Epilepsy or recurrent epileptic seizures are a neurological disease of the brain. Especially the convulsive and twitching seizures are a clear sign of epilepsy.
What is epilepsy?
Infogram showing EEG changes during an epileptic seizure. Click image to enlarge. Epilepsy is a neurologic and chronic disease in which the typical epileptic seizures may occur. These seizures are usually accompanied by convulsions. Epilepsy is present when such seizures occur regularly. Biologically, epileptic seizures are acute dysfunctions in the central nervous system in the brain. As a rule, seizures last up to two minutes. Furthermore, epilepsy causes tremors or twitching and impaired consciousness as well as memory lapses. In Germany, about one percent of the population (mainly children and adolescents) suffer from epilepsy or epileptic seizures.
Causes
The causes of epilepsy can vary widely. However, depolarizations, or abnormal discharges, in the nerve cells of the brain are considered most common, and this can lead to high excitability. Other causes include hyperventilation, lack of sleep, psychological and emotional stress, drug use (including alcohol), and lack of oxygen. Epilepsy can have hereditary or familial causes. Especially if there were predispositions in the direct ancestors related to metabolic disorders, brain diseases and psychosomatic diseases. Epilepsy itself, can be divided into idiopathic and symptomatic epilepsy.
Symptoms, complaints, and signs
Symptoms in epilepsy can vary widely. For example, twitching and convulsions do not occur in every affected person. In addition, a distinction must be made between focal and generalized epileptic seizures. A typical feature of an epileptic seizure is open, empty, twisted or fixed eyes. The seizure takes a maximum of two minutes. It is not uncommon for it to last only a few seconds and to be noticeable only as an interruption. In some epileptics, however, the symptoms also degenerate into twitching of limbs or extensive disturbances of consciousness or movement. If a so-called grand mal seizure occurs, which is accompanied by rhythmic twitching and convulsions, the following days often result in a muscle ache. A distinction must also be made between a focal and a generalized epileptic seizure. A focal seizure originates in a specific region of the brain. The type of symptoms depends on this region. If the seizure occurs on the right side of the brain, it results in twitching on the left side of the body. In contrast, if the seizure originates on the left side of the brain, the limbs on the right side of the body are affected. Some epileptics also perceive colors or flashes of light. Furthermore, there is a risk of symptoms such as pressure in the abdomen, palpitations, dizziness, anxiety, and the perception of voices or sounds. A generalized epileptic seizure is said to occur when it originates from the entire brain. In this case, there is pronounced clouding of consciousness, which can extend to severe unconsciousness.
Course
Epilepsy exhibits a chronic disease course. This means that the disease is recurrent and the seizures or epileptic fits may recur again and again. If epilepsy is treated, its prognosis for recovery is quite favorable. Nevertheless, it is not possible to speak of a holistic cure as long as the affected person is on medication against the epilepsy. Nevertheless, the chance of living without epileptic seizures with successful treatment is about 60 to 80 percent. Complications usually only occur when generalized seizures occur. In this form of epilepsy (status epilepticus), the affected person does not regain consciousness between seizures. Here, a life-threatening course can then occur.
Complications
Well-controlled patients must attend regular check-ups despite being symptom-free. This is because epilepsy can recur even if medication is taken. The specialist uses blood tests to determine whether the medication is sufficient or perhaps can even be lowered. Check-ups are also important after a surgical procedure.If the seizures were triggered by a tumor or a blood clot in the head, the events may recur despite removal of the cause. Shortly after surgery, the controls are in a narrow time frame. After a while, the interval can be extended. Untreated epilepsy regularly leads to the death of brain cells. This is true for BMS – seizures in infancy as well as grand mal seizures in adolescents and adults. Healthy brain cells can take over the activity of the affected cells to a certain degree. The statement “to some degree” should be taken literally because, unlike other cells in the body, the cells of the brain cannot be repaired or replaced. Another danger of untreated epilepsy is that seizures become more frequent and endanger more than just the sufferer. Drivers who suffer from it are a risk to other road users. If an accident is based on an epileptic seizure, the affected person must expect high penalties.
When should you go to the doctor?
