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Epilepsy: Chronic neurological disease > Health and Wellness.

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What is epilepsy

It epilepsy is one of the most important chronic neurological diseases and prevalent, caused by one or more disorders that predispose the brain to generate recurrent seizures, which has consequences not only neurobiological, but also cognitive and psychological. Literature about epilepsy has been, historically, plagued by errors that have fed his black legend and have motivated epileptic patients suffering from unjustified social stigma.
To consider that a person suffers from epilepsy as a disease, the World Health Organization (who) and the International League against epilepsy (ILAE), require chronic recurrence of seizures, i.e. the epilepsy is diagnosed when the patient has had two or more spontaneous crisis throughout his life.
Epilepsy is the third most common neurological disorder after stroke (cerebral vascular accident) and dementia, and it is estimated to affect 5-1, 0, 5% of the population. In Spain alone there are more than 400,000 affected, according to the estimates of the Spanish Federation of epilepsy (FEDE).
The majority of cases occur in people older than 65 and children under 10 years old. They are more common in underdeveloped countries and among disadvantaged socio-economic classes.

Seizure

Epileptic seizures are caused by an abnormal and exaggerated discharge of certain neuronal groups in the brain. So abnormal neuronal discharges trigger epileptic seizures a number of processes should take place: timing, amplification and propagation of the discharges.
The epileptic discharge occurs as a result of an imbalance between excitatory and inhibitory mechanisms that neurons are exposed. Epileptogenesis is the process by which a normal nerve structure becomes hiperexcitable, to generate spontaneous seizures.
To determine if it's a seizure should take into account that:
  • Not all paroxysmal discharge of the brain, although it is detectable in the electroencephalogram (EEG), is a seizure if it produces no clinical.
  • Paroxysmal brain dysfunction that have not occurred as a result of a download neuronal hipersincrona, but otherwise, not be considered epileptic seizures, although they may cause similar clinical manifestations.
  • Downloads of other neuronal groups outside of the cerebral cortex, for example of the brain stem or cord, give rise to paroxysmal manifestations, such as muscle spasms, which non-epileptic seizures, but they respond to the same drugs.

Types of seizures

There are two major groups of seizures: focal (or partial) seizures and generalized seizures.

Before a crisis

  • Prodromal symptoms: are nonspecific sensations such as changes of mood, irritability, sleep disturbances, appetite or behavior, from hours to days before the seizure, especially.
  • Epileptic aura: is the feeling immediately prior to the crisis. Applies to the psychic as fear, distress, indefinable unease or nervousness or epigastric sensations.

Generalized seizures

They are those whose first noticeable symptom depends on the injury of both cerebral hemispheres. Loss of consciousness occurs from the first moment of the attack and motor manifestations affect the four extremities.
Generalized seizures
Tonic-clonic seizures or "grand mal"
The tonic phase begins with the contraction of the muscles in flexion or extension. Lasting from 10 to 30 seconds. Breathing is interrupted. The sick can emit a sharp scream by spasm of the larynx and the tight jaw. The clonic phase begins with very short light and little shocks that gradually become more spacious, violent and spaced, synchronised and symmetrical in all four extremities. Lasts around 1 minute. The patient sweats and drooling. Breathing is choppy. There may be a rise in blood pressure and tachycardia. It is frequent that the sick get hurt falling and will urinate. The language can be biting. To the awakening of the crisis, the patient is confusing and does not remember what happened, has headache and muscle pain. You may be tired and sleep several hours.
Tonic crisis
They produce a prolonged muscle spasm. Muscle contraction is increased and gradually extends over the trunk and extremities. It is common at the beginning of the crisis the patient has open the eyes and mouth and emit noise. Bend the arms and legs and trunk extends. These crises are very brief, less than 1 minute, and often cause the fall of the patient.
Crisis Myoclonic
They are brief muscle jerks, as electric shock. They appear spontaneously or caused by sensory or sensory stimuli (beams of light flashing), and facilitated by fatigue, stress, alcohol or sleep deprivation.
Atonic seizures
There is a loss of postural tone, i.e., muscles "lose their strength". They cause the fall of the patient. They can last from a few seconds to several minutes.
Generalized seizures
Typical absences or "Petit mal"
Manifested by a sudden loss of consciousness without loss of postural tone. The beginning and end of the crisis is abrupt. The most lasting less than ten seconds. The crisis manifests itself as a disconnection of the patient with their environment. The sick disrupts activity was carried out at that time and keeps staring, expressionless face, and ajar eyelids. When he regains consciousness resumes the interrupted activity and most of the times does not remember what happened. They can be frequent waking up or be provided by fatigue, sleep, and the intermittent photostimulation. They are sensitive to hyperventilation (breathing very fast).
Atypical absences
They are characterized by the sudden loss of consciousness. The beginning is more gradual and they are longer. The patient may suffer a partial unconsciousness and wandering during the crisis. They tend to be accompanied by low intellectual level or learning disorders.

