Epilepsy is a neurological condition that leads to frequent seizures.
Epilepsy is one of the most common disorders of the nervous system, affecting people of all ages.
Epilepsy can have many causes that are difficult to diagnose.
The types of epilepsy are divided into:
- Symptomatic epilepsy
- Idiopathic epilepsy
- Cryptogenic epilepsy
- Photosensitive epilepsy
Epilepsy is symptomatic if there is a cause for it, for example:
- Cranial trauma
- Infection (for example, meningitis)
- Cerebral vascular malformations
- Senile dementia (affects the elderly)
Some symptomatic epilepsies are caused by diseases such as tuberous sclerosis.
Epilepsy is idiopathic if there is no clear cause for it, but it is believed to be caused by a genetic problem (inherited from one or both parents). Idiopathic epilepsy may be caused by a genetic alteration during pregnancy.
Epilepsy is cryptogenic if the cause has not yet been identified despite existing test results.
Photosensitive epilepsy exists when the seizures are caused by flickering light or light-dark contrast patterns.
These glitches can occur while playing video games.
Photosensitive epilepsy is rare: it can be diagnosed by an electroencephalogram (EEG). This form of epilepsy improves with treatment.
With flashing lights, people with photosensitive epilepsy may be disoriented and feel discomfort.
What frequencies of light can cause epileptic seizures?
Frequencies between 3-30 hertz (repetitions per second) can trigger epileptic seizures, but sometimes frequencies of 60 hertz or those below 3 hertz can also trigger seizures.
What are the causes of epileptic seizures?
In some individuals, epileptic seizures are caused by contrasts of light and shadow, such as stripes or bars, especially when they change direction or flash.
Flashes of light, fantasy effects and the alternation of black and white can cause disorientation, discomfort and general malaise in the affected persons.
This does not mean that they suffer from photosensitive epilepsy.
For most people with photosensitive epilepsy, watching a movie can trigger a seizure.
Risk factors include stress, alcohol, menstrual cycle, insomnia, and some sounds.
There is a type of epilepsy called sleep epilepsy, which only occurs at night and produces seizures during sleep.
Epilepsy in children
What do epileptic seizures mean in newborns?
Epileptic seizures that occur in newborns are caused by oxygen starvation of the fetus during labor (childbirth).
This can occur for the following reasons:
- Developmental disorders
- Problems during childbirth
Absence epilepsy in childhood
Seizures with absences (also called petit-mal seizures) during childhood are temporary loss of consciousness in which the child is unresponsive.
The child’s eyes may twist backwards. The duration of these seizures is about 10 seconds.
Most of the time, the child is not aware of what has happened.
These episodes occur between 1 to 50 times a day.
Myoclonic epilepsy in childhood
Juvenile myoclonic epilepsy manifests when muscle twitching (called myoclonus) occurs upon awakening from sleep. They are sudden, irregular and arrhythmic movements of both arms. Sometimes these movements are limited to the fingers, the person in question appears clumsy and clumsy.
Certain types of myoclonus are normal and do not occur along with epilepsy. The best known is the sleep twitch. Most people feel this involuntary muscle twitch immediately before falling asleep.
Children from 6 months to 5-6 years can get tonic-clonic convulsions with high fever.
If a child falls ill and has a viral disease with high fever, the body temperature increases and convulsions may occur. The epileptic seizure occurs in all body muscles. The febrile seizures can last from a few minutes to half an hour. The epileptic seizures may recur.
Benign Rolando’s epilepsy
Benign Roland epilepsy is a childhood disease with seizures. The convulsions begin at the age of 2 to 13 years.
In most cases, the convulsions are partially motor (muscle spasms) or sensory seizures (numbness or tingling ants).
They occur on the face or tongue and can lead to speech difficulties.
Roland seizures can occur during sleep.
The sudden cramps or spasms are followed by stiffness. During seizures, the arms are forcibly stretched from the body and the body bends forward.
Other seizures are characterized by light and limited movements towards the neck or other parts of the body. A brain disorder or brain injury (such as birth trauma with lack of oxygen) precedes seizures in 60% of these newborns, but in the other 40% the cause cannot be determined.
Lennox-Gastaut syndrome is a rare but very serious disease.
It is characterized by three main symptoms:
- Mental retardation
- Changes in the electroencephalogram (EEG)
- Atypical absences
- Myoclonus and drug-resistant tonic-clonic seizures
Benign occipital epilepsy
In this syndrome, epilepsy and seizures begin between the ages of 5 and 7 years and arise in the posterior lobe of the brain.
The signs and symptoms are:
- Optical hallucinations
- Loss of vision
- Eye deviation and other eye symptoms
The hallucinations can take different forms, are often colored and appear in all sizes. Children complain of headaches and may suffer from nausea and vomiting.
Temporal lobe epilepsy
Temporal lobe epilepsy (outside of the brain) can cause epileptic seizures during the day and night, which may pass silently or occur along with convulsions.
Lactic acidosis can cause mitochondrial encephalopathy:
It occurs at a young age even before the age of 40.
People with mitochondriopathies may have generalized seizures (including myoclonal and tonic-clonic convulsions) and partial or focal convulsions.
Another mitochondrial disease that causes epileptic seizures is shaggy red fiber myoclonus epilepsy (MERRF).
MERRF is one of the progressive myoclonus epilepsies. It occurs along with hearing loss, instability, dementia and loss of balance during physical training. In addition to myoclonic seizures, patients with MERRF may have tonic-clonic seizures (also called grand males).
