The word epilepsy comes from ancient Greek epilepsiswhich means "the seizure" or "the assault". Epilepsy is a clinical picture which, strictly speaking, may only be described as such if at least one epileptical attack - Seizure - occurs with findings typical of epilepsy in the EEG and or MRI of the brainwhich is indicative of an increased likelihood of further epileptic seizures.
Under epilepsy one understands different symptoms regarding the Musculature (motorized), of the Senses (sensory), of Body (vegetative) or the psyche (mentally), which result from abnormal arousal and Spread of excitation in nerve cells of the brain occur more than once. These symptoms are summarized as "Seizure“.
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Depending on the type of epilepsy, it can be, for example rhythmic twitches or Cramping of muscle groups, sweat, Olfactory disorders, Increase in blood pressure, Increased salivation, wetting, tingling, pain or hallucinations come.
In epilepsy, there is not always some prior identifiable explanation for when the seizure occurred, such as a Encephalitis, poisoning or scars in the brain. However, there are various causes that favor the occurrence of epilepsy.
Epilepsy is a common disease. In Germany alone, around 0.5% suffer from it, which affects around 400,000 people. Every year 50 people out of 100,000 inhabitants contract the seizure disorder. The rate of new cases is particularly high in children and adolescents.
Around 3 - 5% worldwide suffer from epilepsy.Children with one of their parents suffering from genetic epilepsy have a chance of developing seizures of up to 4%, which is an eight-fold increase in risk compared to the general population. In symptomatic epilepsy, too, an increased willingness for a seizure disorder was observed in first-degree relatives.
It is now assumed that most epilepsy diseases are based on a genetic predisposition that can be inherited. This applies not only, as has always been assumed so far, to the idiopathic forms of epilepsy, which are almost always of genetic origin, but also to symptomatic epilepsy.
The latter are caused by brain damage as a result of a lack of oxygen, inflammatory processes or accidents. However, recent studies have shown that most patients who have epilepsy as a result of such brain damage are also genetically predisposed. In families in which one person suffers from epilepsy, one can assume a slightly increased risk within the entire family, regardless of the type of epilepsy.
The risk that one parent will pass on an existing epilepsy to the children is approx. 5%, if it is an idiopathic sub-form, it is even 10%. If both parents are affected, the probability of passing on is 20%.
Here, the cause of epilepsy is divided into three categories. There is idiopathic epilepsy, which describes a congenital, i.e. genetic cause. For example, a mutation in an ion channel in the brain can lower the seizure threshold. There is also symptomatic epilepsy, in which structural and / or metabolic (metabolic) reasons can explain the epilepsy.
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The third is cryptogenic epilepsy, in which there is a symptomatic seizure disorder without evidence of the underlying disease being found.
In addition, there are epilepsy-triggering factors that favor a specific epileptic seizure if there is a tendency to seizure.
To what extent stress increases the likelihood of an epileptic seizure has not yet been fully clarified. What is certain, however, is that the relevance of this factor differs from person to person. For example, some people say that stress is the most important trigger factor for them and that they only get seizures during stressful situations.
This was particularly evident in patients whose epilepsy focus is in the temporal lobe. Other studies, however, have shown that stress, in the right amount, can have a positive effect on the course of the disease and reduce the risk of a seizure. Most epileptics learn in the course of their disease to assess well to what extent stress is a triggering factor for them or not.
It has now been proven that drugs can be a trigger for an epileptic seizure. This applies not only to people who already suffer from epilepsy, but also to healthy people, for whom such an attack is then referred to as an occasional attack. But not only the consumption of drugs can lead to a seizure, but also withdrawal from them.
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Mainly amphetamine (speed) is associated with a greatly increased risk of seizures. Thus, people who suffer from epilepsy are strongly advised against the consumption of drugs. If you were already addicted to drugs before the diagnosis of epilepsy, you should definitely talk to a neurologist about this topic in order to discuss how to proceed.
There are many different types of classification. One attempt at classification comes from the International League Against Epilepsy. The disease is divided into focal, generalized, non-classifiable epileptic seizures. In focal epilepsy there is a further subdivision that depends on the state of consciousness of the person.
