Easing Epilepsy

You phase out for a few minutes just staring into space. Another time you have a more intense seizure where you drop to the ground. You may have epilepsy.

Epilepsy is a neurological condition that produces brief disturbances in the brain’s electrical functions that can cause seizures and other symptoms.

Anyone can develop epilepsy. Epilepsy affects males and females of all races, ethnic backgrounds and ages.

Seizure symptoms will vary. Some people will stare off into space during a seizure, while others may jerk their arms and legs. Having one seizure will not get you a diagnosis of epilepsy. At least two seizures without a known trigger (unprovoked seizures) that happen at least 24 hours apart are generally required for an epilepsy diagnosis.

Treatment with medication and sometimes surgery can control seizures for many people with epilepsy. Some people require lifelong treatment to control seizures, while with others the seizures will go away. Some children will outgrow the condition with age.

According to the Centers for Disease Control and Prevention, in 2015, 1.2 percent of the total United States population have active epilepsy. This is about 3.4 million people with epilepsy nationwide: 3 million adults and 470,000 children. According to the latest estimates 0.6 percent of children aged 0-17 years have active epilepsy.

Since epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain plans and executes. Seizure signs and symptoms may include temporary confusion, a staring spell, stiff muscles, uncontrollable jerking movements of the arms and legs, loss of consciousness and awareness, and psychological symptoms such as fear, anxiety, or déjà vu.

Seizures can be classified as focal or generalized. When seizures result from abnormal activity in one area of the brain, these seizures are focal seizures. These seizures can be categorized into two types: focal seizures without loss of consciousness and focal seizures with impaired awareness. Focal seizures without loss of consciousness may change the way things look, feel, smell, taste, or sound like. These seizures are referred to as simple partial seizures. This type of seizure may result in involuntary jerking of one body part such as an arm or leg and sensory symptoms like tingling, dizziness and flashing lights.

Focal seizure with impaired awareness describes a condition where a certain amount of awareness during a seizure is lost. This type of seizure is like a dream state. During focal seizure with impaired awareness, you may stare into space and not respond in a normal way to your environment or perform repetitive movements such as chewing, hand rubbing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other conditions such as migraine, narcolepsy or mental illness. Thorough testing can be done to separate these seizures from other conditions.

Seizures that incorporate all areas of the brain are known as generalized seizures. There are six types of generalized seizures:

·       Absence seizures which are formerly known as petit mal seizures which typically occur in children. They are characterized by staring into space with or without minor body movements such as eye blinking or lip smacking and only lasts for 5-10 seconds. These seizures may happen in clusters at up to 100 times a day and cause a brief loss of awareness.

·       Tonic seizures cause stiff muscles and may affect consciousness. These type of seizures affect muscles in your legs, arms, and back and may cause you to fall to the ground.

·       Atonic seizures also known as drop seizures, cause muscle control loss. This most often affects the legs, causing you to fall down.

·       Clonic seizures are associated with repeated, or rhythmic jerking muscle movements. These seizures affect the arms, face, and neck.

·       Myoclonic seizures are brief jerks or twitches that affect the arms, legs, and upper body.

·       Tonic-clonic seizures or grand mal seizures can cause abrupt loss of consciousness and body stiffening, twitching, and shaking. They sometimes cause loss of bladder control or biting the tongue.

Epilepsy may be caused by several factors including genetic influence (it may run in families), brain abnormalities, head trauma, prenatal injury, infections, and developmental disorders. And certain factors may increase your risk of epilepsy such as age, family history, dementia, brain infections, head injuries, stroke and other vascular diseases, and seizures in childhood.

To diagnose epilepsy, your doctor may want to perform a neurological exam after taking a detailed medical history. Blood tests may need to done in order to check for signs of infection, genetic conditions or other conditions linked to seizures. Your doctor may also recommend tests that check for brain abnormalities such as an electroencephalogram (EEG), which is a common test for epilepsy. A high density EEG may be recommended to check out what areas of the brain are affected by seizures.

A computerized tomography (CT) will reveal abnormalities in the structure of your brain that might be causing the seizures. A magnetic resonance imaging (MRI) shows lesions and abnormalities that might be causing seizures. A functional MRI measures the change in blood flow that can occur to indicate specific parts of the brain are working. Doctors may use a functional MRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places when operating. A positron emission tomography (PET) uses a low dose radioactive material that’s injected into a vein to help visualize metabolic activity of the brain and detect abnormalities. A single-photon emission computerized tomography (SPECT) is used if you had an MRI and EEG that didn’t pinpoint the location in your brain where the seizures are originating.

Doctors generally try to treat epilepsy with medication. There are more than 20 different types of anti-seizure medications available. At least half of the people newly diagnosed with epilepsy will become seizure-free with medication. But if these anti-epileptic medications don’t produce satisfactory results then your doctor may suggest surgery or other types of therapy.

In surgery, your surgeon will remove the part of your brain that’s causing the seizures. In these procedures, doctors direct a thermal laser probe at the specific area in the brain causing the seizures to destroy that tissue in an effort to better control the seizures.

Patients who undergo these procedures still require medication but you will take fewer drugs and reduce your dosages. Please be aware that surgery for epilepsy may cause complications such as altering your cognitive abilities.

Other therapies for epilepsy include vagus nerve stimulation where doctors implant a device, a vagus nerve stimulator underneath the skin of your chest. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It reduces seizures by 20 to 40 percent. You still have to take medication but it can be at a lower dose.

Some children with epilepsy have been able to reduce their seizures with the ketogenic diet, which is high in fats, low in carbohydrates. In this diet, the body breaks down fat for energy instead of carbs. Discuss with your doctor whether this is the right choice. Some side effects from the diet are dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood which can lead to kidney stones.

Deep brain stimulation is where doctors implant electrodes into a specific part of the brain, usually your thalamus. The electrodes are connected to a generator implanted in your chest. The generator sends electrical pulses to your brain at timed intervals and may reduce seizures.

Then there is responsive neurostimulation. These pacemaker-like devices can help significantly reduce how often seizures occur. These responsive stimulation devices analyze brain activity to detect seizures as they start and deliver an electrical charge or drug to stop the seizure before it causes impairment.

There are potential future treatments to look forward to such as continuous stimulation of the seizure onset zone (subthreshold stimulation) which involves continuous stimulation to an area of the brain below a level that is physically noticeable, appears to improve seizure outcomes for some people with seizures. This treatment is supposed to stop seizures before they start.

Minimally invasive surgery is surgery that is MRI guided focused ultrasound which shows promise at treating seizures with fewer risks than traditional open-brain surgery for patients with epilepsy.

Other potential treatments include transcranial magnetic stimulation (which applies focused magnetic fields on areas of the brain in which seizures occur) and external trigeminal nerve stimulation (an external device that stimulates specific nerves to reduce frequency of seizures).

Having epilepsy can be a frightening experience but it doesn’t need to rule your life. Seizures can be managed or controlled. See and talk to your doctor so that together you decide the next course of action.