Epilepsy

11 mins read

Seizures are caused by excessive and rapid discharge of abnormal electrical activity between nerve cells or neurons in the brain. All or part of the brain may be involved.

Seizures are one of the main symptoms of epilepsy, although if you have a single seizure you do not necessarily have condition. About 2 in 100 people in the United States will experience an unprovoked seizure once in life. However, on-going seizures over time are a sign of epilepsy and require immediate medical treatment.

Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. The condition is more likely in those with a family history of seizures or epilepsy.

Causes
A seizure is a symptom of an underlying central nervous system dysfunction. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior, such as staring, loss of consciousness, involuntary jerking of the limbs.

If you have multiple seizures over time, you likely have epilepsy. This condition occurs when there have been permanent changes or damage to the brain. Possible causes of epilepsy include:

Head trauma of any type: The more severe the injury, the greater the chance of developing epilepsy

  • Stroke
  • Dementia, such as Alzheimer’s disease
  • Injury, infection, or systemic illness of the mother during pregnancy
  • Aftermath of infection (meningitis, viral encephalitis)
  • Infections, including brain abscess, meningitis, encephalitis, and AIDS
  • Metabolism disorders that a child may be born with (such as phenylketonuria)
  • Abnormal blood vessels in the brain
  • Brain tumor
  • Other illness that damage or destroy brain tissue

If you are diagnosed with epilepsy, certain events may trigger seizures including:

  • Alcohol, cocaine and some other drugs
  • Stress
  • Exposure to flashing or strobe lights
  • Skipping meals or poor nutrition
  • Intense emotions, such as anger, fear
  • Illness, fever and allergies
  • Missed medication
  • Hormonal changes
  • Hyperventilation
  • Insufficient sleep

Symptoms

  • Many people think the word ‘seizure’ means a whole-body convulsion, where someone falls unconscious and their limbs jerk uncontrollably. However, this is just one type of seizure, called generalized or tonic-clonic seizure (previously known as grand mal).
  • If you have epilepsy, your symptoms will depend on what type of the brain is affected. Focal seizures, also called partial seizures, happen in just one part of the brain. Generalized seizures also called are a result of abnormal activity on both sides of the brain.
  • Patients with simple focal seizures do not lose consciousness. They will be aware of and remember the events that occur at the time.
  • A complex focal seizure affects one part of the brain and the person’s conscious state is altered rather than lost. The person may often appear confused and dazed and may do strange and repetitive actions like fiddling with their clothes, smacking their lips, chewing or uttering unusual sounds. These trance-like, unconscious behaviors are called automatisms. The seizure usually lasts for one to two minutes but the person may be confused and drowsy for some minutes to several hours afterwards and have no memory of the seizure or the events just before or after it. At times, complex partial seizures can spread to become secondarily generalized seizures.
  • Generalized seizures occur when both sides of the brain are affected and the patient loses consciousness, although it may be short-lived and barely noticeable (as happens with an absence seizure) or a grand mal with full body convulsions. Generalized seizures can be:
    • Absence: The patient looks blankly for a brief time. These type of seizures generally occur in children.
    • Atonic: Sudden loss of muscle tone. The person may fall during this type of seizure although recovery is usually rapid.
    • Tonic-clonic seizure: The muscles suddenly stiffen and the person may fall. Rhythmic jerking follows. The person may bite their tongue or become incontinent. They are often confused afterwards.
    • Myoclonic: Seizures are characterized by sudden, brief shock-like contractions.
    • Tonic: The body stiffens and the person may fall, sometimes causing injury. Recovery is usually quick.

Other symptoms include:

  • Muscle jerking: Abnormal head movements
  • Lip smacking or other abnormal mouth movements
  • Behaviors that seem to be a habit, such as fiddling with their clothes
  • Chewing/swallowing without cause
  • Forced turning of the eyes
  • Numbness, tingling, crawling sensation (patients have described this sensation to feel like ants crawling on the skin)
  • Hallucinations
  • Abdominal pain or discomfort
  • Nausea
  • Sweating
  • Flushed face
  • Dilated pupils
  • Rapid heart rate/pulse
  • Blackout spells — periods of time lost from memory
  • Changes in vision
  • Sense of déjà vu
  • Mood swings

Diagnostic tests
If you have a seizure, your doctor will likely want to figure out whether it is caused by epilepsy or another condition. Your doctor will do a physical exam and ask about your symptoms, their severity and duration. During the exam, they may measure motor abilities, behavior, speech and cognitive skills to help determine the type of epilepsy affecting the person.

