Epilepsy is a neurological disorder that can affect people of all ages. The distinguishing feature of this disease is the recurrence of convulsive seizures to which the patient falls prey
Information passes from the brain to the nerves via neurons (nerve cells) and constitutes brain activity; this is an electrochemical process that can be followed by means of an electroencephalograph, an instrument capable of recording the electrical activity of neurons and ‘transcribing’ it.
Epileptic seizures are caused by abnormalities in this electrical passage of information.
Types of epilepsy
There are two types of seizures, generalised seizures, which affect all or a large part of the brain, and partial seizures, which affect only part of the brain.
Epilepsy usually presents with generalised seizures, except in those cases that occur during childhood and have a definite local point.
Generalised epilepsy seizures are divided into two species, the big bad and the small bad.
Partial seizures, on the other hand, are characterised by localised seizures, during which the affected person remains alert but has altered movements and sensations, and complex partial seizures, during which the abnormal movements and sensations are accompanied by changes in the individual’s consciousness.
Symptoms of epilepsy
Epilepsy is a disease characterised by chronic and recurrent seizures that have no known cause.
In addition to seizures, however, other peculiar signs or symptoms may be present, such as headaches, a change in mood or energy, dizziness, fainting, confusion and memory loss.
In some patients, the actual crisis is preceded by an aura, which indicates the impending crisis.
Generalised crises: the minor ailment
Specific symptoms of a minor illness crisis are minimal or absent movements that usually present as a glance into space, brief and sudden loss of consciousness for a few seconds, recurrence of the crisis itself, reduced learning.
Often minor ailment crises (also called absence crises precisely because of the patient’s apparent absence) occur during childhood and then tend to rarefy and sometimes disappear.
Generalised crises: the great evil
Characteristic symptoms of a grand mal seizure are violent muscular contractions that shake the patient’s body, rigidity, loss of consciousness, lack of breathing for a few seconds, urinary incontinence, possible biting of the tongue and cheeks, confusion and weakness at the end of the crisis.
Partial seizures: simple partial seizures
Specific symptoms of simple partial seizures are muscular contractions of a specific part of the patient’s body, the presence of abnormal sensations, possible nausea, sweating, flushing and dilated pupils.
Complex partial seizures
Characteristic symptoms of complex partial seizures are a certain automatism, the presence of abnormal sensations, nausea, sweating, hot flushes, dilated pupils, changes in personality or alertness, a possible loss of consciousness, alterations or hallucinations in the senses of taste or smell.
Epilepsy, the causes of a seizure
To discover the primary cause of epileptic seizures, one must first investigate the age at which the disease first occurred.
In some, seizures may be caused by hormonal changes due to pregnancy or menstruation, pre-existing pathologies or sensory stimuli such as light, sound, touch.
In many cases, there is no real trigger.
Assuming that the circumstances in which a seizure occurs are in any case special circumstances, it can be said that anyone can have an epileptic seizure.
The amount of stimulation required to trigger such a seizure is commonly called the ‘seizure threshold’; many epilepsy patients have a low threshold.
Common seizure triggers can be considered:
- Idiomatic causes
When there is no clearly identified cause. In this case, the disease often begins between the ages of 5 and 20, has no clinical history of other neurological diseases, but a family history of other seizures.
- Genetic or developmental conditions or lesions during birth
In this case, seizures may begin in early childhood.
- Metabolic disorders
Such as diabetes mellitus, electrolyte imbalances, renal insufficiency, nutritional deficiencies, phenylketonuria, use of, intoxication or abstinence from drugs or alcohol; in this case the disease can occur at any age.
- Head injuries
Epileptic seizures usually occur within 2 years of the onset of the lesion, but do not necessarily indicate chronic development of the disease; they can occur at any age (depending on how long the patient has suffered the injury), with a higher incidence in adulthood and are more likely in the case of damage to the cerebral membranes.
- Cardiovascular diseases
They represent the most common cause in people over 60 years of age.
- Degenerative diseases
Senile dementia due to Alzheimer’s and similar diseases.
Meningitis, encephalitis, brain abscesses, chronic infections, complications of AIDS and other diseases that affect the immune system; seizures can occur at any age, but they can also be reversible (i.e. once the underlying disease has been overcome, the seizures also disappear).
- Preventing epileptic seizures
In general, it is not possible to speak of preventing the disease.
What is possible, however, is prevention of the exacerbation of seizures.
An adequate diet, good sleep and abstinence from drugs and alcohol can greatly decrease the possibility of aggravating or accelerating a seizure,
- Diagnosis of epilepsy
To make the diagnosis of epilepsy one must first investigate the patient’s clinical history, which typically documents the presence of recurrent seizures; physical examination may document specific neurological deficits.
