The Science of a Brain Short Circuit
Tirai Kehidupan: The terms "seizure" and "epilepsy" are interchangeably used more or less. Perhaps when the seizure is more visibly evident by muscle jerking and loss of consciousness, the more it might be said, "That person has epilepsy." In any case, the process is caused by repetitive and abnormal electrical discharges in the brain. These can be mapped and recorded by the electroencephalogram, or EEG. This involves hooking a lot of wires to the scalp and recording where the abnormal activity is taking place. If the discharges are taking place in the motor area of the brain, the typical jerking movements are seen. If they are taking place in the temporal area, the patient might smell something funny. Seizure activity in the occipital, or back area of the brain, might cause odd things to be seen. The abnormal activity can spread from one area to another, causing combinations of these.Under Creative Commons License: Attribution No Derivatives When the entire brain is discharging abnormally, this is called a generalized seizure. There are other variations of seizures: ones that result in abnormal emotions, problems with learning, or dysfunctions in systems controlled by the autonomic nervous system. It simply depends on where the abnormal discharge activity is taking place.
There were a lot of descriptive terms used in the past to try and classify seizures. This has been simplified into two specific types and seems to work well. The first group is "partial" or "focal" onset seizures. They start in one specific area. The second type is "generalized" or "distributed" seizures which start in all areas of the brain cortex at once. In simple partial seizures there is no loss of consciousness; in complex partial seizures there is a loss of consciousness.
Under Creative Commons License: Attribution No Derivatives There is a loss of consciousness in all generalized seizures. The generalized seizures are further classified according to their effect on the body, and may include absence seizures, myoclonic, clonic and atonic seizures. These two main types of seizures of partial and generalized are called primary epilepsy. Secondary epilepsy might include alcohol withdrawal seizures, drug overdose seizures, and the seizures of brain infections such as meningitis.
It can be a challenge at times to diagnose a seizure condition. One interesting side note is that if a person has bite lacerations to the tongue after a seizure-like episode, it is 99% certain that he indeed had a seizure. Only 24% of people having true seizures actually bite their tongues. You can't say they don't have seizures because the tongue wasn't bitten. To proceed the usual first step in diagnosis is an MRI scan and blood testing. The purpose is to look for structural abnormalities like tumors, enlarged blood vessels, or atrophic brain areas that might be the cause of seizures, and which might be potentially repairable. The next step is the EEG, or brain wave test. It is usually done after a period of sleep deprivation, as this condition might elicit an otherwise quiet seizure. It is important that the entire EEG be performed. It is done awake, during rapid- fire strobe lights, and asleep. Often the patient is videotaped during the entire test to look for subtle clues to seizures. The other thing is that some kinds of seizures, like partial seizures especially of the frontal area, tend to occur during sleep. Generalized seizures are more prone to occur in the morning. The video camera might pick up subtle changes, like appearing stunned, having rapid blinking, or inability to follow directions.
It would seem obvious why seizures should be treated; that is, not to have them. There are a lot of other issues which mandate treatment of seizures. People with seizures don't live as long. The most extreme example of this is Sudden Unexplained Death of Epilepsy (think of John Travolta's tragic loss of his son). A person with epilepsy is forty-two times more likely to die suddenly of unexplained causes than a person without it. There is increased risk of cognitive impairment: epileptics often don't finish school, often do not marry, and many have difficulty finding employment. Depression and suicidality are greatly increased in epilepsy.
The good news is that there are excellent treatments for seizures. First-line drugs that have been around for a long time are Phenobarbital, valproic acid, and carbamazepine, though these can have side effects like sleepiness which may make them less desirable. There are at least nine new "second generation antiepilepsy drugs (AED's) which have become available since 1993. These often work as single agents, though sometimes they have to be combined. They have to be carefully chosen and tailored to the seizure patient based on other drugs taken and the condition of the liver and bone marrow. Blood levels of the drugs sometimes require careful monitoring. Some of these newer drugs include gabapentin, lamotrigine, and topiramate.
Here's the downside, though. In up to one-third of cases, the drugs simply do not bring complete control. It used to be that people were walking around for years and years on three or four drugs which were not working. Current thinking now is that if three drugs have been given in sufficient doses over a sufficient length of treatment, it's time to refer for epilepsy surgery evaluation. This type of treatment is bringing complete control in over 80% of those treated, and over half of those referred are surgical candidates. The numbers are that there are a hundred-thousand people out there right now who would benefit from surgery.
So, in conclusion, epilepsy or seizure disorder, affects over two and a half million Americans. There are excellent drug treatments available after the diagnosis has been established. Drug treatment is demanding and exacting, and is probably best managed by physicians who deal in seizures all the time. If there is a situation where drug therapy is proven to be ineffective, referral to an epilepsy surgery center is warranted. There are numerous reasons why seizures should be completely managed; most of them centered on longevity and quality of life issues.
John Drew Laurusonis M.D
Doctors Medical Center
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