Epilepsy

nadersmadi@hotmail.com
 Introductio
n
• Epilepsy is a disorder that disrupts the
transmission of electrical signals inside the
brain. Although you may assume that
epilepsy always causes episodes of
uncontrolled movements and loss of
consciousness, the condition is actually
quite variable. Symptom episodes — known
as seizures — are often subtle, causing
strange sensations, emotions and behavior.
Some people with epilepsy simply stare
blankly for a few seconds when having a
seizure, while others have full-fledged
 Introductio
n
• About one in 100 people in the United
States has experienced an unprovoked
seizure at some point in life. However, a
solitary seizure doesn't mean you have
epilepsy. Many people — for example,
children with high fevers — experience one
seizure and then never have another one.
But after you've had two seizures, the
chance that you'll have additional seizures
increases dramatically. At least two
unprovoked seizures are required for a
diagnosis of epilepsy.
 Introductio
n
• The onset of epilepsy is most common
during childhood and after age 65, but
the condition can occur at any age.
Treatments may leave you free of
seizures, or at least reduce their
frequency and intensity. Many children
with epilepsy even outgrow the
condition with age
 Signs &
Symptoms
• Because epilepsy is caused by abnormal
activity in brain cells, seizures can affect
any process your brain coordinates. A
seizure can produce temporary
confusion, complete loss of
consciousness, a staring spell, or
uncontrollable jerking movements of the
arms and legs.
• Symptoms vary depending on the type of
seizure. In most cases, a person with
epilepsy will tend to have the same type
of seizure each time, so the symptoms
will be very similar from episode to
episode. But some people have many
different types of seizures, with different
 Signs &
Symptoms
• Doctors classify seizures as either
partial or generalized, based on how
the abnormal brain activity begins.
When seizures appear to result from
abnormal activity in just one part of
the brain, they're called partial or focal
seizures. Seizures that seem to involve
all of the brain are called generalized
seizures. In some cases, seizures can
begin in one part of the brain and then
spread throughout the rest of the
 Partial
Seizures
• Simple partial seizures. These seizures
don't result in loss of consciousness. They
may alter emotions or change the way
things look, smell, feel, taste or sound.
• Complex partial seizures. These
seizures alter consciousness, causing you
to lose awareness for a period of time.
Complex partial seizures often result in
staring and nonpurposeful movements —
such as hand rubbing, lip smacking, arm
positioning, vocalization or swallowing.
 Generalized
Seizures
• Absence seizures (petit mal). These
seizures are characterized by staring, subtle
body movement and brief lapses of
awareness.
• Myoclonic seizures. These seizures
usually appear as sudden jerks of your arms
and legs.
• Atonic seizures. Also known as drop
attacks, these seizures cause you to
suddenly collapse or fall down.
• Tonic-clonic seizures (grand mal). The
most intense of all types of seizures, these
are characterized by a loss of
 Causes
• Several types of epilepsy have been linked to
defective genes that regulate how brain cells
communicate with each other, but only a few
rare types of the disorder are known to arise
from specific gene defects. Otherwise, it
appears that abnormalities in any of several
hundred genes may play a role in the
development of epilepsy. Although some
forms of epilepsy tend to run in families,
genetic inheritance plays only a partial role in
causing epilepsy — perhaps by making a
person more susceptible to environmental
factors that cause seizures.
• In many cases, the onset of epilepsy can be
traced to an accident, disease or medical
trauma — such as a stroke — that injures
your brain or deprives it of oxygen. In rare
 Risk Factors
• If you have a family history of epilepsy, you may be at increased
risk of developing a seizure disorder.
• Head injuries are responsible for many cases of epilepsy. You
can reduce your risk by always wearing a seat belt while riding
in a car and by wearing a helmet while bicycling, skiing, riding a
motorcycle, or engaging in other activities with a high risk of
head injury.
• Stroke and other vascular diseases can lead to brain damage
that may trigger epilepsy. You can take a number of steps to
reduce your risk of these diseases, including limiting your intake
of alcohol, following a healthy diet, managing your weight,
exercising regularly and avoiding cigarettes.
• Other epilepsy risk factors include brain infections, such as
meningitis, and prolonged seizures in childhood due to high
fevers.
 When to seek medical
advice
Seek medical help if any of the
following occur:
• The seizure lasts more than five minutes.
• Recovery from your seizure is slow.
• A second seizure follows immediately.
• You're pregnant or have diabetes.
• Your seizures change in frequency and
severity.
• There's a change in the way you feel
during and after the seizures.
 When to seek medical
advice
• Your seizure is preceded by a sudden,
severe headache or other symptoms or
signs of stroke — including weakness or
numbness on one side of your body, vision
loss, confusion, and coordination or speech
problems.
• If you see someone having a seizure, call for
medical help immediately and then follow
these tips:
• Gently roll the person onto one side and put
something soft under his or her head.
Loosen tight neckwear.
 When to seek medical
advice
• Don't try to restrain someone having a
seizure, and don't attempt to rouse the
person by shouting at or shaking him or her.
If the person is moving, clear away
dangerous objects.
• Look for a medical alert bracelet. The
bracelet should state who to contact in an
emergency and what medications the
person uses.
• Stay with the person until medical personnel
arrive. If possible, observe the person
closely so that you can provide details on
what happened.
 Screening & Diagnosis
• Electroencephalogram (EEG)