In the event of an epileptic seizure, a doctor should always be consulted. The cause of the seizure should be medically investigated, even if it lasts only a few minutes or if several years have passed between the onset of the seizure. There is a risk with any seizure that brain damage may be present or that the seizure may lead to further dysfunction. These must be diagnosed and subsequently treated to avoid triggering permanent consequences. An individual decision is made after a comprehensive examination as to whether further therapy should be carried out. At the latest after suffering several epileptic seizures, it is recommended to start a therapy. If inflammatory symptoms or a metabolic disease are present, medical care is necessary. In some patients, surgical intervention is performed, which can lead to permanent freedom from symptoms. Since any epileptic seizure can occur due to a different cause, it is necessary to be re-examined if another seizure occurs. It is helpful if an observer of the epileptic seizure is present during a visit to the doctor. This person can provide important information about the course of the seizure, which helps to establish the diagnosis. If the patient decides to take medication, he or she should consult a physician as soon as unusual side effects develop or intolerances occur.
Treatment and therapy
The therapy or treatment of epilepsy should definitely be carried out by a specialist. It is also important to bring witnesses of an epileptic seizure to better describe the exact symptoms. Afterwards, the patient’s brain is usually examined with magnetic resonance imaging (MRI). The main purpose here is to detect structural abnormalities and abnormalities. After that, unusual neuronal discharges can then be diagnosed using electroencephalography (EEG). Immediate measures to be taken in the event of a sudden epileptic seizure are primarily to prevent injury from falls. Likewise, dangerous and sharp objects should be avoided in a household where an epileptic resides. A soft floor is also favorable. In addition, family members or other accompanying persons should document the seizure in detail. This will help the doctor later in individual treatment. If the acute seizure lasts longer than two minutes, the emergency physician or urgent medical assistance should be requested.
Outlook and prognosis
Epilepsy has a very individual prognosis. There are people who experience an epileptic seizure once in their lifetime and subsequently have complete freedom from symptoms. No sequelae or other health impairments occur. These patients have a good prognosis, although they do not initially know that they belong to this group of patients. If no further seizures occur within 3-4 years, doctors speak of recovery. No more abnormalities can be detected in the EEG. Thus, the epilepsy is considered cured. In a large number of patients, an underlying disease can be diagnosed. The prognosis depends on the disease and can be quite different. If the underlying disease is cured, the epilepsy also disappears. If, however, the epilepsy cannot be cured, in most cases relief of the symptoms can be achieved with drug treatment.Approximately 90% of patients become seizure-free with the drugs and can experience a good quality of life despite epilepsy. This is especially true for patients affected by brief seizures with mild disturbances of consciousness. 50-80% of patients who experience particularly severe seizures experience a significant improvement in symptoms within one year with therapy. Nevertheless, there is a possibility of lifelong severe impairment as well as severe sequelae due to epilepsy.
Follow-up
Because epilepsy is incurable, regular and comprehensive follow-up care is required. Epilepsy, which has its cause in the brain, can change constantly during the course of the disease. Therefore, an EEG should be done regularly, and imaging of the head such as MRI may even be necessary to identify the cause and readjust if necessary. Likewise, the physician should puncture cerebrospinal fluid, or nerve fluid, as the cause can also be found this way. The patient should see a doctor regularly to check the setting of the medication as well as possible side effects and, if necessary, make a change. If a drug therapy and also its change fail, a surgical therapy can be an alternative possibility. The patient should be informed about this possibility and, if he agrees, prepared accordingly. Psychological support for the patient can also be useful in order to recognize and prevent psychological sequelae. Antidepressants may then be necessary, as depression is a frequent secondary illness. Psychological care for the patient’s relatives may also be advisable. In addition, the relatives should be trained to recognize an epileptic seizure in case it occurs and to take appropriate measures. In the event of a seizure, emergency medical attention should be called immediately, as it can be life-threatening.
What you can do yourself
People with epilepsy have some ways to reduce the chances of having a seizure without taking medication exclusively. For example, a ketogenic diet (high in fat, low in carbohydrates, moderate in protein) has been shown to reduce the risk of seizures in about two-thirds of sufferers. Why this is so is unclear. This diet is effective after a few weeks and should be followed for several years. It has a few side effects, especially at the beginning, and can have a negative effect on the cardiovascular system in the long term. Within the framework of a so-called biofeedback therapy and in the course of behavioral therapy measures, it is possible for those affected to gain increased control over the triggering brain areas. Thus, in many cases it is possible to counteract a stimulus-induced overdrive of the corresponding area. Transcutaneous vagus nerve stimulation is non-invasive and does not require hospitalization. It consists of targeted stimulation of the vagus nerve by means of a pulse generator placed in the ear, the intensity and frequency of which can be adjusted by the patient. The excitation by a mild tingling sensation is conducted to the brain and reduces the probability of seizures. Carrying an epilepsy dog brings safety because it provides an early warning system. For the most part, these dogs can be trained to alert the epileptic, remove dangerous objects from their environment, and draw attention (for the purpose of helping them have a seizure).