The most relevant examination for the diagnosis of epilepsy is certainly the electroencephalogram, which, in some cases, may even be able to locate the exact point of the lesion causing the seizures.
Other laboratory and instrumental tests may also be prescribed, such as blood cell counts, liver and kidney function tests, tests for viral markers, cerebrospinal fluid analysis, CT scans, MRI scans, and lumbar puncture.
These examinations are also useful for discovering other temporary and reversible causes of epileptic seizures, such as fever, possible chemical imbalances, toxaemia during pregnancy, abstinence from alcohol and drugs (especially barbiturates and benzodiazepines), and drug use.
There are disorders that can have symptoms similar to those caused by epileptic seizures; these disorders are transient ischaemic attacks, rage and panic attacks or any other disorder that generally causes tremors and loss of consciousness.
Treatment of epilepsy
First aid in grand mal seizures
In the event of a grand mal seizure, one must
- take care to protect the person from injury;
- one must not attempt to force a hard object, e.g. a spoon, between the teeth, as this may cause even more damage than one is trying to prevent;
- it is necessary to remove objects from the surroundings which, falling during the seizure, could injure the patient (e.g. furniture in a room, such as chairs, drawers, something sharp, etc.);
- absolutely forbid trying to hold the patient down during the crisis;
- try to prevent the patient from aspirating vomit or mucus; to this end, it is preferable to turn the patient on his side if he vomits or falls asleep;
- if the patient becomes cyanotic or stops breathing, turn the patient to one side and try to keep the airways open, possibly by moving the tongue which is obstructing them. Breathing resumes automatically immediately after the crisis. Only rarely is mouth-to-mouth respiration needed, which, in any case, should never be performed during a crisis.
Emergency medical intervention
Prolonged or repeated seizures can lead to severe oxygen deprivation in the seizure sufferer.
In this case, urgent intervention by specialised medical personnel is required.
When caring for a patient with this type of seizure, it is therefore vital to seek medical attention immediately; it may also be necessary to implement breathing maintenance measures.
It may also be necessary to administer intravenous glucose and thiamine if the seizures are caused by low blood levels of these elements, or intravenous administration of diazepam or lorazepam or anticonvulsant drugs (phenytoin and phenobarbital) to control prolonged seizures.
General anaesthesia can also be used for this purpose.
Only when the seizure is under control can oral anticonvulsants be administered.
What to do after a seizure
It is good practice to record every detail of the epileptic seizure and then present them to the attending physician.
The data needed are certainly the date and time of the seizure, its duration, the part of the body involved, the type of movements or other symptoms present, possible causes or other known factors.
Isolated seizures are often treated based on the type of seizure and the possible trigger; generally, anticonvulsant drugs are used.
In any case, injuries resulting from falls or shocks should never be overlooked.
What to do after the diagnosis of epilepsy
If the trigger is known, treatment of the cause usually puts an end to epileptic seizures.
This is the case, for example, with brain injuries, tumours, etc.
There are, however, other factors that can trigger an epileptic seizure or aggravate a previously well-controlled disorder; these conditions are pregnancy, lack of sleep, failure to take doses of a drug, the use of drugs, medication and alcohol, and the presence of other illnesses.
The most common complications of epilepsy are closely linked to seizures and depend on them
Frequent complications are
- injuries caused by falls, shocks and those caused by using dangerous machinery or driving motor vehicles during a seizure;
- aspiration of fluid into the lungs;
- possible permanent brain damage,
- side effects due to medication;
- learning difficulties;
- malformations in the foetus in women using certain anti-epileptic drugs (if pregnant, consult your doctor who will consider reducing doses or changing medication).
Prognosis: is it possible to recover from epilepsy?
Epilepsy is, to all intents and purposes, a lifelong chronic condition; in some cases, however, an improvement may occur that may lead to a reduction in doses or even discontinuation of the current therapy.
A period of at least four years, characterised by the absence of seizures, may confirm the reduction or discontinuation of the drug.
Death or permanent brain damage due to an epileptic seizure is a rare occurrence, but can happen if the seizure is prolonged or if the patient suffers from seizures close together, a short distance apart.
In this case, death or brain damage is caused by the absence of oxygen (ischaemia) in the brain tissue and its death (infarction).
Serious injuries can occur if the seizure strikes the patient while driving or while using particularly dangerous material or machinery; it is clear, therefore, that such activities should generally be prohibited for patients with poorly controlled seizures.
It is also true, however, that infrequent seizures do not affect or seriously impair the patient’s quality of life.
In fact, work, school and recreation need not be banned for patients with epilepsy, as long as proper precautions are taken.