So a distinction can be made between simple-focal (with awareness) and complex-focal (without awareness).
Primarily generalized epilepsies are diseases in which both hemispheres are affected at the same time. The patients suffer from a deterioration in consciousness and usually cannot remember anything after waking up. The non-classifiable seizures include all seizures that cannot be classified into any other category.
There is also the so-called status epilepticus. These are seizures in rapid succession with no pause (recovery) between them. A status epilepticus can be focal, i.e. restricted to a part of the brain, and must last at least 20 minutes in order to be defined as such.
A generalized epileptic seizure that lasts longer than 5 minutes is also referred to as status epilepticus. This clinical picture must be treated as quickly as possible, as there is a risk of death.
Patients who have epilepsy have no symptoms most of the time. However, this symptom-free time is interrupted by recurring epileptic seizures, which can be associated with the most varied of symptom constellations. There are basically many different types of epilepsy, each associated with different symptoms. Most of those affected report so-called auras that occur shortly before an acute attack. These can be accompanied by feelings of oppression, stomach pain, sensory changes and hot flashes and are in themselves a seizure of their own, which, however, only causes subjective symptoms.$config[ads_text1] not found
The exact severity and timing of these symptoms depend on the location of the epilepsy focus and are groundbreaking in the diagnosis of epilepsy. Furthermore, many patients describe that shortly before an attack they can no longer have clear thoughts. At this moment they seem very apathetic to observers. However, some patients complain of symptoms such as headache, dizziness, or anxiety long before an attack. This phase is known as the prodromal phase.
People who have been suffering from this disease for a long time and have already suffered several seizures can usually assess these symptoms very well and then already have a premonition that an attack is looming in the next few days. However, even in the time between two attacks, some patients report some symptoms that can occur. These include headaches, increased irritability, mood swings and manic depression.
You might also be interested in the topic: Symptoms of epilepsy
A careful examination must be carried out after an epileptic seizure has occurred. This checks whether there is an increased likelihood that more seizures could follow. Genetic causes as well as structural and metabolic reasons are carefully examined and, if possible, diagnosed or excluded.
The diagnosis is structured as follows:
The type of seizure must be determined, so a detailed discussion is important.
When, where, how often did the epileptic seizure occur?
Was there a suspected trigger?
Were you still conscious?
Did the whole body twitch, or just one part of the body?
These and other questions are asked. The diagnosis also includes the age of onset, as there are different causes of epilepsy in different age groups. For example, if an adult has a seizure, it is more likely to be symptomatic, such as a brain tumor, inflammation, etc.
In adolescents, genetic seizures tend to come to the fore. The EEG findings as well as the imaging findings using computer tomography of the head and magnetic resonance tomography of the head are further important components of the diagnosis.
With the EEG, important causes for the development of convulsions can often be filtered out. However, one must not forget that in many cases the EEG can be completely normal during an attack.
CT and MRI of the brain are part of the initial examination to rule out possible symptomatic causes. In addition, inflammatory processes in the central nervous system can give rise to epilepsy, which is why a CSF puncture should be performed if there is clinical suspicion.
In the case of certain suspicions, an organ-specific ("internal") diagnosis is carried out. In particular, provocation factors such as alcohol, drugs, fever and other factors such as hypoglycaemia and excess sugar are examined.
Read more on the topic: Diagnosis of epilepsy
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The MRI is one of the standard diagnostics that was almost always performed after the occurrence of the first epileptic seizure. This imaging procedure can, for example, detect brain lesions that can lead to epilepsy. Furthermore, in some cases you can also see changes that were caused by the previous seizure. The latter are mostly characterized by increased contrast absorption or circulatory disorders.
Changes in the brain structure can be detected in the MRI, especially in the presence of focal epilepsy, that is to say originates from a specific epilepsy focus. Furthermore, the calcification of certain brain structures, such as the hippocampus, can be seen in an MRI, which can also be indications for certain forms of epilepsy.