• Computerized tomography (CT)

• Magnetic resonance imaging (MRI)

• Positron emission tomography (PET)

• Single-photon emission computerized tom

 Electroencephalogram
(EEG)
• An EEG records the electrical activity of your
brain via electrodes affixed to your scalp.
People with epilepsy often have changes in
their normal pattern of brain waves, even
when they're not having a seizure.
• To prepare for an EEG, avoid elaborate hair
styling, metallic hair spray or greasy hair
dressing. Refrain from caffeine for six hours
before the test. The procedure itself is
painless and usually lasts about 30 minutes.
However, it can take as long as an hour to
place the electrodes on your scalp.
 Electroencephalogram
(EEG)
• In some cases, your doctor may recommend
video-EEG monitoring. This can be helpful
because it allows your doctor to compare —
second by second — the behaviors that
occur during a seizure with your EEG pattern
from exactly that same time. This helps your
doctor pinpoint exactly where your seizures
originate, which aids treatment decisions.
• Video EEGs are expensive because you
usually must stay at the testing facility for
several days. The EEG electrodes stay
attached for that entire time, and you are
videotaped continuously.
 Computerized tomography
(CT)
• Using special X-ray equipment, CT
machines obtain images from many
different angles and join them together to
show cross-sectional images of your brain
and skull. CT scans can reveal
abnormalities in brain structure, including
tumors, cysts, strokes or tangled blood
vessels. This helps your doctor rule out
other potential causes of your seizures.
 Computerized tomography
(CT)
• To prepare for a CT scan of your head, you
should remove such things as earrings,
eyeglasses, dentures and hairpins. You
may need to have an intravenous (IV) line
inserted if your test requires the injection
of a contrast material — which makes
abnormalities easier to see. During the
test, you will lie on a table that slides into
the CT machine. Depending on the number
of images needed, the scan can take
between two and 20 minutes. The
procedure is painless.
 Magnetic resonance imaging
(MRI)
• An MRI machine uses radio waves and a strong
magnetic field to produce detailed images of your
brain. Like CT scans, MRIs can reveal brain
abnormalities that could be causing your
seizures. Dental fillings and braces may distort
the images, so be sure to tell the technician
about them before the test begins.
• During the test, you will lie on a padded table
that slides into the MRI machine. Your head will
be immobilized in a brace, to improve precision.
The test is painless, but some people experience
an uncomfortable feeling similar to
claustrophobia inside the MRI machine's close
quarters. If you think you may have a problem
 Magnetic resonance imaging
(MRI)
• A special type of MRI — called functional MRI
(fMRI) — can measure the small metabolic
changes that occur when a part of your brain
is working. An fMRI can record which areas of
your brain are working when you perform
certain tasks, such as rubbing a block of
sandpaper or answering simple questions.
• Doctors know the general areas of the brain
responsible for such tasks as thought, speech,
movement and sensation, but the precise
locations vary by individual. An fMRI can
identify the locations of these critical
functions so that your doctor can determine if
epilepsy surgery would be a safe option for
 Positron emission tomography
(PET)
• PET scans use injected radioactive material to help
visualize active areas of the brain. The radioactive
material is tagged in a way that makes it attracted
to glucose. Because the brain uses glucose for
energy, the parts that are working harder will be
brighter on a PET image.
• After the radioactive material is injected, it will take
between 30 and 90 minutes for the substance to
accumulate in your brain tissue. During this waiting
period, you will be asked to rest quietly and not talk
or move around much. The actual scan takes 30 to
45 minutes. The amount of radioactive material
used in the test is very small, and its glucose-
binding activity in the brain lasts only a short period
of time.
 Single-photon emission
computerized tomography
(SPECT)
• This type of test is used primarily in people
being evaluated for epilepsy surgery when
the area of seizure onset is unclear on MRIs
or EEGs. SPECT imaging requires two scans
— one during a seizure and one 24 hours
later. Radioactive material is injected for
both scans and then the two results are
compared. The area of the brain with the
greatest activity during the seizure can be
superimposed onto the person's MRI, to
show surgeons exactly what portion of the
 Complications
• If you fall during a seizure, you may
sustain a head injury. Drowning is a
very real risk if you have a seizure
while swimming or bathing.
• A seizure that causes either loss of
awareness or control can be
dangerous if you're driving a car or
operating other equipment. Drugs
used to control seizures also can cause
drowsiness, which may affect your
driving ability. Many states have
 Complications
• Seizures during pregnancy pose dangers
to both mother and baby, and certain
anti-epileptic medications increase the
risk of birth defects. If you have epilepsy
and you're considering becoming
pregnant, talk to your doctor. Most
women with epilepsy can become
pregnant and have a healthy baby, but
many need to adjust their medications
and be carefully monitored throughout
pregnancy. It is very important to work
with your doctor and to plan your
 Complications
• Life-threatening complications from epilepsy
are uncommon, but do occur. People who
have severe, prolonged or continuous
seizures (status epilepticus) are at increased
risk of permanent brain damage and death.
People with epilepsy, particularly people with
poorly controlled epilepsy, also have a small
risk of a condition called sudden unexplained
death in epilepsy (SUDEP). Your risk of SUDEP
increases if you:
– Began having seizures at an early age
– Have frequent seizures that involve more
than one area of your brain
 Treatment