Focal seizures

They are those in which the discharge originates in a relatively limited area of the cerebral cortex and during which the patient experiences a combination of motor, sensory, sensory, psychic and vegetative, signs and symptoms of which is partially or fully aware.
  • Vegetative signs and symptoms: include color changes (pallor or redness) skin, increase in blood pressure, tachycardia or bradycardia, piloerection, pupil dilation... They are sometimes serious, and even fatal, because they produce fainting, respiratory arrest, anoxia (lack of oxygen) and pulmonary edema (fluid in the lung).
  • Sensory symptoms: can be elementary, such as tingling, burning, pain and other unpleasant sensations; or more elaborate.
  • Simple Visual symptoms: consist of hallucinations in the form of lights or colors. They can also be more complex hallucinations or illusions.
  • Motor signs and symptoms: occur in a given body segment and not the entire body. They tend to be repetitive behaviors.
  • Speech impairments: speech or vocalization can be stopped in some cases. In other cases, the patient repeat meaningless phrases, or inadequately answered to the observer.
  • Psychic symptoms: the patient experiences a feeling of unreality and unfamiliarity with the environment that surrounds him, as if everything was unknown and you got yourself in a strange place (jamais vu); either to the contrary, notices a familiar feeling or attend a family event (déjà vu).
  • Hallucinations: as well as Visual, olfactory and auditory there is. In each case can be simple (an unpleasant smell, a buzz, beep...) or complex (elaborate smells, hearing music, voices or messages). They may also have experiences of happiness next to mystical States with feeling of grandeur, levitation space, or celestial appearances.
  • Automation: the simplest are the chupeteo, swallowing, opening and closing of a hand or a change in facial expression (joy, surprise and fear). Other more complex are rubbing the hands together, clothes or genitals.
  • Gelasticas crisis: are those in which the subject experiences a feeling of joy unprompted and automatic uncontrollable laughter.

Continuous crisis, status epilepticus or status epilepticus

A status epilepticus is considered when the crisis lasts at least 30 minutes, or when its repetition is so prevalent that there is no recovery of the patient from one episode to the next. They can be divided into two groups: the convulsive evil and the evil States non-convulsive (they have the same clinic as described above but lasting at least 30 minutes or crises overlap without recovery among them). The most frequent cause is the abandonment of the medication in patients treated with antiepileptic drugs, but also occurs with alcohol abuse, fever, some drugs and because of metabolic alterations. It is more common in children than in adults.
It is called status epilepticus refractory to treatment when the crisis last more than 60 minutes, while the patient follow a treatment with antiepileptic drugs.

Causes of epilepsy

Epilepsy can have various causes:
Hereditary causes
They are genetically determined Epilepsies.
Congenital causes
  • Brain tumors.
  • Intrauterine lesions.
  • Vascular malformations.
  • Syndromes (neurofibromatosis, tuberous sclerosis, Sturge-Weber) Neurocutaneous.
  • Chromosomal abnormalities (Down's syndrome, Angelman Syndrome).
  • Congenital disorders of the metabolism (aminoacidurias, leukodystrophies).
  • Congenital myopathies.
  • Myoclonic Epilepsies.
Acquired causes
  • Trauma.
  • Post-surgical injury.
  • Postinfecciosas lesions (sequel to bacterial meningitis or viral encephalitis).
  • Infarction and cerebral hemorrhage.
  • Tumors (astrocytomas, oligodendrogliomas and meningiomas).
  • Sclerosis of the hippocampus (of the temporal lobe).
  • Toxic (alcohol and other drugs).
  • Degenerative illnesses (dementia and others).
  • Acquired metabolic diseases.

Classification

According to the cause of epilepsy it is classified into:
  • Sintomaticas: is the one that has a proven history, in which the cause that produces it is known.
  • Cryptogenic: is one to which the clinical context or image is assumed a cause or lesion origin, which can not be safely. I.e., you sensed the cause but it has not been demonstrated.
  • Idiopathic: it is the one that has no known cause and in which the genetic influence is greater.

Symptoms of epilepsy

Epileptic symptom par excellence, and one that defines the disease, is the seizure, since it is necessary two or more spontaneous crises arise that will diagnose this pathology, since you can have an isolated seizure and does not mean that you have epilepsy. Other symptoms of epilepsy, include dizziness, difficulty to speak, feeling of disconnection with the environment, seizures, muscle rigidity, etc.
On the other hand, epileptic syndrome is called to the set of signs and symptoms that define a process epileptic by the type of crisis, its natural history, which includes one or several known causes, hereditary predisposition, a certain type of crisis and abnormalities in the EEG, the response to treatment and prognosis.
The clinical manifestations of a seizure occur suddenly and its duration is short. They may be mental, vegetative, sensitive, motor with or without decrease in consciousness. The symptoms depend on the area of the brain in which originates is the download, and its extension or not the whole of the brain. A seizure is considered a symptom, and isolated character, does not demonstrate the existence of a syndrome or epileptic disease; in fact, from 2 to 3% of the population suffers a seizure at some point in their lives.

