Medical

Epilepsy : Causes, symptoms, and treatment

Epilepsy is one of the most common neurological diseases in the world.

Epilepsy is one of the most common diseases in the world and has many complications. The most important risk factors for epilepsy are physical illnesses, mental illnesses, and heredity. This statistic is higher than the statistic of other countries.

There are 60 million people with epilepsy worldwide. Epileptic seizures may be related to brain injury or genetics; But for 70% of patients with epilepsy, the cause is unknown. Ten percent of people will experience seizures in their lifetime. The disease increases with age, especially when they have a stroke, brain tumor, or Alzheimer’s disease.

Men are more likely than women to have epilepsy. Brain injury or infection can cause epilepsy at any age. The reason for the onset of epilepsy varies from person to person. Babies may be born with a defective brain structure or may have a brain injury or infection that causes epilepsy. Severe head injuries are the most well-known cause of epilepsy in young people. In middle-aged people, strokes, tumors, and injuries are the leading causes. In people 65 and older, stroke is the most common known cause, followed by neurodegenerative diseases such as Alzheimer’s. Most seizures do not start long after the person has a head injury but may occur within a few months.

What is epilepsy?

Epilepsy is a brain disorder characterized by recurrent seizures. Convulsions are usually defined as a sudden change in behavior due to a temporary change in the brain’s electrical function. The brain produces typically small electrical impulses in a regular pattern. These impulses travel along neurons and are transmitted throughout the body through neurotransmitters. The Greek philosopher Hippocrates was the first to think that epilepsy began in the brain.

In this disease, the electrical rhythms of the brain become unbalanced and lead to recurrent seizures. In patients with seizures, the typical electrical pattern is disrupted by sudden bursts of electrical energy that may briefly affect consciousness, movement, or emotion. Epilepsy is usually diagnosed after a person has at least two seizures that are not caused by a known medical cause, such as alcohol withdrawal or severe hypoglycemia. If the seizures come from a specific area of ​​the brain, the early signs of a seizure may reflect that area’s function. The right side of the brain controls the left side of the body, and the left side of the brain controls the right side of the body. Accordingly, if a seizure occurs in the right side of the brain in the area that controls the limbs’ movement, the seizures may be accompanied by tremors and shaking of the thumb or left hand.

Different types of epilepsy have one thing in common: the tendency to have seizures that begin in the brain. This disease causes not all seizures. Other conditions that may look like epilepsy include fainting or severe hypoglycemia in some patients treated for diabetes. Each person may have seizures under certain conditions, but most people do not have seizures under normal circumstances. Seizures are sometimes referred to as fainting and seizures. Seizures occur when the ordinary course of brain function is disrupted. In the interval between seizures, the brain functions normally.

There are more than forty types of seizures so that seizures can vary significantly from person to person. For example, a person may be stunned for a few seconds, or people may fall to the ground and shake. Some people are unconscious during a seizure and do not remember what happened to them. It is helpful to have people who have seen him help explain the symptoms to help diagnose him.

Causes of epilepsy

Different epilepsies can have very different causes. These causes can be complicated and sometimes challenging to identify. Having one or more of the following conditions can cause these types of seizures:

  1. Genetic predisposition inherited from parents.
  2. Genetic predisposition that results from a new change in an individual’s genes
  3. Structural changes in the brain such as underdevelopment of the brain or injury due to injury Brains such as infections such as meningitis, stroke, or trauma
  4. Structural changes due to genetic problems such as tuberous sclerosis or neurofibromatosis that affect the brain

Some researchers now believe that the chances of developing epilepsy are somewhat genetic. Anyone who has a seizure always has a genetic predisposition to developing the disease. The range of this probability varies between different people. Even if seizures start after a brain injury or other structural change, it can result from structural change and a person’s genetic predisposition to epilepsy. Many people may experience the same brain injury, but not all of them develop epilepsy afterward.