In drug therapy for epilepsy, a distinction must first be made between two groups. On the one hand, there are drugs that must be taken daily by those affected and act as a prophylaxis to avoid seizures. On the other hand, drugs are used that are for acute cases, i.e. must be taken shortly before an attack occurs.
The general goal of doctors is to achieve seizure freedom, either by correcting symptomatic factors or through well-controlled drug therapy. Which medicine is used depends on the type of seizure. The prophylactic drugs are grouped together as so-called anticonvulsants. There are now over 20 different active ingredients in this group of drugs, each with a different spectrum of action and associated with different side effects.
The most important "anticonvulsant" drugs are: Carbamazepine, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, topiramate, valproic acid.
In focal epilepsies are mainly Lamotrigine and Levetiracetam prescribed, in generalized epilepsy rather valproic acid or Topiramate. In the case of rare individual attacks, i.e. fewer than 2 attacks per year, no medication is prescribed.
For more information, read on: The valproic acid.
The exact dosage and a possible combination of these drugs are individually adapted to each patient, as there are different therapeutic focuses. However, it may be that different drugs have to be tried in the course of the disease, as not everyone reacts equally well to the drugs. Therapy with the first drug leads to permanent freedom from seizures in only about 50% of patients. If a patient is on the right medication, it usually has to be taken by the patient for life.
Otherwise, it is important that the medication is taken regularly and that it is carefully controlled and monitored.
When discontinuing an anticonvulsant drug, it is necessary to take it slowly. That means: At the beginning, a low dose should be given, which is increased over the course of time until the desired concentration in the blood is reached. When monitoring, the focus is on blood values, as they are easy to check and the drug in the body and its concentration can also be detected.
Only after three years of seizure freedom with normal EEG results can an end to drug treatment be considered. A gradual decrease should take place.
Surgical measures should only be considered if no single or multiple drug therapy was successful. An existing isolated area in the brain that causes epilepsy is another requirement. In addition, no areas in the brain that perform important functions may be injured or removed during the operation. If the seizure disorder is pronounced and is based on a larger area in the brain, a partial brain removal (brain amputation) can be considered as the last possible solution.
In preparation for surgical treatment, an EEG and imaging using computed tomography must be performed in order to find the exact location of the focus of the attack. Temporal lobe epilepsy foci are particularly suitable for surgical therapy.
If there is an acute attack, an epileptic attack is first treated with benzodiazepines. The best-known drugs in this group of active ingredients include Tavor and Valium. If these remedies do not bring the desired success, other drugs such as phenytoin or clonazepam are available as a reserve.
In addition to drug treatment, there are general life measure that should be followed. Plenty of sleep and abstinence from alcohol are just as much a part of this as the driving ban.
However, there are rules of their own here: a driver's license is given if the person has been free from seizures for two years, has no abnormal EEG and the drug treatment is regularly checked by a doctor.
Furthermore, epilepsy has an impact on the profession or the choice of profession. Drivers or locomotive drivers, as well as those workers who require climbing ladders and scaffolding, should consider changing jobs.
Read more on the topic: Drugs for epilepsy
Since status epilepticus is a life-threatening situation, it should be treated as soon as possible. This is done using a needle that is placed in a vein Benzodiazepine given. If this does not have an antispasmodic effect, it will act first Valproate and then worked with phenytoin, an anesthetic drug.
Since around 8% of the population will suffer from an epileptic seizure at some point in their life, it makes sense to find out about first aid measures for this situation. An epileptic seizure usually looks very frightening to observers, and an emergency doctor is called quickly, which is absolutely correct. In almost all cases, an epileptic seizure is accompanied by spasm of the entire musculature, which leads to uncontrolled twitching of the body.
An attempt is often made to restrain the patient in order to suppress these twitching. However, this should be avoided at all costs, as the body develops so much force during a seizure that joints or broken bones can become dislocated. In addition, no attempt should be made to push anything between the affected person's teeth, as this can break the jawbone.
