Epilepsy is a condition characterized by recurrent episodes of disturbance of movement, behavior, sensation and consciousness primarily of cerebral origin.
All disorders affecting the grey matter of brain can cause epilepsy.
Causes of symptomatic epilepsy
Increased intra-cranial pressure- tumor, hydrocephalus, and subarachoid hemorrhage.
- Infections- meningitis, encephalitis, cerebral abscess.
- Trauma- head-injury and intra-cranial bleed.
- Cerebrovascular diseases- cerebral atheroma, embolism, cerebral venous infarction.
- Congenital- cerebral diplegia (paralysis of like part on either side of the body).
- Anoxic encephalopathy.
- Alcohol, drugs and metabolic disturbances.
Idiopathic epilepsy causes
- It is usually seen below 20 years.
- It is hereditary in origin.
- Precipitating causes are pain, trauma, shock, emotional stress, starvation, noise, fever, alcohol and premenstrual stage.
Classification And Types Of Epilepsy
- Generalized (grandmal, petitmal and myoclonic seizures).
- Partial seizures (simple partial seizures and complex partial seizures).
Generalized seizures
Grandmal epilepsy
- Prodrome characterized by irritability and tension for hours or days.
- Loss of consciousness without warning. Patient becomes rigid and may urinate. Patient may have an apnoeic spell of breathing (temporary stoppage of respiration) due to contraction of thoracic and abdominal muscles.
- Tonic phase (10 seconds): The patient’s eyes are open, elbows flexed, arms pronated, breath held, and cyanosis and bladder/bowel control lost.
- Clonic phase (1-2 minutes): The tremor due to generalized shaking, eyes roll backwards and forwards and tongue bite may occur.
- Post-ictal phase characterized by confusion, headache or sleep.
Petitmal epilepsy
- Patient present with characteristic features like stops and stares blankly. It lasts for a few seconds.
- Consciousness not lost and abrupt onset with full recovery.
- Epilepsy presents with blinking and rolling of eyes several times a day.
Myoclonic seizures
- Characterized by single or multiple muscle jerks, consciousness not lost and usually as a part of generalized epilepsy.
Partial Seizures
It starts with activation of a group of neurons limited to a part of a single hemisphere.
Simple partial seizures (SPS)
- It is short lasting seizure with abrupt onset. Symptom depends on cerebral site of epileptic discharge.
- Jerking of limbs (frontal lobe of the brain).
- Sensory (parietal lobe of brain).
- Psychic (temporal lobe of brain)
- SPS is due to structural lesion like tumor, vascular abnormality, developmental or infective abnormality.
Complex seizure
- It is also called as psychomotor epilepsy or temporal lobe seizure. Hippocampus sclerosis is its common cause or developmental or brain damage during a febrile convulsion.
Diagnosis Of Epilepsy
- Blood tests usually do not help in diagnosis but hemogram, serum electrolytes, liver function test should be done before starting treatment as anti-epileptic drugs may alter its values later.
- Cerebrospinal fluid examination if intracranial infection is suspected.
- EEG – during ictal phase spikes is characteristic of epilepsy.
- CT and MRI to make etiological diagnosis.
Management Of Epilepsy (Seizures)
Seizures can hurt patients and may also cause accidental asphyxia.
Care of patient during seizures
- Move patient to place of safety (away from fire, water and machinery).
- Do not try to forcibly introduce a gag or tightly rolled handkerchief once seizure begins. Do not use metallic or plastic objects.
- After seizure is over, keep patient in semi-prone position, ensure patent airway and proper oxygenation.
- With continued convulsions, hospitalize the patient.
Drugs for epilepsy
- Mono-therapy is preferred.
- Introduce drugs in small doses strictly as per doctor’s instructions.
- Aim is to find lowest possible dose and achieve complete seizure control. Doctors commonly prescribe drugs like carbamazepine, phenytoin, phenobarbitone and valproate.
Surgical removal of an epileptic lesion in temporal lobe is highly effective.