What is epilepsy?
Epilepsy is a disease in which certain repeated insults take place as a result of chronic abnormalities in the brain structure, which lead to abnormal and / or synchronized activity of neurons. Epilepsy is often confused with seizures; However, not everyone who has a seizure actually receive epilepsy; the reverse is actually the case. Epilepsiën are often described according to the type of attack that occurs or an epilepsy syndrome that underlies. Treatment consists mainly of prescribing anti-epileptic medication. Antiepileptic drugs are by definition anti-ictogeen; they prevent seizures, but can not cure epilepsy. Surgery and other alternative interventions are primarily used when a patient is insufficiently controlled by medication.
Feature
Epilepsy manifests itself in many different forms. What all types have in common is a temporary verandering- or loss of consciousness, often with the loss of control over certain muscles. Sometimes an epileptic attack can feel coming. There is then question of a so-called aura, or a prodrome. The aura that one experiences is very personal. Some people experience a strange taste in the mouth, or hear, see or smell something not perceive another. Others, for example, have a strange feeling uncomfortable from the stomach or intestines or in one or more limbs.
What causes epilepsy?
Epilepsy can be congenital or later. There is a strong correlation has been found between schizophrenia and epilepsy. They are connected to each other. People with epilepsy are 8 times more likely to develop schizophrenia. People with schizophrenia have a six times greater risk of epilepsy.
Sometimes there is a demonstrable cause (symptomatic) but often not (idiopathic). Acquired epilepsy following brain injury can occur, for example, after a birth injury, after a cerebral contusion or as a result of circulatory disorders (stroke). Other causes of epilepsy are stimulation by a brain tumor or a brain inflammation, but also a genetic defect (e.g., a deviation on the SCN1A gene) may be the cause.
The diagnosis of epilepsy is made on the basis of the characteristic phenomena and on the basis of an electro-encephalogram (EEG or 'brain film'), that in the different types of attacks shows characteristic disorders. An MRI scan can not demonstrate epilepsy. However, the cause of epilepsy can, if there are epilepsy has been established, are marked by an MRI, if there are any abnormalities in the area that causes the epilepsy. Sometimes, this causal be treated.
Types of epilepsy
Epilepsy can be broadly classified into four types:
- Partial epilepsy
- Generalized epilepsy
- Epilepsy, which is uncertain whether it is localized or generalized
- Special syndromes
In partial seizures arise from local electrical discharges (called a focus or place), phenomena that correspond to the function of that part of the brain. The symptoms that occur are dependent on the part of the brain. The attack (electrical discharges) can cause other symptoms, and then expand the involvement of a different part of the brain.
Partial seizures are divided into elementary partial and complex partial seizures. The difference between these two forms is that none at elementary partial seizures and complex partial seizures exist consciousness changes. Elementary partial seizures can manifest itself for example by contractions of an arm or a leg. Complex partial seizures can manifest themselves in the form of sudden episodes of disturbance of consciousness and psychic phenomena (eg twilight states in which the patient may wander or roam, without there afterwards to remember something). Also avoid automatic movement (which, for example stereotyped movements such as fidgeting with his hands, smacking mouth movements, etc. are made).
Other common symptoms include:
- The patient may include salivation get a prior seizure / attack.
- The attack begins with a strange feeling in the stomach (epigastric aura), a smell or taste hallucination or a speech disorder (aphasia).
- Sometimes the patient during the attack shows him strange, aggressive, or very anxious behavior.
- Jackson epilepsy is a form of (elementary) partial epilepsy. A typical Jackson attack begins with tingling in the hand. This starts to shake and it spreads throughout your body.
Generalized epilepsy
Tonic clonic seizure
(formerly known as grand mal) The most famous and dramatic seizure is the generalized seizure (tonic-clonic seizures or grand mal). It suddenly all brain cells stimulated by electrical discharges. On such an attack is often a strange malaise or an aura before. The attack itself, the patient loses consciousness and creates a contraction of the whole body. This is the tonic phase. This could prevent a tongue bite. After a few seconds arise increasingly violent muscular jerks, the clonic phase. The eyes are often open and turned away. There is often urinary incontinence. Since breathing falters as the spasm, the patient is first red, then blue. Then follows a breath blowing foam at the mouth. After the twitching is a 15 minute-long unconsciousness from which the patient often wakes up in a confused state. Such attacks can sometimes continual succession, so that the consciousness in between is not clear at all (status epilepticus). This is a dangerous condition because of lack of oxygen brain damage can occur.
