
The two known types are:
- Partial Seizures
- Generalized Seizures
Further, we will look into these two types in detail, their subtypes (if any), and also how they are different from each other.
1. Partial Seizure
Partial seizure is also known as focal seizure. This is localized to one hemisphere of the brain or at the very least a small part of it. Hence the name partial seizure and it results from abnormal activity in specific regions of the brain.
As the brain is divided into two equal hemispheres, they are also aligned on opposite sides of the body. Which simply means, that the left hemisphere of the brain controls the right side of the body. So, if anything ever goes wrong in the left side of the brain, the right side of the body will start showing effects of the same and vice versa.
Partial seizures can further be classified into two subtypes based on whether the person affected remains conscious or unconscious throughout the attack, and they are:
- simple partial seizure and
- complex partial seizure
Simple Partial Seizure
During a simple partial seizure, there is no impairment in the consciousness or responsiveness of the person affected. They are almost completely aware of their surroundings throughout the episode. It lasts for about a few seconds to a couple of minutes. An episode of simple partial seizure may look like involuntary movements of the body and contractions of muscles like repetitive twitching, and jerking.
They may have a feeling of deja vu and also might not be able to communicate for a short while. They can also have autonomic symptoms like changes in breathing patterns and heartbeat and sweating.
Complex Partial Seizure
Unlike simple partial seizure where there is no impairment in the consciousness, during an episode of complex partial seizure the person remains in a state of complete unconsciousness and altered awareness of the surroundings. These also last for about 30 seconds to a couple of minutes. The most common actions that are physically visible are lips smacking, chewing, and picking clothes.
These are all involuntary actions. The person experiencing the episode can be seen looking through a blank space. It may look like they are spaced out. They also remain unconscious and unresponsive.
2. Generalized Seizures
Unlike partial seizure, generalized seizure is localized on both hemispheres of the brain. Many times seizures can start as focal seizures and extend their potential to generalized seizures2. In such cases, the generalized seizure is termed a secondary seizure because the partial seizure(primary seizure) occurs primarily to the generalized seizure.
These also have subtypes. they are:
Absence seizures are also known as ‘petit mal’ seizures. This is a type of epilepsy with childhood onset. These generally affect younger people and children between the age of 4 to 15 years old. There is an impairment in awareness and responsiveness. The children seem to be stunned and look blankly into space. An episode of absence seizure last for about 15 seconds or even less. There is generally no memory of the seizure to the child affected.
Myoclonic seizure feels like the sudden brief jolts, specific muscles or muscle groups face when we sleep. Though the sleep jerks are harmless, myoclonic seizures are malignant. These are only a couple of jerk movements, so, they only last for a couple of seconds. A subtype of myoclonic seizure is infantile spasms also known as West syndrome.
This affects infants below the age of one. These look like sudden jolts followed by stiffening of the baby’s body. Trigger factors for myoclonic seizures can be anxiety, stress, and sleep deprivation.
Tonic seizures are characterized by prolonged stiffness of muscles. This can cause the patient to lose control over the body and fall off as if they are stunned. They might also hold their breath and have difficulty breathing normally. This can cause a low level of oxygen to reach their body, and hence cause a bluish tinge on the patient’s skin.
Which usually appears around the lips and nose at first. They are usually short lasting and stay for 20-30 seconds. After this, the patient may feel irritated or confused.
Atonic seizures are also known as drop attacks due t their characterization of loss of muscle tone. Contrary to tonic seizures where muscles contract, in atonic seizures muscles relax or slump completely and this can also cause the patient to fall. Here also the patients lose control over the contraction and relaxation of their muscles. This can also be a part of certain epilepsy syndromes such as Lennox-Gastuat syndrome3.
Clonic seizures are characterized by violent outbursts of muscle contraction also known as convulsions. Generally, muscles of the arms, neck, and legs flex and relax rapidly. An episode can have a duration of 1-2 minutes.
After the episode, the patient may have a deep sigh to get back to a normal breathing pattern. There can also be signs of drowsiness, confusion, and fatigue. A clonic seizure can be sometimes difficult to differentiate from a myoclonic seizure. Due to their similar symptoms.
Tonic-clonic seizure primarily known as grand mal seizure, is the most known seizure worldwide. These have two distinctive degrees that is tonic and clinic seizure as the name suggests. In tonic-clonic seizure Tonic seizure(as discussed above) happens primarily.
