EPILEPSY (FITS/ CONVULSIONS)miracleshealthclinic
Epilepsy is a serious neurological disorder affecting children as well as adults. The patient experiences episodes of convulsive body movements medically termed as seizures. The seizures are typically described and observed as spasmodic, irregular body movements, affecting various muscle groups of the body. It may present with varying intensity and duration, and different groups of muscles in different individuals, at different times.
Typically, epilepsy or seizures occur due to abnormal electrical activity in the brain which is reflected in different groups of muscles.
Epilepsy is a chronic disease having a tendency to relapse periodically and for many years to lifetime, if not adequately treated.
Signs and symptoms of epilepsy:
The most common symptom or a sign of epilepsy is recurrent seizures or convulsions.
Seizures are involuntary movements, like jerking or thrashing or experiencing unusual feelings or sensations, which can be associated with loss of consciousness or being unaware of things happening around.
One may experience and describe seizures in various ways, as it is often a subjective experience:
- Before the appearance of the seizure may be hours or days ago, a person can notice various changes in his behavior or mood.
- The relevant history can be obtained from a friend or patient himself.
- The patient can also experience an aura before the seizure attack, something like “déjà vu” phenomenon in which the patient feels that he has seen this before or lived this before or can smell strange things or see flashes of lights.
- After a partial seizure, there may be the temporary weakness of the affected limb.
- After the generalized seizure, the patient may feel awful with a headache, myalgia, confusion, and a sore tongue.
It all happens because the transmission of the electrical activity between the brain cells pauses for a while manifesting as seizures.
Seizures could be of various forms, but for a given patient they tend to be stereotyped.
Generally, seizures can also be caused due to a decrease in sodium salts from the body, or due to high fever or even due to hypoxia.
The diagnosis could be stigmatizing and has implications for employment, insurance, and driving.
Not everything that twitches is epilepsy, but tongue biting is very suggestive of epilepsy
Causes of epilepsy:
There are several possible causes for epilepsy: They may be grouped as:
- Space-occupying lesion
- Very raised blood pressure
- Tuberous sclerosis
- Hypoglycemia (low sugar level)
- Hyperglycemia (high sugar level)
- Hypoxia low oxygen level)
- Hyponatremia (low sodium level)
- Hypernatraemia (high sodium level)
- Liver diseases
- Alcohol withdrawal
- Drugs-phenothiazines, cocaine, benzodiazepines
Classification of epilepsy:
The seizures that the patient experiences are of various forms, they are classified as below:
In this, the patient may lose consciousness, there may be twitching or jerking of one single part like twitching of finger or fingers, or twitching of facial muscles. It happens because of the passing of the electrical activity in the brain, which could be in one part or can move to another part or may stay in one area until the seizure is over.
Electrical disturbances occurring all over brain at the same time are generalized seizures. They are further classified as follows:
a Petit mal: the conversation is associated with brief pauses e.g.: suddenly stops talking in the middle of the sentence, and then carries on where he left off. Usually seen in childhood.
b Grand mal: has the sudden onset, with loss of consciousness, limbs stiffened, and then they jerk and can feel drowsy post-seizure.
c Myoclonic jerk: a sudden fall on the ground or giving up of the limb.
d Atonic: becoming flaccid
e Akinetic: usually associated with less motility of limbs like in infantile spasms
Diagnosis of epilepsy:
- Obtaining authentic history from the patient and the witness
- Establishment of the cause
- Past medical history or family history
- Blood glucose both fasting and post-food
- Calcium and phosphorus levels
- Imaging: CT scan and MRI (also MRI angiography) is indicated to evaluate the structural changes in brain
- Electroencephalogram (EEG) is suggested for nonconclusive status.
Treatment of epilepsy:
a. Conventional treatment:
Diagnosing epilepsy in error can be hazardous as conventional therapy has significant side-effects.
Carbamazepine: Usually used as the first line of treatment in partial seizures.
Sodium valproate: Usually used as the first line of treatment in the generalized seizure.