Risk factors for epilepsy

  • Premature birth or low birth weight
  • The occurrence of congenital disabilities (such as lack of oxygen)
  • Convulsions in the first month of life
  • Abnormal brain structures at birth
  • Intracerebral hemorrhage
  • Abnormal blood vessels in the brain
  • New brain injury or lack of oxygen to the brain
  • Brain tumors
  • Abnormal brain structure at birth
  • Brain infections such as meningitis and encephalitis
  • Stroke due to blocked arteries
  • Cerebral Palsy
  • Seizures that occur shortly after a head injury
  • Family history of epilepsy or febrile seizures
  • Alzheimer’s disease
  • Convulsions caused by prolonged fever
  • Drug and alcohol use

Seizure threshold

The genetic component of a seizure is called the seizure threshold. This is the individual level of seizure resistance. Each of us can have seizures in certain conditions, but for most people, their natural resistance to seizures is high enough to prevent them from having seizures. Our seizure threshold is part of our genetic background that can be passed from parent to child. Therefore, the likelihood of a person having a seizure depends in part on whether their parent or parents have had epilepsy. If a person has a low seizure threshold, they have less seizure resistance, so they have a seizure suddenly and for no apparent reason than people with a high seizure resistance threshold.

The following factors may increase the risk of seizures in people prone to seizures:

  • Stress
  • Lack of sleep or fatigue
  • Inadequate food intake
  • Alcohol consumption or drug addiction
  • Do not take prescribed antiepileptic drugs.

Facts About Epilepsy

Most seizures occur suddenly and without warning, last a short time (a few seconds or minutes) and stop on their own.

  • Convulsions can be different in each person.
  • Just knowing that a person has epilepsy does not determine their epilepsy or what their seizures are.
  • Calling seizures big or small does not contain information about what will happen to a person during a seizure.
  • In all seizures, there is no movement or vibration. Some people experience confusion during a seizure.
  • Some people have seizures when they wake up, which is called wakefulness. Some people also have seizures during sleep, which is called sleep seizures or nocturnal seizures. These titles do not specify the type of seizure and only refer to when the seizures occurred.
  • Injuries may occur during a seizure, but most people do not injure themselves and do not need to see a doctor.

Misconceptions about epilepsy

Misconception: Anyone with epilepsy will tremble.

Not every seizure necessarily means that the person is shaking, and it is not always the case that the person loses consciousness during the seizure. A wide range of seizures have different side effects and affect different people in different ways.

Myth: Flashlight causes seizures in all people with epilepsy.

Up to three percent of people with epilepsy are affected by flashlights (cut-off and switch-on lights), which is called light-sensitive epilepsy. In most people with epilepsy, these lights do not trigger seizures. Light-sensitive epilepsy is more common in children and young people.

Misconception: A person should be restrained during a seizure.

During a seizure accompanied by tremors, the person should not be held and put anything in his mouth under any circumstances.

Myth: Epilepsy is rare.

Epilepsy is not as rare as people think. There are about 60 million people with epilepsy in the world. Anyone can have epilepsy. The disease occurs at all ages and among all races and social classes.

Misconception: The only side effects of epilepsy are fatigue and confusion.

Having epilepsy can affect a person in different ways. For example, some people may have problems with sleep or memory, and some may have mental health problems.

* Historical misconceptions about epilepsy still exist, and some people still believe that evil spirits’ dominance causes epilepsy. *

Diagnosis of epilepsy

Since a person with epilepsy has no apparent symptoms until they have a seizure, it is challenging to diagnose epilepsy. The diagnosis is usually made after a person has had more than one epileptic seizure. Diagnosing epilepsy is not easy. Doctors gather a wide variety of information to assess the causes of seizures. If a person has had two or more seizures that started in his or her brain, they may be diagnosed with epilepsy. Because there is no specific test that can diagnose epilepsy, it is not always easy to diagnose. The diagnosis of epilepsy in a person is made based on what happens to the person before, during, and after the seizure. For example, some fainting spells may look like epileptic seizures, but a person often feels cold and blurs before fainting. But epileptic seizures occur very suddenly, and the person does not have a warning about a seizure.