In the event of an attack like this, first-aiders can usually do little except to make an emergency call early and memorize the exact course of the attack, as this is very important for the diagnosis. In most cases, the patient is slowly waking up by the time the ambulance arrives, but they are usually confused and disoriented. In addition to giving an electrolyte infusion, the doctor will draw blood to measure the levels of anti-epileptic drugs and to determine the alcohol level.
If another seizure occurs within the next few minutes, one speaks of a status epilepticus, which requires immediate admission to an emergency room.
Many patients who suffer from epilepsy wear what is known as an epilepsy bracelet.In addition to the fact that you are epileptic, it usually also states the means by which you must be treated during an attack and other data that can be important for treating an attack, such as allergies. It is a kind of emergency ID card because you can always carry it with you and can be seen quickly by paramedics or emergency doctors.
Basically, the law says that people suffering from seizures are not allowed to drive vehicles as long as there is an increased risk of seizures with disorders of consciousness or motor skills. So epileptics have to meet some conditions in order to be re-classified as fit to drive. First of all, a patient must be free of seizures for at least one year after a seizure. In addition, it must be assumed that no more seizures will occur in the future, which is usually only possible with adequate drug therapy in the form of prophylaxis.
In principle, people who have suffered from a seizure are initially deprived of their driving license for three to six months. This period depends on whether a clear avoidable trigger, such as drug intoxication, can be identified or not. If several seizures occur within a few years, the person concerned may have their driver's license permanently withdrawn, which for most people represents a major cut in everyday and career planning.
To what extent abstaining from alcohol as part of epilepsy prophylaxis is necessary and sensible, divides the minds of many neurologists to this day. On the one hand, there is evidence that increased consumption can act as a trigger for an epileptic seizure. On the other hand, there is a suspicion that alcohol withdrawal is also a possible trigger in people who are used to small amounts.
So it has been difficult for years to find a uniform guideline for dealing with alcohol in epileptics. Many specialists try to find a compromise between these two sides and advise that epileptics can consume small amounts of alcohol if they are already used to this in their everyday life. It is clear, however, that too much alcohol consumption should be avoided in any case, as this clearly increases the risk of a seizure.
It is no longer a secret that sport has a positive effect on the body and the psyche. This also applies to epilepsy patients, as this not only keeps the body fit, but also reduces the risk of depression. It used to be assumed that there was an increased risk during exercise, as the increased breathing rate could trigger an epileptic seizure.
This fact has since been largely invalidated and it has been proven that many substances that accumulate in our body during exercise, such as lactic acid in our muscles, even inhibit the likelihood of an attack.
However, attention should be paid to the disease in terms of the choice of sporting activity. For example, sports should be avoided in which a sudden attack can have dangerous consequences, such as diving or climbing. In addition, sports should be avoided that involve strong force on the head, as is the case with boxing. With these exceptions, most sports are safe to do.
Like many other drugs, the caffeine in coffee has a stimulating effect on the nerve cells in the brain, which can lower the stimulus threshold for triggering a seizure and thus increase the risk of a seizure occurring. The extent to which coffee has this effect differs from person to person, in addition to the dependence on the amount consumed.
In general, as with alcohol, it is advisable to keep coffee consumption as low as possible. However, if you have drunk coffee your whole life and your body is used to it, it is advisable to continue consuming coffee in small quantities, as it is known that withdrawal can also act as a trigger for an attack.
Probably the most common long-term consequence of epilepsy is an increased risk of developing depression. We now know that this increased risk is not only due to the seizures themselves, but that depression can be a direct result of brain damage, which then leads to symptomatic epilepsy. So it would not be epilepsy that causes depression, but its underlying cause.
Another indirect long-term consequence of epilepsy is the side effects of drug therapy. These mainly include fatigue, mood swings, and possible addiction.
Fortunately, a very rare long-term consequence can be brain damage as a result of a long-lasting epileptic seizure. This is especially the case with a so-called grand mal seizure that lasts longer than 30 minutes. Fortunately, these days this can often be prevented by fast and effective therapy.
Research has long underestimated the connection between migraines and epilepsy. It was only a few years ago that research into and understanding of the precise interaction between these two diseases began. A migraine can in some cases precede an epileptic attack and is then described as a so-called aura. It is even believed that a migraine itself can act as a trigger for an epileptic seizure.
