What are the common symptoms of epilepsy. How is epilepsy diagnosed and treated. What are the different types of seizures associated with epilepsy. What causes epilepsy and who is at risk. How does epilepsy impact daily life and what support is available.

Understanding Epilepsy: A Neurological Disorder

Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures. These seizures are sudden, uncontrolled electrical disturbances in the brain that can cause changes in behavior, movements, feelings, and consciousness. While a single seizure doesn’t necessarily mean a person has epilepsy, two or more unprovoked seizures are typically required for an epilepsy diagnosis.

Understanding epilepsy is crucial for both patients and caregivers. Are you aware of how common epilepsy is? Approximately 50 million people worldwide live with epilepsy, making it one of the most prevalent neurological disorders. This condition affects people of all ages, though it’s more commonly diagnosed in children and older adults.

Types of Seizures: Classifying Epileptic Episodes

Seizures are the primary symptom of epilepsy, but not all seizures are the same. They can vary in intensity, duration, and the parts of the body affected. The International League Against Epilepsy (ILAE) classifies seizures into two main categories: focal onset and generalized onset.

Focal Onset Seizures

Focal onset seizures, previously known as partial seizures, originate in a specific area of the brain. These can be further categorized into:

• Focal Onset Aware Seizures: The person remains conscious and aware during the seizure.
• Focal Onset Impaired Awareness Seizures: Consciousness is affected, and the person may appear confused or unresponsive.

Do focal seizures always remain localized? Not necessarily. Some focal seizures can spread to both sides of the brain, evolving into bilateral tonic-clonic seizures.

Generalized Onset Seizures

Generalized onset seizures involve both sides of the brain from the start. These include:

1. Absence Seizures: Brief lapses in awareness, often mistaken for daydreaming.
2. Tonic Seizures: Cause muscle stiffening.
3. Atonic Seizures: Lead to loss of muscle control and sudden falls.
4. Clonic Seizures: Characterized by repeated, jerking muscle movements.
5. Myoclonic Seizures: Cause quick, shock-like jerks of muscles.
6. Tonic-Clonic Seizures: The most dramatic type, involving loss of consciousness, muscle stiffening, and jerking.

Symptoms and Warning Signs of Epilepsy

Recognizing the symptoms of epilepsy is crucial for early diagnosis and treatment. While seizures are the primary symptom, epilepsy can manifest in various ways. Can you identify an epileptic seizure? Here are some common signs:

• Temporary confusion
• Staring spells
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychological symptoms such as fear, anxiety, or déjà vu

Many people with epilepsy experience auras, which are warning sensations that precede a seizure. These can include strange smells, tastes, or sensations. Auras are actually focal aware seizures and can sometimes occur without progressing to more severe seizures.

Causes and Risk Factors of Epilepsy

Understanding the causes of epilepsy is complex, as the condition can result from various factors. In many cases, the exact cause remains unknown. However, several known factors can contribute to the development of epilepsy:

Genetic Influences

Some forms of epilepsy run in families, suggesting a genetic component. Certain genes may make a person more susceptible to environmental conditions that trigger seizures.

Brain Injuries

Trauma to the brain, such as from car accidents or strokes, can lead to epilepsy. These injuries can cause scarring in the brain, which may disrupt normal neuronal activity and trigger seizures.

Developmental Disorders

Conditions like autism, Down syndrome, and cerebral palsy are associated with a higher risk of epilepsy.

Infections

Certain infections that affect the brain, such as meningitis, HIV, and viral encephalitis, can increase the risk of developing epilepsy.

Brain Tumors

Both benign and malignant brain tumors can cause seizures and lead to epilepsy.

Is age a factor in developing epilepsy? While epilepsy can develop at any age, it’s most commonly diagnosed in children and older adults. This is partly due to the higher incidence of congenital conditions in children and age-related brain changes or strokes in older adults.

Diagnosis and Evaluation of Epilepsy

Diagnosing epilepsy can be challenging, as many other conditions can cause seizure-like symptoms. A comprehensive evaluation typically involves several steps:

Medical History

A detailed account of seizure episodes, including frequency, duration, and any potential triggers, is crucial. Family history of epilepsy or neurological disorders is also considered.

Neurological Examination

This assesses brain function, including behavior, motor abilities, mental function, and other areas to identify any neurological problems.

Blood Tests

These can help rule out other conditions or identify any underlying health issues that might be causing seizures.