There are a number of tests used to diagnose epilepsy:

  • Electroencephalogram (EEG). This is the most common test to help diagnose epilepsy. An EEG records brain waves detected by electrodes placed on the scalp. If you have epilepsy, it’s common to have changes in your normal pattern of brain waves, even when you’re not having a seizure. However, this test isn’t fool proof – many people who do not have epilepsy also show some unusual brain activity on an EEG. At other times, the EEG cannot detect the epilepsy brain waves as they are generated to deep in the brain. Before your or during your test, the doctor may ask you to do things to provoke a seizure such as forgoing sleep or skipping a meal.
  • Brain Imaging: CT (computed tomography), PET (positron emission tomography) and MRI (magnetic resonance imaging) are all used to visualize the brain, and examine whether there are abnormalities such as tumors, bleeding and cysts that could be causing the seizures.
  • Blood Tests: Your doctor may take a blood sample to check for signs of infections, electrolyte imbalance, anaemia or diabetes, which can be associated with seizures.

Treatment  options
If you are diagnosed with epilepsy, it is important to begin treatment as soon as possible. Some people will need to go to a range of specialists, while others may be able to prevent seizures with single anti-epileptic drug. More than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. About 80 % of persons find that a treatment(s) that is right for them and that is successful in controlling their seizures.

  • Medications: There are more than 20 different antiepileptic drugs are now on the market, all with different benefits and side effects. For new cases of epilepsy, doctors often prescribe
    • Carbamazepine,
    • Valproate,
    • Lamotrigine,
    • Oxcarbazepine, or
    • Phenytoin first.
  • Surgery: If the seizures cannot be controlled with medication alone, your doctor may evaluate you for surgery. Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn’t interfere with vital functions like speech, language or hearing. In these surgeries, your doctor removes the area of the brain that’s causing the seizures. If that isn’t possible, your doctor may make cuts to the brain to contain your seizures and prevent them from affecting the whole brain. As surgery for epilepsy involves the brain, it is performed by teams of doctors.
  • Devices: The vagus nerve stimulator is a device that is surgically implanted under the skin of the chest, and is attached to the vagus nerve in the lower neck. This device delivers short bursts of electrical energy to the brain via the vagus nerve. On average, this stimulation reduces seizures by about 20 – 40 percent.

Alternative Therapies

  • Ayurveda defines epilepsy as ‘Apasmara or Apasmrti”, and seeks to treat it by unblocking the channels of heart and mind which are considered to be clogged by excess of doshas [1]. Certain ayurvedic herbal remedies have found to be beneficial in alleviating epilepsy symptoms, such as ashwagandha (Withania somnifera), jalbrahmi (Bacopa monnieri), shankhapushpi (Evolvulus alsinoides) [1,2,3].
  • Herbal remedies help to strengthen the body from within and encourage healing by restoring the balance of bodily functions. Certain herbs documented in the treatment of epilepsy may interact with prescription medicines, nutritional supplements etc. and may result in diminishing their therapeutic effectiveness. Hence, it is advisable to talk to your doctor before using these herbs. Herbs like bacopa, chamomile, kava, valerian root and passionflower can help in reducing the frequency of seizures in epileptic patients [4].
  • Certain ayurvedic herbal remedies like evening primrose oil, St. John’s wart, Gingko, white willow are associated with triggering seizures in some people and hence must be avoided by epileptic patients [1,4].
  • Homeopathic remedies such as Belladona [10], Cuprum mettalicum, Cicuta, Causticum have been studied for their effectiveness in treating epilepsy.
  • Traditional Chinese Medicine (TCM) emphasizes the use of acupuncture in the treatment of epilepsy [5]. Traditional acupuncture along with scalp and auricular acupuncture can help in stimulating the nerve endings which in turn can alter the activity of the brain. Although acupuncture may not directly improve the epilepsy, it can certainly help in reducing stress and anxiety amongst patients thereby lowering the frequency of epileptic fits [6].
  • Neurofeedback or biofeedback can also help patients in reducing their seizures. This technique can help patients to control their seizure related brain activity and may be able to limit the length of their seizure [7]. Relaxation techniques in combination with biofeedback are seen to significantly improve the brain wave pattern and hence reduce seizures [8].
  • Yoga and other relaxation techniques like meditation can help relieve the stress from the body which is a well-recognized trigger for seizure activity. Meditation helps in stimulating the production of neurotransmitters like serotonin, improving the blood flow to the brain and maintaining the normal homeostasis [9]. Relaxation techniques like progressive muscle relaxation and deep diaphragmatic breathing or Pranayama have shown benefits in epileptic patients [12].
  • Aromatherapy has also been explored in helping epilepsy patients by teaching them to alter their brain activity and state of arousal with the aid of a peculiar scent or aroma [11]. While oils such as chamomile, lavender can help in initiating relaxation, others like eucalyptus, sage, rosemary , wormwood, thuja, fennel, tansy and hyssop  may have unnecessary side effects and should therefore be avoided [11].
  • Anti-convulsants often lead to the depletion of certain essential nutrients from the body. Hence it is necessary to replenish the body with the lost supplement. Vitamin D, K and B12 can be supplemented with pills or through appropriate diet. Folic acid and taurine both help in maintaining the electrical activity of the brain and thus can be included in the treatment of epilepsy.