A person who has a seizure may not remember what happened. He should record what happened in the language of the person who saw him show it to his doctor. Here are some questions that may help record important information about the seizure that has occurred.

Before seizures

  • Has anything started a seizure? For example, has the person felt tired, hungry, or sick?
  • Has the person had any warning signs that they are going to have a seizure?
  • Did his mood change? For example, was he excited, anxious, or silent?
  • Does the person make strange noises such as crying or whispering incomprehensibly?
  • Did he have any unusual sensations such as a strange taste or smell and a special feeling in his stomach?
  • Where and what was the person doing before the seizure?

During a seizure

  • Did the person feel empty or stare somewhere?
  • Did he lose consciousness, or was he confused?
  • Has there been anything unnatural like me doing, getting confused with clothes?
  • Did it change colors, such as paleness or redness?
  • Did the person’s breathing change?
  • Has there been a feeling of shaking and trembling in a part of the body?
  • Did the person fall, or did he feel stiff or weak?
  • Did the person develop urinary incontinence?
  • Did he bite his tongue or lips?

After seizures

  • How did the person feel after the seizure? Did he feel tired or needed sleep?
  • How long did it take for him to return to normal?

Apart from the description of seizures, other topics can help with the cause of seizures. The patient’s medical history and other health problems are also part of the diagnosis process. Sometimes the cause of a person’s epilepsy may be known. However, in most people, there is no apparent cause for epilepsy.

Epilepsy tests

Blood tests, electroencephalography (EEG), and brain scans are used to gather information for diagnosis. These tests alone cannot confirm or rule out epilepsy.

  • General tests: Some tests can help rule out other diseases. These include the following:
  • Blood tests: A blood sample is usually taken from a sick person. This sample is used to check his general health and to rule out other possible causes of seizures such as low blood sugar or diabetes.
  • Electrocardiogram (ECG): An ECG is used to record the electrical activity of the heart. This is done by attaching electrodes to the arms, legs, and chest. These electrodes capture the heart’s electrical signals. An ECG can determine the likelihood of a seizure due to brain function.

Epileptic seizures

Epileptic seizures are caused by a disturbance in the electrical activity of the brain. There are different types of epileptic seizures, but they all start in the brain. Other seizures may look like epileptic seizures but do not start in the brain. Some seizures occur in conditions such as hypoglycemia or changes in heart function. Some young children also develop febrile seizures at high temperatures. These are not equivalent to epileptic seizures.

Seizures are so variable that epilepsy specialists frequently reclassify them. Seizures are usually divided into two main groups of seizures: primary pervasive seizures and regional seizures. The difference between the two is in the way they begin. Primary general seizures begin with a large electrical discharge involving both sides of the brain at once. Regional seizures begin with an electrical discharge in a limited area of ​​the brain. Epilepsy, in which seizures start on both sides of the brain simultaneously, is called primary pervasive epilepsy.

Convulsions are also classified according to the following criteria:

  • The area of ​​the brain where seizures begin
  • The effect of seizures on a person’s consciousness
  • Presence or absence of motor and vibration symptoms during seizures

status epilepticus

A person’s seizures usually last the same amount of time each time they occur and stop spontaneously. Sometimes, seizures do not stop, or one seizure occurs after another without recovering in the interval between two seizures. If such a condition lasts for five minutes or more, it is called persistent epilepsy. Persistent epilepsy is not common, but it can occur with any seizure, and the person may need to see a doctor.

Having regular notes of seizures helps a person identify their triggers and avoid them as much as possible.

Epilepsy treatments

Medications: Antiepileptic drugs (AEDs) work by controlling the brain’s electrical activity that causes seizures

These drugs do not cure epilepsy and are not used to stop a seizure when it is happening. These drugs work best when taken regularly and at about the same time. Seizures are entirely controlled in 70% of people taking these drugs.