In addition, it is assumed that epilepsies, which are associated with severe development of migraines, can be traced back to a focus in the area of the anterior temporal lobe. As a result, inquiries about possible migraines as part of the anamnesis (medical history) play an increasingly important role in diagnosis.
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There are now many studies that show that the likelihood of developing depression in epilepsy patients is significantly higher than the rest of the population. This fact can be attributed to several causes. On the one hand, epilepsy is associated with great emotional stress for many sufferers, as they are always afraid of having another attack.
In addition, many drugs from the range of anti-epileptic drugs have the side effects that they can have a very depressant effect on the mind and thus also increase the risk of developing depression. New research has also shown that in some cases depression is also due to brain damage that is also the cause of epilepsy, adding to the increased risk in patients with symptomatic epilepsy.
Read more on the topic: Symptoms of depression
When treating epilepsy, one must basically differentiate between two different therapeutic goals. The fundamental goal of any epilepsy treatment is to be seizure free. This is achieved when patients have not suffered any new seizures within two years. Nowadays, this goal can be achieved in around 80% of patients. The exact type of epilepsy is particularly decisive for the treatment prognosis.
A cure for epilepsy can be assumed if the patient has slowly stopped taking their medication and still remains free from seizures. However, a cure is only possible in a few forms of epilepsy. Those forms of epilepsy that manifested themselves in childhood and are not associated with major brain damage have the highest chance. The chances of a cure for epilepsy that only manifested itself in adulthood are considered extremely slim. Most patients have to take prophylactic medication their entire life in order to remain seizure-free.
As in adults, the forms of epilepsy in children are divided into idiopathic, usually with a genetic background, and symptomatic forms. Symptomatic epilepsies are mostly based on changes in the cerebral cortex, inflammatory diseases or complications during childbirth. In children, they are associated with an increased risk of developmental disorders and even severe neurological impairments.
Idiopathic epilepsies usually have fewer complications in terms of development. For example, children with generalized epilepsy, which affects the entire brain, usually do not show any abnormalities and can easily be controlled with medication. In contrast, the idiopathic focal form, which is based on a so-called epilepsy focus, leads to abnormalities in school in some patients. This applies above all to language development and impairment of the ability to concentrate.
All children diagnosed with epilepsy should receive adequate therapy to minimize the risk of developmental disorders. In addition, it is important to carry out extensive diagnostics when an epileptic seizure is suspected, especially in children, as there are many other causes, such as inflammatory processes, that can lead to an attack and a correct one, in addition to the actual epilepsy disease In need of therapy.
For more information, also read: Epilepsy in the child.
In principle, the risk of an epileptic seizure in newborns is very low. However, this changes when babies are born prematurely. About every tenth child born prematurely has a seizure within the first 24 hours. These seizures are summarized under the collective term newborn seizures. The best-known forms of epilepsy that occur within the first year of life include:
The reason for the increased likelihood of seizures in premature babies is that the risk of complications during childbirth is greatly increased, which means that bleeding or lack of oxygen can occur more frequently. These can cause brain damage, which can then trigger a seizure.
Other causes of newborn seizures include:
Depending on which of these factors is the cause of the attack, a different prognosis is assumed. In general, however, it can be said that around half of all newborns with seizures go through normal development through appropriate therapy. However, a third of babies will develop chronic epilepsy at some point in life.
Read more on the topic: Seizure in baby
Febrile convulsions are short epileptic fits that occur after the first month of life and occur in connection with an increased body temperature as part of an infection. It is important that the infection does not affect the central nervous system and that no seizures have occurred before without the fever. With a frequency of around 2-5% in Europe, febrile seizures are the most common form of cramps in childhood. They are also associated with an increased risk of repetition of around 30%.
The risk of developing epilepsy as a result of a febrile seizure in childhood is relatively low, but slightly higher than the rest of the population. The number of febrile seizures, a family history of epilepsy, and the age at the time of the last seizure play a role in the estimated risk.
Read more on the topic: Febrile seizure