• Anti-epileptic drugs

• Surgery

• Vagus nerve stimulation

• Ketogenic diet
 Anti-epileptic drugs
• Most people with epilepsy can become
seizure-free by using a single anti-epileptic
drug. Others can decrease the frequency
and intensity of their seizures with
medication. More than half the children with
medication-controlled epilepsy can
eventually stop medications and live a
seizure-free life. Many adults also can
discontinue medication after two or more
years without seizures.
 Anti-epileptic drugs
• Finding the right medication and dosage can
be complex. Your doctor likely will first
prescribe a single drug at a relatively low
dosage, and may increase the dosage
gradually until your seizures are well
controlled. If you've tried two or more
single-drug regimens without success, your
doctor may recommend trying a
combination of two drugs.
• All anti-seizure medications have some side
effects, which may include mild fatigue,
dizziness and weight gain. More severe side
effects include depression, skin rashes, loss
 Anti-epileptic drugs
• To achieve the best seizure control possible,
take medications exactly as prescribed.
Always call your doctor before switching to a
generic version of your medication or taking
other prescription medications, over-the-
counter drugs or herbal remedies. And
never stop taking your medication without
talking to your doctor.
• If anti-epileptic medications don't provide
satisfactory results, your doctor may
suggest other treatment options — such as
surgery, vagus nerve stimulation or a
ketogenic diet.
 Surgery
• Surgery is most commonly done
when tests show that your
seizures originate in a small, well-
defined area in the temporal
lobes or the frontal lobes of your
brain. Surgery is rarely an option
if you have seizures that start in
several areas of the brain or if
you have seizures originating
from a region of the brain that
 Surgery
• During the procedure, your surgeon makes
an incision in your scalp and removes a
piece of the skull bone. He or she then cuts
into or removes the area of the brain that's
causing the seizures.
• Although many people continue to need
some medication to help prevent seizures
after surgery, you may be able to take fewer
drugs and reduce your dosages. In some
cases, surgery for epilepsy can cause
complications such as permanently altering
your cognitive abilities. Talk to your surgeon
about his or her experience, success rates
 Vagus nerve stimulation
• A device called a vagus nerve stimulator is
implanted into your chest under the
collarbone. Wires from the stimulator are
wrapped around the vagus nerve in your
neck. The vagus nerve connects your brain to
your heart, lungs and gastrointestinal tract.
The device turns on and off according to an
adjustable program. It's not clear how brain
stimulation via the vagus nerve inhibits
seizures, but the device reduces seizures by
about 20 percent to 40 percent on average.
Most people still need to take anti-epileptic
 Ketogenic Diet
• Some children with epilepsy have been
helped by adopting a rigid diet that's high in
fat and protein and low in carbohydrates.
The goal of the diet is to get the body to
produce ketones, which cause the body to
use fat instead of glucose for energy. The
exact way in which the ketogenic diet works
is unclear.
 Self-care
• Understanding your condition can help
you control it. Be sure to take your
medication correctly. Don't take it
upon yourself to adjust your dosage
levels. Instead, talk to your doctor if
you feel something should be
changed.
 Self-care
• It's also important to keep a detailed
seizure record. This record can help your
doctor better understand your condition
and direct your treatment. Each time a
seizure occurs, write down the time, the
type of seizure it was and how long it
lasted. Also make note of any unusual
circumstances, such as changes in
medication, increased stress or other
events that might trigger seizure activity.
Seek input from people who may observe
your seizures — including family, friends
and co-workers — so that you can record
information you may not know.
 Self-care
• As with many chronic conditions,
maintaining your overall health is an
important step in controlling epilepsy.
Sleep deprivation is a powerful trigger of
seizures. Be sure to get adequate rest
every night, and make a conscious effort
to eat a balanced diet, exercise and
manage stress effectively.
• Excessive alcohol consumption may
trigger seizures. If you have difficulty
avoiding alcohol and cigarettes, ask your
doctor for help.
• Wear a medical bracelet to help
emergency personnel. The bracelet
should state who to contact in an