Tuesday, April 10, 2012

Epilepsy


Epilepsy is a disorder that occurs worldwide and is one of the oldest known to mankind. It is characterized by a tendency to repeated seizures that can lead to loss of alertness or consciousness, disturbances of movement, sensation (including vision, hearing and taste), autonomic function, mood and mental function. Epilepsy includes any situation where there are repeated episodes of seizures of any type. Epilepsy (idiopathic seizure disorder) is a term used when seizure disorder does not cause that can be detected as a brain disease. Epilepsy affects about 0.5% of the population. It can affect people of any age. Transferring information from one nerve cell to another occurs by an electrochemical process. This process can be detected as electrical activity electroencephalogram (EEG).
Abnormal electrical activity associated with seizures. The cause of the seizures is to some extent correlated with age at onset. In some people, seizures can be caused by hormonal changes such as pregnancy or menstruation.They can also be caused by illness or by sensory stimuli such as light, sound and touch. In many cases, can be found for the seizures. Under certain conditions, each person can have a seizure. The amount of stimulus required to cause a seizure is called the seizure threshold. It is believed that many people with epilepsy have a low seizure threshold.

Who is at risk?
Epilepsy is one of the most common neurological disease with a 20-50 year / 100 000 new cases.

Frequency
First decade of life: 85/100 000
Second decade of life: 36/100 000
Third decade of life: 27/100 000
4th decade of life: 37/100 000

This means that most new cases occur in childhood (75%). There are no geographical, racial or social class boundaries. Anyone can be affected by seizures. Epilepsy can occur in both sexes at any age. In fact, up to 5% of the world population can have a single seizure in the course of life. However, the diagnosis of epilepsy is reserved for people who have recurrent seizures. Idiopathic (which can not detect the cause) of epilepsy usually begins between the ages of 5 and 20 years, but can occur at any age, without having to present other neurological abnormalities.

There are some situations that may trigger the development of seizures:
Birth defects and perinatal (around the time of birth) problems
Brain injury-seizures usually begin in infancy or early childhood
Metabolic disorders
Complications of diabetes mellitus
Electrolyte Disorders
Kidney failure, uremia (toxic accumulation of wastes)
Disadvantages of substances in the diet
Phenylketonuria - may rarely cause seizures in infants
Entering or intoxication by alcohol or drugs
Treatment of alcohol or drugs
Tumors and brain lesions that occupy space in the brain (such as hematomas)
The main reasons for the higher incidence of epilepsy in developing countries are at higher risk of acute and chronic infections of the brain, pre-and post-natal obstetric complications that lead to brain damage, and malnutrition.


What are the symptoms?
There might be changes in mental status (such as vigilance and awareness) and / or focal neurological symptoms (symptoms of localized changes in brain function) associated with seizures. Type of seizure that occurs varies depending on location and type of problem that causes seizures and the individual response to disturbance.Seizures may occur in the generalized form (affecting all or most of the brain) or partial form (affecting only part of the brain). Epilepsy is typically generalized (except in some cases that develop in childhood and have a specific focus). Generalized seizures involve a variety of generalized tonic-clonic seizures and petit mal seizures. Partial seizures include focal seizures (during which the person remains conscious, but there are abnormal movements or sensations) and complex partial seizures (during which the abnormal movement or sensation accompanied by a change in consciousness). Epilepsy is characterized by seizures of any type that occur on chronic, repeated basis and have no known cause. Non-specific symptoms and / or characters may appear along with seizures, and include headache, changes in mood or energy level, dizziness, fainting, confusion and memory loss. Aura, the sensations that indicate that the attack soon, occurs in some people prior to generalized seizures.

Types of seizures and their symptoms:

PETIT MAL ATTACKS
Minimal or no movements (usually, except for "eye blinking")
Brief sudden loss of awareness or conscious activity
Appears frequently
It most often occurs in childhood
Reduced ability to learn


Grand mal seizures (generalized tonic-clonic ATTACKS)
Generalized, severe muscle contractions
Affect most of the body
Loss of consciousness
Temporarily stops breathing, then the "groaning"
Incontinence of urine
Bite the tongue or cheek


SINGLE FOCAL ATTACKS
Contraction of certain muscles of the body
Abnormal sensations
It can develop nausea, sweating, skin redness and dilated pupils
There may be other focal (localized) symptoms


PARTIAL COMPLEX ATTACKS
Automatism (automatic performance of complex behaviors)
Abnormal sensations
It can develop nausea, sweating, skin redness and dilated pupils
There may be other focal (localized) symptoms
Remembering or inappropriate emotions
Changes in personality or consciousness
It can not be losing consciousness, olfactory (smell) or gustatorne (taste) hallucinations or disturbances temporal focus


What tests will the doctor spend?
The diagnosis of epilepsy and / or seizure disorder involves recurrent seizures of any type in the history of the disease. Physical examination, including a detailed neuromuscular examination may be normal or show focal neurologic deficits (localized disorders of brain function). Electroencephalogram (EEG) readings of brain electrical activity, usually confirms the presence of different types of seizures. It may, in some cases, indicate the location of lesions that cause seizures. Tests to determine the causes may include various blood tests (depending on the cause of which is suspected) that include:
blood tests, blood glucose
liver function tests
kidney function tests
testing the existence of infectious diseases
analysis of cerebrospinal fluid
Tests to detect the cause may include procedures such as CT or MR imaging of the head and lumbar puncture (spinal puncture)

Physical examination and tests can be used to exclude other temporary and reversible causes of seizures such as high temperature, chemically different temporary disorders, toxemia of pregnancy, abstinence in the treatment of alcohol or drugs (especially benzodiazepines and barbiturates), drug use (particularly those are acquired illegally) and other causes.

Treatment

AFTER ATTACKS
Write down the details of the attack in order for them to inform your doctor. Important details include date and time of the seizure, how long it lasted, which body parts were affected, the type of movement and other symptoms, possible causes and other factors observed. Isolated seizures are treated according to the type of seizures and the cause of which is suspected (see specific types of seizures for details). Generally, this involves treating the cause and / or use of anticonvulsant drugs.

AFTER diagnosed with epilepsy (seizure disorder)
Treating the cause, if the cause was discovered, the occurrence of seizures can be stopped. It may include treatment of disorders with drugs, surgery for tumors or lesions in the brain, and other treatments. Oral anticonvulsants to prevent or reduce the minimum number of future seizures. The answer is individual, and the drug used and the dose may need to be adjusted several times. Controls for re-assessment should be conducted at least once a year. Monitoring plasma levels is important for continued control of seizures and reduction of side effects. Pregnancy, sleep deprivation, skipping doses, drug use, drug or alcohol abuse or disease can cause seizures in people with previously well-controlled epilepsy. It can also recommend the use of jewelry or a card with information indicating epilepsy in order to obtain rapid medical assistance if an attack.

Prevention
In general, no known prevention of epilepsy.

Complications
Prolonged seizures or seizures that are repetitive (status epilepticus)
Injuries from activities such as falls, blows, bites
Injuries due to seizures that occurred while driving and / or work with machinery
Seizures in dangerous circumstances (drowning, burns, head injuries, etc.).
Aspiration of fluid in the lungs and subsequent aspiration pneumonia
Permanent brain damage (stroke or other damage)
Difficulties in learning
Side effects of medications (with or without noticeable symptoms)
Respiratory or cardio-respiratory arrest at seizure 

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