The treatment goal is to stop all seizures by taking the minimum amount and number of antiepileptic drugs and the least side effects. Treatment is usually started with an antiepileptic drug in the smallest amount and gradually increased until the patient’s seizures are under control. If this drug does not control the person’s seizures, another antiepileptic drug is prescribed (by adding a new drug and phasing out the old drug). If the patient’s seizures are not controlled with just one medication, another medication may be added, and the patient may need to take two types of antiepileptic drugs each day. Most antiepileptic drugs have two names, one generic name and one brand designated by the manufacturer. Some antiepileptic drugs have more than one generic prescription, and each prescription may have its name. For some antiepileptics, different prescriptions may differ slightly, and this can affect seizure control. Once it has been determined that an antiepileptic drug can control the patient’s seizures and is appropriate, it is recommended that the patient always take the same prescription.

What are other treatment options available for epilepsy?

Although epilepsy is generally incurable, most people have seizures, so epilepsy has little or no effect on their lives. Most people with epilepsy use antiepileptic drugs to prevent seizures. For people whose seizures are not controlled by antiepileptic drugs, there are other treatment options.

Ketogenic diet

A ketogenic diet is a treatment option for children with epilepsy whose seizures are not controlled by antiepileptic drugs. This diet may reduce the number or severity of seizures and often has positive effects on behavior. This diet is very specialized and should be done under the care, supervision, and guidance of relevant experts.

The ketogenic diet is a high-fat, low-carbohydrate, protein-controlled diet that has been used to treat epilepsy since the 1920s. This diet is a medical treatment and is often considered only when at least two appropriate medications have been used but have not been effective. A ketogenic diet is a good treatment option for children who have difficulty controlling epilepsy.

The body usually uses glucose from carbohydrates as an energy source. When the body uses fat as an energy source, chemicals called ketones are produced in the body, and the body uses ketones as an energy source instead of glucose. Another chemical called decanoic acid is produced in the body by consuming this diet. These chemicals help reduce seizures in some people.

Of course, this diet may not work for everyone. It is still suitable for various seizures and epilepsy syndromes, including astatic myoclonic epilepsy, Drave syndrome, infantile spasm (Western syndrome), and tuberous sclerosis.

There are several forms of ketogenic diets. The types of foods consumed and how each diet is calculated are slightly different, but each diet has effectively reduced seizures in some people.

Constipation is a common problem with these diets. This is because fats take longer to break down than carbohydrates and lack fiber, which can be treated. Hunger, vomiting, and lack of energy are also expected at the beginning of this treatment, but these side effects may diminish over time and be avoided with careful monitoring. Many children experience a sense of increased energy and alertness by consuming this diet.

Vagus nerve stimulation

Vagus nerve stimulation (VNS) is a treatment for epilepsy that involves implanting a pacemaker under the upper chest area’s skin. This device is connected subcutaneously to the vagus nerve in the neck with a wire. The stimulus device sends gentle, regular electrical stimuli to this nerve to calm the brain’s irregular electrical activity, leading to seizures. Vaginal nerve stimulation is a treatment for people with epilepsy whose seizures are not controlled by medication.

The vagus nerves are a pair of nerves that start in the brain and continue throughout the body. They exchange messages between the brain and the body. The goal of vagal nerve stimulation is to reduce the number, duration, and severity of seizures. In some people, the number of seizures decreases; for some, this method may reduce seizures to some extent, and in some, it has no effect at all. This treatment may reduce the duration or severity of the seizures, but this does not apply to everyone. This procedure may reduce the time it takes for a person to recover from a seizure. It is unlikely that this method can completely stop seizures. It may also take up to two years for effect to be felt on a person’s seizures. This method is used with antiepileptic drugs and not instead. However, if vagal nerve stimulation treatment is useful, it may be possible to gradually reduce the drug dose.

What is a pacemaker?

The stimulus device is something like a heartbeat. The device is implanted under the skin of the upper chest during a small operation under general anesthesia. A small lump is felt where the device is placed, and a small wound can be seen at the implant site. An interface wire connects the actuator to the vagus nerve on the left side of the neck.