Absences
(formerly called petit mal) This form of epilepsy is characterized by almost always short bout with drop of consciousness. These attacks are often so short-lived that they go unnoticed. The head can nod briefly, the speech may be a few seconds and then resumes normal sticks or a blank look (stare) can attack characteristics. Occasionally, a few shocks in the arm or the patient flashes with the eyelids. Also suction and chewing movements often occur.
Epilepsy in children
In children, epilepsy is often reflected in a different way than in adults. In children aged 4 to 12 years can occur absences. These attacks take 5 to 10 seconds in which the child abruptly stop activity and then again abruptly resumed. The child may have a hazy expression, and may involve muscle jerks around mouth and eyelids or smak-, chewing or friemelbewegingen. After the absence child continues with its activities without itself having noticed anything. Attacking these particles occur many times a day. This form of epilepsy is usually treatable and often goes back over a few years.
Much more serious are the so-called infantile spasms, this is a form of epilepsy that occurs from the age of 5 to 6 months. Often there is a brain injury. These attacks include sudden bending or stretching spasms head with trunk for a few seconds. These cramps usually occur in ranges from a few to very many cramps. The prospects are often poor: learning disabilities and severe epilepsy. This also applies to the so-called syndrome of Lennox-Gastaut. This is a form of epilepsy that can occur in two to five year old children with brain damage. Attacks of sudden stiffening of the muscles or just relax the muscles, causing the child falls abruptly and be injured.
Dravet's syndrome is a relatively newly described epilepsy syndrome. Children with this syndrome have many different types of seizures and often have a severe learning disability. Epilepsy starts very young, within a few months after birth. The initial attacks are often triggered by fever. The attacks can last long, sometimes three hours.
Febrile seizures are seizures in children 6 months to 4 years, which may occur when the body temperature rises sharply and (fever). These seizures can recur at a later fever period. The chance that develops in children with febrile seizures later epilepsy is slightly raised but still not great. Febrile seizures are basically harmless, but the cause of high fever, this is not always - one must be aware of causes as pneumonia or meningitis.
Epilepsy treatment
The treatment of epilepsy mainly consists of drugs that have different mechanisms of action. The drug to be used and the effect of the treatment varies very per person. Some patients with epilepsy benefit from a regular lifestyle to prevent disruption. Other possible treatments are epilepsy surgery, vagus nerve stimulation, deep brain stimulation, ketogenic diet and other diets. Some activities are not wise if seizures occur frequently. For driving only (license) are subject to legal regulations. If, because of a medical situation licenses may no longer be used, an AM license may be requested for the moped. The rules for driving are also strongly determined individually, depending on license type (ordinary driving license or a professional driver), type of epilepsy and the time of occurrence of attacks. Per person applies to other activities are sometimes or always unwise to do, think of swimming, diving, skiing and use of dangerous machinery. For this always holds that should be thought about the consequences of a possible attack during such activity, and the risks to the patient and his environment thereby want to take.
Epilepsy medications
There are special drugs for epilepsy. Some examples of anti-epileptic drugs:
Acetazolamide, apelesca, carbamazepine, clobazam, clonazepam, diazepam, ethosuximide, felbamate, phenobarbital, phenytoin, gabapentin, heptobarbital, lacosamide, lamotrigine, levetiracetam, lorazepam, midazolam, mesuximide, nitrazepam, oxcarbazepine, pentobarbital, pregabalin, primidone, rufinamide, stiripentol, sulthiam, tiagabine, topiramate, valproic acid, vigabatrin, zonisamide
Epilepsy surgery
Indication
Not every epileptic patient just undergone surgery. Surgery is considered only if the patient does not respond to the medications that are prescribed. The attacks keep coming and impede his life. The attacks affect his life and can inflict serious damage to the patient in his life. There is clearly an area designated in the brains where the epileptic fireplace is located. It is here that the seizures. It can operate only in a partial form of epilepsy. It is often operated in the area of the temporal lobe (temporal lobe) and the frontal lobe (frontal lobe). The surgeon must make sure that the part where the epilepsy arises can be removed and that the operation will not damage the brains can lead to a result of the loss of brain function. The surgery should not take place if there is a risk of loss of memory, speech or other important functions of the brains.
Risks
Surgical intervention is not without risk, both for the operation itself as in the previous investigations. There is always a chance of brains damaged by the surgery. This damage can lead to paralysis, problems with language, memory problems or vision problems. Also doing a depth-EEG or conducting investigations WADA brings risks. The WADA studies, research on exactly where the language and memory functions are in the brains.