Electroencephalogram (EEG)

An EEG records the brain’s electrical activity and can help identify abnormal patterns associated with epilepsy. How does an EEG work? Electrodes are attached to the scalp to detect and record brain wave patterns. Sometimes, a normal EEG may not capture seizure activity, necessitating prolonged EEG monitoring.

Imaging Studies

MRI (Magnetic Resonance Imaging) or CT (Computed Tomography) scans can reveal brain abnormalities that might be causing seizures, such as tumors or cysts.

Video EEG Monitoring

This involves continuous EEG recording along with video monitoring of the patient’s behavior. It’s particularly useful in diagnosing epilepsy and identifying the type of seizures a person is experiencing.

Treatment Approaches for Epilepsy Management

The primary goal of epilepsy treatment is to control seizures effectively with minimal side effects. Treatment strategies are tailored to each individual and may include:

Antiseizure Medications

Also known as anticonvulsants or antiepileptic drugs (AEDs), these are the mainstay of epilepsy treatment. They work by altering the chemical processes in the brain to prevent or minimize seizures. Common AEDs include carbamazepine, valproic acid, and levetiracetam.

How effective are antiseizure medications? About 70% of people with epilepsy can become seizure-free with appropriate medication. However, finding the right medication or combination of medications can take time and may require adjustments.

Dietary Therapies

Some people, especially children with certain types of epilepsy, may benefit from specific diets. The ketogenic diet, a high-fat, low-carbohydrate diet, has shown effectiveness in reducing seizures in some cases.

Vagus Nerve Stimulation (VNS)

This involves implanting a device that sends electrical pulses to the vagus nerve in the neck. VNS can help reduce seizure frequency and severity in some people who don’t respond well to medications.

Responsive Neurostimulation (RNS)

RNS involves implanting a device in the skull that monitors brain waves and delivers electrical stimulation to prevent seizures when abnormal activity is detected.

Epilepsy Surgery

For some people whose seizures are not controlled by medication, surgery may be an option. This typically involves removing the part of the brain where seizures originate. Types of epilepsy surgery include:

• Focal Resection: Removing a small part of the brain where seizures start
• Corpus Callosotomy: Cutting the connection between brain hemispheres to prevent seizures from spreading
• Hemispherectomy: Removing or disconnecting one side of the brain’s cortex

Is epilepsy surgery always successful? While epilepsy surgery can be very effective, success rates vary depending on the type of epilepsy and the specific procedure. In some cases, surgery can lead to complete seizure freedom, while in others, it may significantly reduce seizure frequency.

Living with Epilepsy: Coping Strategies and Lifestyle Adjustments

Living with epilepsy often requires making certain lifestyle adjustments to manage the condition effectively and maintain a good quality of life. Here are some strategies that can help:

Medication Adherence

Consistently taking prescribed medications as directed is crucial for seizure control. Missing doses can increase the risk of breakthrough seizures.

Identifying and Avoiding Triggers

Many people with epilepsy have specific triggers that can provoke seizures. Common triggers include:

• Lack of sleep or changes in sleep patterns
• Stress
• Alcohol or drug use
• Flickering lights or patterns
• Hormonal changes during menstruation

Keeping a seizure diary can help identify personal triggers and patterns.

Safety Precautions

Taking safety measures can prevent injuries during seizures. This might include:

• Avoiding swimming alone
• Using shatterproof glasses and dishes
• Installing safety devices on stoves and other appliances
• Wearing a medical alert bracelet

Regular Medical Check-ups

Regular follow-ups with a neurologist are important to monitor the effectiveness of treatment and make any necessary adjustments.

Healthy Lifestyle

Maintaining overall health can contribute to better seizure control. This includes:

• Getting adequate sleep
• Managing stress through relaxation techniques or counseling
• Regular exercise (with doctor’s approval)
• Maintaining a balanced diet

Support Systems

Joining support groups or connecting with others who have epilepsy can provide emotional support and practical advice for managing the condition.

How can epilepsy affect daily life? Epilepsy can impact various aspects of life, including work, relationships, and the ability to drive. However, with proper management and support, many people with epilepsy lead full and active lives.

Research and Future Directions in Epilepsy Treatment

The field of epilepsy research is dynamic, with ongoing efforts to improve diagnosis, treatment, and quality of life for people with epilepsy. Some promising areas of research include:

Gene Therapy

Researchers are exploring ways to use gene therapy to treat specific types of epilepsy caused by genetic mutations.

Improved Brain Imaging Techniques

Advanced imaging technologies are being developed to better identify the sources of seizures in the brain, potentially improving surgical outcomes.