Followed by clonic seizure. Both of their symptoms are similar to that mentioned above. This lasts for 2-3 minutes. If the duration of tonic-clonic seizure exceeds 5 minutes, it is advised to seek medical attention as soon as possible.
The process by which a normal brain is functionally modified towards the generation of irregular brain electrical activity that causes a chronic seizure. It happens through three phases-
1) The event of the injury may be a traumatic brain injury.
2) the ‘latent period ‘ is the period in which changes occur in the normal brain that is set in by the primary injury.
3) lastly the establishment of epilepsy.
What Causes Abnormal Electrical Activity During Epilepsy?
Multiple factors can lead to an epileptic seizure. Though the science world has not yet been able to pinpoint the cause of epilepsy. Here are a few factors that can be causing it:
1. Imbalance of Neurotransmitters:
Neurotransmitters are signaling chemical messengers that send signals from one neuron to another. During epileptic seizures, these neurotransmitters fail to function. The lead role played in the initiation of epileptic seizures is by an excitatory neurotransmitter, Glutamate.
Similarly, GABA (gamma-aminobutyric acid) is an inhibitory neurotransmitter that if perturbed may cause epilepsy. Decreased GABA inhibition or excessive glutamate release can contribute to increased neuronal excitability and hence ensure seizures.
2. Genetic Mutations:
Epilepsy can also rise from genetic mutation or variation. That affects the structure and functionality of the brain cells. These mutations can change the normal brain chemistry and contribute to anomalous brain electrical activity. Which in turn causes seizures.
3. Metabolic Imbalances:
Metabolic disruptions, such as alterations in energy anabolism and catabolism4. Disturbances in the balance of electrolytes can influence brain chemistry and neuronal excitability. Imbalances can make the brain more predisposed to anomalous electrical activities that cause epileptic seizures
Can Epilepsy Be Cured: Treatment Options
What do you think, “can epilepsy be cured?” Is there any treatment available?
Epilepsy does affect the lives of people who have it and also the support system of the person. It can bring an imbalance in people’s day-to-day life.
However, this condition can be managed in a lot of people simply through medication or other forms of treatment. Although curing epilepsy entirely is not guaranteed through treatment. But it is to be noted that by record around 60% of the people suffering from epilepsy have recovered fully.
Though there is no 100% percent guaranteed recovery treatment for epilepsy. There are treatment methods to reduce the intensity and frequency of episodes of seizure. Down are mentioned some of these methods that can be adopted.
1. Identifying Seizure Triggers
Another good way to avoid seizures is to avoid triggers. Seizures are not caused by triggers, but it plays a role in the initiation of it. Also, every time a person comes in contact with the trigger, they don’t necessarily will have an episode. Many things can trigger seizures.
One of the most familiar is flashing lights, but actually, this only affects a small number of people. Triggers for epilepsy tend to be different for each individual. But more common triggers include stress, periods, sleep deprivation, fever or high temperature, or too much alcohol consumption.
Epilepsy can be caused by a wide range of factors from trauma, genetic disorders, tumors, or infections. Yet in most cases, the cause remains unknown. And that’s why the treatment usually means mainly controlling the seizures, which is done predominantly using medicinal remedies known as antiepileptic drugs.
2. Medication Drugs
Antiepileptic drugs (AEDs)- This is the primarily preferred medication. This help by controlling irregular brain activity. Either by enhancing GABA inhibitor production. While other drugs can be used to block or decrease glutamate receptors to decrease the production of the excitatory neurotransmitter. And both of these mechanisms help control the neurons from rapid repetitious firing.
3. Surgical Treatment
Vagus Nerve Stimulation(VNS)
VNS or vagus nerve stimulation is a surgical treatment option for epilepsy. This includes the implantation of a device called a vagus nerve stimulator. The Vagus nerve runs from the brain to the thoracic region to the abdomen. The device stimulates this nerve which in turn reduces the severity and intensity of the seizure in epilepsy. The device is usually embedded in the chest cavity.
A lead wire connects the device to the left vagus nerve in the neck. This device supplies temperate stimulations to the vagus nerve through the lead wire at regular intervals. This helps to regulate the abnormal electrical activity.