Prevention
Epilepsy has numerous causes and so prevention is difficult. However,

  • One of the key causes is through head injury and so wearing a car seat belt or helmet on a bicycle are recommended to prevent the head trauma that can cause epilepsy.
  • If you already have epilepsy, you can eliminate triggers in your life, such as stress, alcohol and other recreational drugs. If flashing nights are a known seizure trigger for you, avoid nightclubs where there are flashing lights as this is a seizure trigger.
  • Practicing healthy eating, good nutrition and making sure that you don’t miss meals are all beneficial to managing this condition.
  • Yoga and meditation are both good for learning how to manage stress, a key trigger of epilepsy, and improving your quality of life.

Conclusion
Epilepsy is characterized by seizures that occur over a period of time. There are many different types of seizures that can affect different parts of the brain. Most incidences of epilepsy can be controlled with medications. If you have seizures, it is advisable to try to remove triggers, such as stress and recreational drugs.

References

1. Saxena VS, Nadkarni VV. Nonpharmacological treatment of epilepsy. Ann Indian Acad Neurol. 2011 Jul;14(3):148-52. doi: 10.4103/0972-2327.85870. PubMed PMID: 22028523; PubMed Central PMCID: PMC3200033.

2. Ricotti V, Delanty N. Use of complementary and alternative medicine in epilepsy. Curr Neurol Neurosci Rep. 2006 Jul;6(4):347-53. Review. PubMed PMID: 16822357.

3. McElroy-Cox C. Alternative approaches to epilepsy treatment. Curr Neurol Neurosci Rep. 2009 Jul;9(4):313-8. Review. PubMed PMID: 19515284.

4. Gaby AR. Natural approaches to epilepsy. Altern Med Rev. 2007 Mar;12(1):9-24. Review. PubMed PMID: 17397265.

5. Li Q, Chen X, He L, Zhou D. Traditional Chinese medicine for epilepsy. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006454. doi: 10.1002/14651858.CD006454.pub2. Review. Update in: Cochrane Database Syst Rev. 2014;3:CD006454. PubMed PMID: 19588391.

6. Cheuk DK, Wong V. Acupuncture for epilepsy. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD005062. doi: 10.1002/14651858.CD005062.pub3. Review. Update in: Cochrane Database Syst Rev. 2014;5:CD005062. PubMed PMID: 18843676.

7. Nagai Y. [Biofeedback treatment for epilepsy]. Nihon Rinsho. 2014 May;72(5):887-93. Review. Japanese. PubMed PMID: 24912291.

8. Nagai Y, Trimble MR. Long-term effects of electrodermal biofeedback training on seizure control in patients with drug-resistant epilepsy: two case reports. Epilepsy Res. 2014 Jan;108(1):149-52. doi: 10.1016/j.eplepsyres.2013.10.004. Epub 2013 Oct 19. PubMed PMID: 24238895.

9. Yardi N. Yoga for control of epilepsy. Seizure. 2001 Jan;10(1):7-12. PubMed PMID: 11181093.

10.  Sie PG. Extractum belladonnae in epilepsy therapy. (A preliminary study). Paediatr Indones. 1965 Jul-Dec;5(3):47-54. PubMed PMID: 5873754.

11. Betts T. Use of aromatherapy (with or without hypnosis) in the treatment of intractable epilepsy–a two-year follow-up study. Seizure. 2003 Dec;12(8):534-8.  PubMed PMID: 14630489.

12. Dalal K, Devarajan E, Pandey RM, Subbiah V, Tripathi M. Role of reflexology and antiepileptic drugs in managing intractable epilepsy–a randomized controlled trial. Forsch Komplementmed. 2013;20(2):104-11. doi: 10.1159/000350047. Epub 2013 Apr 15. PubMed PMID: 23636029.

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