Neuromodulation Techniques

New forms of brain stimulation are being investigated as potential treatments for drug-resistant epilepsy.

Precision Medicine

This approach aims to tailor treatments to an individual’s genetic profile, potentially leading to more effective and personalized therapies.

Anti-Inflammatory Therapies

Research is exploring the role of inflammation in epilepsy and investigating anti-inflammatory treatments as potential therapies.

What breakthroughs can we expect in epilepsy treatment? While it’s difficult to predict specific breakthroughs, the rapid advancements in neuroscience and genetics are likely to lead to more targeted and effective treatments for epilepsy in the coming years.

In conclusion, epilepsy is a complex neurological disorder that requires comprehensive management and ongoing research. While it can present challenges, many people with epilepsy lead fulfilling lives with proper treatment and support. As our understanding of the brain and seizure mechanisms continues to grow, so does the hope for more effective treatments and potentially a cure for epilepsy in the future.

Glossary of Epilepsy Terms

Written by WebMD Editorial Contributors

Absence seizure: (also know as “dialeptic seizure” or “petit mal seizure”) a seizure that causes a brief loss of awareness. During an absence seizure, the patient stops any activity and stares blankly. Rarely, there may be some blinking.

Antiseizure drug (ASD): Also called an anticonvulsant an antiepileptic drug used to control both convulsive and nonconvulsive seizures.

Atonic seizure: a seizure that causes a sudden loss of muscle tone, particularly in the arms and legs, and often causes the patient to fall.

Aura: a warning or initial symptom at the beginning of a seizure, experienced by the patient, but not visible to observers. Auras may progress to become focal or even generalized seizures, or they may exist alone.

Bilateral tonic clonic seizure: Formerly called grand-mal seizures, an older term for a seizure in which the patient loses consciousness and collapses. The patient also has body stiffening and violent jerking, and then often goes into a deep sleep. Also known as a generalized convulsion.

Clonic seizure: repetitive, rhythmic jerks that involve all or part of the body.

Corpus callosum: a band of nerve fibers located deep in the brain that connects the two halves (hemispheres) of the brain. The corpus callosum helps the hemispheres share information.

Corpus callosotomy: an operation that cuts the corpus callosum and interrupts the spread of seizures from one hemisphere of the brain to the other. Callosotomies may be complete, or may involve only a portion of the corpus callosum. Although seizures generally do not completely stop after this procedure, they usually become less severe.

EEG-video monitoring: Continuous simultaneous recording of brainwaves and video observation of the behavior accompanying the EEG. This technique, carried out at comprehensive epilepsy centers, is employed to diagnose epilepsy and localize the seizure focus. The results are useful to determine therapy — medical or surgical.

Epilepsy: a chronic medical condition marked by recurrent epileptic seizures. Patients may have single seizures as a result of fever, drug withdrawal, or trauma, for example, but are not labeled as having epilepsy if seizures do not recur.

Epileptogenic zone: the region of the brain responsible for the abnormal electrical signals that cause seizures.

Electrode: a conductive disk (usually metal) attached to the scalp which conveys the electrical activity of the brain through a wire to an EEG machine. During an electroencephalogram, typically around 20 electrodes are temporarily pasted to the scalp.

Electroencephalogram (EEG): a diagnostic test that measures brain waves, the electrical impulses in the cerebral cortex. This test helps a doctor to diagnose epilepsy.

Epilepsy surgery: a neuro-surgical procedure to prevent further seizures, usually accomplished by resecting the epileptogenic zone. Successful in eliminating seizures in a large majority of patients, depending on the type of epilepsy identified during EEG-video monitoring.

Extratemporal cortical resection: an operation to cut out (resect) brain tissue that contains a seizure focus. “Extratemporal” means the tissue is located in an area of the brain other than the temporal lobe, most often the frontal lobe.

Focal onset aware seizure: (also known as a “partial seizure”) a seizure that occurs in a limited area in only one hemisphere of the brain. This type of seizure is more amenable to treatment with surgery than are generalized seizures.

Focal onset impaired awareness seizure: Formrly called complex partial seizures are seizures that includes impairment of awareness, for example, patients seem to be “out of it” or “staring into space.” Unintentional movements or other movements are frequently a part of the seizure.

Functional hemispherectomy: a procedure in which portions of one hemisphere of the brain which is not functioning normally are removed, and the corpus callosum is split. This interrupts the communications among the various lobes and between the two hemispheres and prevents the spread of seizures.