The stimulus device is usually activated within four weeks after implantation. The specialist programs the device and adjusts the amount (intensity and length) of electrical stimulation. The amount of stimulation varies from person to person but usually starts at a low level and increases slowly to that person’s appropriate level. The pacemaker has a built-in battery that can last for ten years. When the battery is depleted, the device is replaced during a surgery similar to the one performed for the first time.

What can the vagus nerve stimulation during a seizure?

Some people experience a small alert before a seizure. At this time, they can pass a special magnet over the actuator to create a more potent stimulus for a short period. This may prevent or reduce the seizure of a small seizure to another seizure. For people who do not have a warning sign before a seizure, another person can use a magnet when a seizure occurs.

Although this treatment can cause side effects, they usually only occur when the nerve is being stimulated. Side effects may not occur for everyone but include sore throat, cough, difficulty swallowing, and hoarseness. These side effects may subside over time and usually do not mean that the actuator needs to be turned off. Vaginal nerve stimulation does not affect antiepileptic drugs and does not affect them.

Some people feel that stimulation of the vagus nerve improves their mood, memory, or alertness and may help reduce depression or positively affect their quality of life. However, vagal nerve stimulation treatment is not useful for everyone. If, after two years, no improvement in seizures is observed in the person, the device can be turned off or removed.

If a person is undergoing treatment and needs an MRI, the people involved in the brain scan should be aware of this and decide whether to scan the scan. MRI magnetic fields can cause the interface wire to overheat, which can cause skin burns near the electrodes or interface, depending in part on the device used for the scan. X-rays and CT scans do not affect this treatment and are not affected by it. They do not produce enough waves to damage the actuator. However, extra care may be needed, or it may be necessary to turn off the actuator during the scan and then reactivate it.

Epilepsy surgery

Epilepsy surgery is another type of brain surgery that some people with epilepsy perform to reduce or stop seizures. There are several types of epilepsy surgery. One type of surgery involves removing a specific part of the brain that is thought to cause seizures. Another type of surgery is to separate the brain parts that cause seizures from other parts of the brain. For some people, surgery can reduce or stop the number of seizures. If antiepileptic drugs do not prevent seizures or significantly reduce the number of seizures a person has, surgery may be considered another treatment. If a person is considered eligible for surgery, they may need to have several tests before surgery.

One of the tests that are sometimes used to diagnose epilepsy is a brain scan. The person may have an MRI scan or a CT scan. Although these two methods use different technologies, they result from both brain images that may show the cause of epilepsy. These causes can include brain injuries, developmental abnormalities (problems with brain formation), or damage to the brain from damage to the brain, or an infection such as meningitis.

If a person is being considered for epilepsy surgery, they will need to have it tested before the operation. These may include further MRI scans, electroencephalography (EEG), and video telemetry. Other scans may be done by tracking a chemical that is being injected into the body. This can provide accurate information about where seizures begin in the brain. These tests will confirm whether:

  • Is the surgeon able to find an epileptic lesion in the brain and remove it from the brain?
  • Can other parts of the brain also be affected by surgery?
  • Is the chance of stopping seizures by surgery acceptable?
  • Does the patient have other health problems that can not perform this type of surgery?

Preoperative test results help the patient and physician decide whether surgery is a viable option. For many people, surgery is not a good option.

What are the potential risks of surgery?

Risks associated with surgery vary depending on the type of surgery a person experiences. The most common type of epilepsy surgery is removing part of the brain’s temporal lobe. Possible risks associated with this type of surgery include memory problems, minor vision loss, depression, and other mood-related problems. These risks vary from person to person and, in some cases, may be temporary. For some people, their memory and mood improve after epilepsy surgery.

Immediately after surgery, doctors will monitor the patient’s recovery. For the first few days, she may feel tired and need sleep, as it takes time for the anesthesia to go away completely. Some people who have brain surgery will have seizures during the first week of surgery, but that does not mean that the surgery was unsuccessful. After surgery, seizures may be due to the brain’s direct pressure during surgery, not due to the patient’s history of epilepsy. It usually takes two years after surgery to determine how successful the surgery has been entire.