RNS or responsive neurostimulation is a surgical treatment option for epilepsy. where a device called a responsive neurostimulator is implanted in the brain to track and respond to abnormal electric brain activity. The source of seizures is first identified by diagnostic testing using EEG (electroencephalogram) monitoring.
Now, during surgery, a couple of electrodes are implanted at the site of the source of seizures. These electrodes are attached to a small battery-powered generator, which is generally embedded under the scalp or in the chest wall. The RNS stimulating device then monitors the abnormal electrical activities in the brain in real time. It detects patterns that are related to the onset of epileptic seizures.
Different Types of Scans
Magnetic resonance imaging (MRI) and functional imaging such as positron emission tomography (PET) scan, Magnetoencephalography (MEG) scan and others can show areas of the brain that may be causing seizures. Electroencephalogram (EEG) is used for diagnostic testing.
It helps to pinpoint the region that onsets the epileptic seizure. All this information will be discussed at a conference. Including several doctors who specialize in different areas of epilepsy and the team will make recommendations about what type of surgery should be considered.
4. Diet and Lifestyle Modifications
Lifestyle modifications: Having a more healthy lifestyle can surely help in reducing the frequency and intensity of seizures. Sleep is very essential to maintain a healthy active body. Fatigue or deprivation of sleep can onset seizure attacks. It is best to have a regular sleep schedule to get enough sleep to feel rested. Wherever possible try to prioritize a good night’s sleep.
Screen time must be reduced otherwise, it may lead to fatigue which is worsened if you have photosensitive epilepsy. Lifestyle changes such as getting proper sleep, maintaining a sleep schedule, managing stress levels, and more.
A ketogenic diet is a recommended diet for people with epilepsy. This diet follows a low-carbohydrate, high-fat, and adequate protein schedule which is efficient for reducing seizures. This is because the high fat consumed is used for the production of energy instead of sugars and carbohydrates.
This produces ketones which act as an alternate source of energy. A ketogenic diet improves the synthesis of GABA5 (Gamma-aminobutyric acid). Which helps in the regulation of brain activity. The diet is generally adopted for children having epilepsy to boost the effects of medications. It is typically implemented under medical supervision and requires careful monitoring.
Drinking plenty of water is also suggested. And intake of meals rich in vitamins and minerals is essential. Consumption of alcohol or other drug abuse may cause delays in the working of your medication. It may also cause bad reactions to your medications. So it is highly advised to avoid the consumption of alcohol or drugs.
How is Epilepsy Different in Females?
Epilepsy can affect females differently due to many factors. Some of them are:
Hormonal fluctuations: During PMS(premenstrual syndrome) and menstruation estrogen levels are irregular. This can cause the intensity and frequency of seizures to increase. The same can be said for the hormonal changes during pregnancies. Though the frequency of seizures during pregnancies depends on the individual it may increase, decrease or even remain the same.
Asking for Help
Many people find asking for help very difficult, especially those who need help suffering from epilepsy. This is because they find it embarrassing or as being weak.
However, asking for help in such scenarios is very necessary.
Sudden Unexplained Death in Epilepsy (SUDEP)
Each year it is estimated that one out of 1000 people with epilepsy die from sudden unexpected death by Epilepsy(SUDEP). It is the most devastating outcome of epilepsy. This can happen to anyone with epilepsy, but certain individuals are at higher risk.
Like senior citizens and people who have other underlying disorders. Especially those whose seizures are frequently generalized into tonic-clonic and poorly controlled and or not treated with anti-seizure medications.
Having epilepsy can be difficult. It is the commonest neurological condition. That’s why all of us need to know how to act if we see someone having a seizure. All you have to do is to put that person in a recovery position. Make sure to time the duration of the episode. If the episode exceeds 5 minutes call for an ambulance immediately.
Move any objects away that might hurt the affected person. Stay calm till the seizure ends, and assure them that everything is going to be OK.
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- Silva, Barbara C., and John P. Bilezikian. “Parathyroid hormone: anabolic and catabolic actions on the skeleton.” Current opinion in pharmacology 22 (2015): 41-50. ↩︎
- Rowley, Nicole M., et al. “Glutamate and GABA synthesis, release, transport and metabolism as targets for seizure control.” Neurochemistry international 61.4 (2012): 546-558. ↩︎