Hemisphere: one half of the cerebrum, the largest part of the brain.

Generalized seizure: a seizure that occurs all through the brain.

Ketogenic diet: a treatment for epilepsy intended to maintain the starvation or fasting metabolism for a long period in order to create ketones, byproducts of fat-burning metabolism. Seizures often lessen or disappear during periods of fasting. The diet is very high in fat and low in carbohydrates and is most often recommended for children ages 2 through 12 who have been diagnosed with a generalized type of epilepsy, and who have failed to respond to a variety of medications.

Lesionectomy: surgery to remove isolated brain lesions that are responsible for seizure activity.

Lobe: one of the sections of the cerebrum, the largest part of the brain. The lobes are divided into four paired sections (frontal, parietal, occipital, and temporal). The seizure focus is usually located in one of the lobes.

Lumbar puncture: a diagnostic procedure in which the fluid surrounding the spinal cord (cerebrospinal fluid) is withdrawn through a needle and examined in a lab. Also known as a spinal tap.

Multiple subpial transection: a surgical procedure to help control seizures that begin in areas of the brain that cannot be safely removed (areas that control movements or speech). The surgeon makes a series of shallow cuts (transections) in the brain tissue to interrupt the movement of seizure impulses.

myoclonic seizure: a seizure that consists of sporadic jerks, usually on both sides of the body. Patients with these seizures may drop or involuntarily throw objects.

Neurologist: a doctor who specializes in the treatment of epilepsy and other disorders of the brain and nervous system.

Neuron: a single nerve cell. The brain is made up of billions of neurons. Many neurons malfunctioning together are necessary to produce a seizure.

Nonepileptic event: an event that resembles a seizure but is actually produced by another condition, such as Tourette syndrome or heart rhythm disturbances (arrhythmias). Certain psychological conditions can also bring on a nonepileptic event.

Responsive neurostimulation device: RNS consists of a small neurostimulator implanted within the skull under the scalp. The neurostimulator is connected to one or two wires (called electrodes) that are placed where the seizures are suspected to originate within the brain or on the surface of the brain. The device detects abnormal electrical activity in the area and delivers electrical stimulation to normalize brain activity before seizure symptoms begin.

Seizure: an event of altered brain function caused by abnormal or excessive electrical discharges in the brain. Most seizures cause sudden changes in behavior or motor function.

Seizure focus: the area of the brain in which a seizure starts.

Status epilepticus: a prolonged seizure (usually defined as lasting longer than 5 minutes) or a series of repeated seizures without regaining consciousness. Status epilepticus is a medical emergency and medical help should be obtained immediately.

Temporal lobe resection: a surgical procedure in which brain tissue in the temporal lobe is cut away (resected) to remove the seizure focus.

Tonic seizure: a seizure that is characterized by stiffening of the muscles, sustained for more than a few seconds.

Tonic-clonic seizure: a seizure marked by loss of consciousness, falling, stiffening, and jerking. This is the hallmark of a generalized motor seizure, which used to be called a “grand mal seizure.”

Vagus nerve: a small cranial nerve that passes through the neck and is connected to various areas of the brain and other organs in the body, including the stomach, heart, and lungs.

Vagus nerve stimulation: a surgical treatment for epilepsy involving implantation in the neck of an electrode on the vagus nerve. The electrode is connected to a pacemaker that is placed under the skin in the chest. While the VNS is usually programmed to cycle continuously, the patient can turn the stimulator on, using a small magnet placed over the pacemaker, if they feel a seizure coming on.

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Epilepsy terminology | Epilepsy Society

Epilepsy terminology

There are a number of common misconceptions surrounding epilepsy and epilepsy terminology.

Saying it right

Some terms used in association with the condition are becoming less appropriate, due to their negative connotations or inaccuracy. While seizures may be referred to as ‘epileptic’, this is not an appropriate term for a person with the condition. The correct term is ‘person with epilepsy’.

Seizure, fit, attack?

The word for an epileptic event is ‘seizure’. This most accurately describes the wide-ranging experiences of people with epilepsy. The words ‘attack’, ‘fit’ and ‘turn’ are still used, but decreasingly. The word ‘fit’, for example, implies a convulsive seizure but not all seizures will be convulsive.

In the interests of accuracy, the terms ‘grand mal’ and ‘petit mal’ should not be used to describe seizure types, as epilepsy is a very complex condition with many different seizure types. These terms have been replaced by a range of classifications which more accurately describe how different seizures manifest themselves.