About 70% of people who have forehead lobe surgery find that the surgery has stopped their seizures, and they no longer have seizures. About 20% of people have seizures. About 50 percent of people who have forehead lobe surgery have no seizures until ten years after surgery, but most will still need to take antiepileptic drugs at times.

Deep brain stimulation

Deep brain stimulation may help people whose epilepsy is difficult to treat and for those who cannot have epileptic surgery to isolate or remove the part of the brain that is causing the seizure. This treatment involves implanting electrodes in specific areas of the brain and then stimulating these areas using small, regular electrical beats. There is currently no conclusive evidence of how good deep brain stimulation is for treating epilepsy. Evidence suggests that deep brain stimulation surgery is associated with risks such as cerebral hemorrhage, infection at the electrode site, depression, and memory problems. These problems may be treatable.

Deep brain stimulation therapy aims to control excess electrical activity in the brain using regular electrical impulses to reduce the frequency and severity of seizures. Tests show that for some people, the number of seizures decreases. For others, this treatment may reduce seizures slightly, and for some, it does not affect. It may also take up to two years for effect to be seen on a person’s seizures. This treatment is used in combination with antiepileptic drugs and not instead. If the treatment is effective, the number of antiepileptic drugs may be reduced over time.

How does this device work?

A battery-powered device called a nerve stimulator transmits electrical impulses to the brain. Electrical impulses are transmitted through connections to electrodes located in the thalamus’s anterior nuclei (ANT). The anterior nuclei of the thalamus are the part of the brain involved in the spread of seizures. A neurosurgeon performs surgery for deep brain stimulation under general anesthesia. During the first part of the surgery, two electrodes are implanted inside the brain through small holes made in the skull. The doctor uses imaging techniques such as MRI to position the brain and position the electrodes. The electrodes are connected to wires that pass under the skin behind the ear through the neck and reach the stimulator. In the second part of the surgery, a stimulus device is implanted under the upper chest area’s skin. It is similar to a pacemaker and has a small battery and a computer chip to send impulses to the brain. After surgery, the actuator is adjusted by a specialist using a small handheld computer. It may take several months to find the correct setting point for the device, and the setpoint is different for each person.

After deep brain stimulation surgery, side effects include drowsiness and tingling, memory problems, and depression that can be seen in some people. These are usually temporary and will decrease over time. Of course, this treatment may not work for everyone. If there is no improvement in the frequency of seizures after two years, your doctor may recommend turning off the device or removing the battery-powered part of the device. Still, the electrodes will probably remain in place.

If a person has had deep brain stimulation and needs to be scanned, people should be informed. The MRI machine’s magnetic fields can cause the electrodes to heat up and burn the brain’s surrounding areas. The risks depend on the type of MRI machine used and the type of scan the person has to do. Deep brain stimulation is not affected by X-rays. However, if a person is exposed to radiation, it is best to temporarily turn off the device.

Use of hemp oil to treat epilepsy

Cannabis is made from hundreds of different components. Two of its well-known compounds are CBD (cannabidiol) and THC (tetrahydrocannabinol). These compounds are commonly found in plant resin. THC is a psychoactive compound that is responsible for the feeling of euphoria (intoxication) in people who take this drug. The maximum allowable THC limit in a product is 0.2%. CBD is not a psychoactive substance and is thought to be the cause of many medical benefits. Medicinal cannabis should only be used in children with the following conditions and as prescribed by a doctor:

  • Having epilepsy that is not affected by regular antiepileptic drugs, the effectiveness of ketogenic diets, or inability to consume ketogenic diets
  • People who are not candidates for epilepsy surgery

However, medical centers say physicians should not be pressured to prescribe cannabis-based products until reliable clinical trial results are obtained. These products must be approved in clinical trials before administration. (Complete Training On The Best Way To Wash Vegetables)

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