One of the main symptoms of this syndrome is speech disorders. They can occur suddenly or slowly. In most cases, the condition affects listening comprehension, but there may also be problems with the ability to speak. The epileptic seizures are rare and occur during sleep.
Rasmussen syndrome begins between the ages of 1 and 14 and causes slow and progressive neurological degeneration with convulsions. Epileptic seizures are the first symptoms that appear. Partial motor seizures are the most common signs. In one-fifth of these children, the first epileptic seizure is an episode of partial epilepsy or a tonic-clonic episode.
Hypothalamic hamartoma and epilepsy
Small benign tumors near the hypothalamus (section of the diencephalon) can cause hypothalamic hamartoma syndrome. It causes partial epileptic seizures.
What are the symptoms?
The main symptom is intense and frequent laughter.
Other symptoms include:
Partial epileptic seizures can be simple or complex and secondary tonic-clonic seizures may occur.
Therapy for convulsions and epilepsy
There are various antiepileptic drugs. They work by changing the concentration of chemical substances in the brain that transmit the electrical impulses. This reduces the likelihood of an epileptic crisis.
Old antiepileptic drugs are phenobarbital, phenytoin and sodium valproate.
There are newer antiepileptic drugs that can be used when old antiepileptic drugs cannot be taken or when other medications are taken that could cause problems (such as the birth control pill).
The new drugs are also well tolerated by pregnant women.
New anticonvulsants are gabapentin, Topamax and vigabatrin. Levetiracetam and the old antiepileptic drugs are not recommended for children.
The doctor first prescribes a low dose of the drug, which is then gradually increased within the limits until the spasms are stopped. If an anticonvulsant does not prevent the cramps, another active ingredient is tried. One starts with the new drug in low doses, while the previous drug is slowly reduced.
Antiepileptic drugs can have some side effects.
Initial and mild side effects include:
- Weight gain
- Osteoporosis (loss of bone density)
- Loss of coordination
- Speech disorders
The most serious side effects, which fortunately rarely occur, include:
- Inflammation of some organs (for example, the liver)
In order to best control seizures, the following measures must be observed:
- Take the medication exactly as directed.
- Do not stop taking medication independently without the consent of the doctor.
- Teachers at school and work colleagues need to know how to behave during a seizure.
Consult the doctor if new symptoms appear, such as:
- Inappropriate behaviour
Epilepsy in pregnancy
Some epilepsy medications can harm the fetus. For example, valproate is not recommended for pregnant women. The drug interferes with the growth and development of the child. Other medications can cause malformations in children.
Seizures during pregnancy can lead to serious consequences such as spontaneous abortion or oxygen starvation in the child.
Surgery is often performed when research shows that the spasms begin in a well-defined zone of the brain that does not affect vital functions such as speech comprehension, speech, movements, vision and hearing. During the operation, the doctor removes the area that triggers the spasms.
If the seizures occur in an area of the brain that controls movement, speech and other functions, the patient stays awake during the procedure while the surgeon asks questions to see what is happening.
If the seizures originate from an area of the brain that cannot be removed, the surgeon performs another type of operation in which doctors make incisions in certain areas of the brain (multiple subpial separation). This cutting technique is designed to prevent cramping. If these continue to occur, these transections prevent them from spreading to other brain regions.
After the procedure, many sufferers continue to take medication to prevent the seizures; however, they take fewer drugs and can reduce the dose.
In rare cases, surgery can lead to complications of cognitive abilities and even permanent damage.
Stimulation of the vagus nerve
Among the treatments, there is also stimulation of the vagus nerve. For this purpose, the doctors attach a device (stimulator) for the vagus nerve under the chest skin. The stimulator is similar to a pacemaker.
The electrodes of the stimulator are connected to the vagus nerve.
The device is powered by a battery and sends electrical impulses via the vagus nerve to the brain.
The device reduces convulsions by 20% to 40%.
Some people feel a malaise or aura that announces an impending convulsion. When this happens, a special magnet is used above the stimulator to amplify the stimulus.
This can interrupt the aura and block the seizure or can shorten recovery time after the convulsions.
Most affected people need to take anticonvulsants in significantly lower doses.
When stimulating the vagus nerve, the following side effects may occur:
- Sore throat
- Hoarse voice
- Shortness of breath
Deep cerebral stimulation
Deep cerebral stimulation is a surgical treatment to avoid medication. This involves the installation of electrodes in special brain areas.
Some children with epilepsy experience fewer epileptic seizures from a diet high in fat but low in carbohydrates and sugar.
With this diet (ketogenic diet), the body uses fats instead of carbohydrates for its energy. After a few years, some children may stop the ketogenic diet and no longer develop convulsions.
A doctor must monitor the children’s diet to avoid the risk of malnutrition.
Side effects of the ketogenic diet include:
- Slower growth
- High uric acid in the blood
- Kidney stones
These side effects rarely occur if the diet is recommended by a doctor.
How long does the disease last? Prognosis for epilepsy
Some people reduce or stop the convulsions with the anticonvulsants.
Epilepsy that occurs in childhood can heal or improve over the years, usually in late teens or around 20 years of age.
Quality of life is normal, except when the patient suffers a seizure.
For many people, epilepsy is a lifelong condition.
In these cases, anticonvulsant drugs must be taken constantly.
There is a small risk of sudden death caused by epilepsy. One can risk serious injuries if the seizures occur while driving or at work while operating machines.