Triggers

Seizures may arise in response to different stimuli, and according to the nature of them are classified as:
  • Provoked crisis: is the one that appears in immediate temporal relationship with an acute injury of the brain such as a stroke, trauma, anoxia (lack of oxygen), encephalitis or acute toxico-metabolica alteration.
  • Crisis precipitated: is what happens as a result of a factor of nonspecific as lack of sleep, stress or excessive consumption of alcohol in a person with or without previous spontaneous crises.
  • Reflects crisis: is what happens to a sensory or sensory stimulation.

Activity and remission

Epilepsy is in activity when the patient has suffered a crisis in the last two years. Epilepsy is in remission if crisis not occurred in two years. This distinction is important to determine if the patient should continue or not in drug treatment.

Diagnosis of epilepsy

The diagnosis of epilepsy is clinical and is based on the interrogation. It is necessary to obtain information from a family member or close friend who has witnessed the attacks, because the patient is not able to describe them as a whole.
We must try to know everything that happened before, during and after the crisis. It is very important to have an impact on the personal history (perinatal trauma, alterations in psychomotor development, febrile convulsions, meningoencephalitis, brain trauma, or family history of epilepsy). Analysis of blood and urine, an electrocardiogram (ECG), chest radiograph and an electroencephalogram (EEG) should always be performed.
Neuroimaging by CT-MRI allows you to identify the majority of epilepsy (visible anatomical lesions) that cause brain lesions, but can not be all patients. Used in those Epilepsies of unknown cause, especially if it is of recent onset, if the neurologic examination is abnormal or if there are signs of focal cerebral suffering in the EEG.

Treatment of epilepsy

The treatment of epilepsy is primarily pharmacological. 50-60% of patients, drug treatment is simple, effective on the first attempt, and requires little supervision; 20% of the patients need settings or combinations of drugs, and another 20% of patients are uncontrollable with current drugs. A minority of patients are susceptible to surgical treatment.
Antiepileptic drugs (FAEs) are intended to complete control of seizures without adverse effects. In general, they inhibit the brain's neural circuits and are effective if they are properly prescribed.
The FAEs should be introduced slowly and progressively. In general the dose increase in 4-6 weeks. Strict adherence to treatment is important and very serious is the sudden abandonment of the same. If a change is necessary, this will take place gradually. If a drug is ineffective, it introduces other progressively, and the second or third week, withdraws the first.
Only the toxicity produced by the FAEs is reason enough to suspend an antiepileptic treatment. If the treatment is effective and no side effects do not modify for any reason. However, considered that the suspension of treatment (generally 2-5 years) may arise after a period of several years without crisis. This decision should be individualized and advised by a neurologist.
The surgical treatment of epilepsy is done to a patient carrier of a lesion benign and static, in order to free it from the crisis. They must meet the requirement of developing a drug-resistant epilepsy. It also takes into account the number and type of crisis and its impact on the quality of life of the patient. A prior to surgery should be done to locate the area that originates the crises, and can remove without cause neurological defects.

Prognosis of epilepsy

The prognosis of a person with epilepsy is very variable. There are benign syndromes that forwards completely; others who, without disappearing, can be adequately controlled with medications and allow the sick to lead a normal life; and others, finally, being rebels to the treatment. A prognosis regarding the specific epileptic syndrome that has a patient can only be.
In general, the prognosis of epilepsy depends on factors as the cause, the type of crisis, the age of onset and the rapid establishment of the treatment. They are generally more serious if they begin in childhood, when there are organic brain injury, if the intellectual level is low, if the patient suffers from different types of crises, and the greater the length of the illness.
If the patient responds to the first treatment and crisis-free during 1-2 years, you have a 95% chance of remission.

Tips for patients with epilepsy

Epileptic patients should take two fundamental precautions: refrain from using alcohol and other drugs, and keep a regular night's sleep.
Most patients do not require restrictions on his usual diet nor changes in his regime's life.
They can sports a moderate under supervision, with the exception of those considered to be sports of maximum risk and either performed solo, or would be very dangerous in the event that the patient suffers a crisis during the practice of them, mountaineering, fishing underwater, or those that require the use of motor vehicles.
The only use of television, computers or video games and assisting clubs are restricted in the case of epilepsy triggered by light stimuli.
Published for educational purposes
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