There has been criticism that the word ‘brainstorming’ is offensive to people with epilepsy. Epilepsy Society recently conducted a small survey among people with the condition and the overwhelming response was that the term is not offensive when used in its correct context, defining a session amassing spontaneous ideas as potential solutions to a problem.

Epilepsy and associated disabilities

Epilepsy is not a disease or an illness and it is not catching. It is the most common serious neurological condition. There is no causal link between epilepsy and learning disabilities, however both are outward symptoms of underlying brain dysfunction or damage and sometimes their cause is the same. 30% of people with learning disabilities have epilepsy; 15% of people with epilepsy have learning disabilities.

Ancient misconceptions about epilepsy are still in evidence today. There is much stigma attached to having the condition. A study by Epilepsy Society showed that around 2% of people in the UK still believe epilepsy is caused by possession of evil spirits. The study also showed that over 75% of people would call an ambulance if they witnessed a seizure rather than apply some simple first aid.

There are many different types of epileptic seizure. Any of us could potentially have a single epileptic seizure at some point in our lives. This is not the same as having epilepsy, which is a tendency to have seizures that start in the brain. 

Epileptic seizuresFind out more

Triggers are situations that can bring on a seizure in some people with epilepsy.

Seizure triggersFind out more

Did you know that the Greek philosopher Hippocrates (460-377 BC) was the first person to think that epilepsy starts in the brain? Find out more interesting facts and debunked myths around epilepsy and seizures.

Epilepsy facts and mythsFind out more

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basic principles of diagnosis and treatment

Epilepsy is currently one of the important problems of pediatric neurology. The frequency of epilepsy in the child population is, according to foreign data, 0.5-0.75% of the child population, and febrile seizures up to 5%. In Russia, exact data are not available. Perhaps this is due to the fact that many specialists treat epilepsy – psychiatrists, neurologists, and sometimes even generalists, although epilepsy is a neurological disease all over the world. Knowledge of the classification of epilepsy is also important.

Epilepsy is currently a curable disease. This means that thanks to modern achievements in neuropharmacology, new highly effective antiepileptic drugs (AEDs) have been synthesized. Seizure control in the world reaches 75-85%.

In addition, in recent years, thanks to clinical research, the understanding of the etiological factors and the main pathophysiological mechanisms of epilepsy has improved.

Epilepsy is a chronic brain disease characterized by recurrent, unprovoked attacks of impaired motor, sensory, autonomic, mental, or mental functions resulting from excessive neuronal discharges.

Seizures may be single or repeated. And only the latter are the basis for the diagnosis of epilepsy. Febrile convulsions, as well as convulsions that occur in acute brain diseases (for example, with encephalitis, subdural hematoma, acute cerebrovascular accident, etc.) are not epilepsy.

The modern classification of epileptic seizures was adopted by the International Epilepsy League in 1981 in Kyoto (Japan). Unlike previous classifications, it takes into account both clinical and neurophysiological (EEG) criteria for most types of epileptic seizures. The classification subdivides all types of epileptic seizures into: partial (focal, focal, local, localization-conditioned), generalized and unclassified.

Partial seizures are diagnosed when there are clear clinical and electrophysiological criteria for the involvement of certain brain structures at the onset of the paroxysm. For example, clonic convulsions of one half of the face and arm (faciobrachial seizures) usually indicate the presence of an epileptic focus in the mid-lower sections of the anterior central gyrus; olfactory hallucinations – in the area of ​​the hook; photopsia – in the cortex of the occipital lobe, etc. In the event that the attack begins as a partial attack, and then the entire muscles of the trunk and limbs are involved and signs of involvement of both hemispheres on the EEG, then it should be classified as focal with secondary generalization.

With the accumulation of clinical experience, the introduction of the video-EEG monitoring method into practice, the development of neuroradiological diagnostic methods (CT, MRI, PET), molecular genetics and other sciences, it has become obvious that there are a number of special forms of epilepsy for which characterized by its own clinic (typical types of seizures), course and prognosis. Some of these forms have been known for a long time, such as West syndrome, Lennox-Gastaut syndrome, Rolandic epilepsy.

Others – benign familial neonatal convulsions, severe myoclonic epilepsy of infancy, juvenile absence epilepsy – have been identified only in recent years. These forms of epilepsy, or according to the International Classification, epileptic syndromes, as a rule, are manifested not by any one type of seizures, but by their combination. Epileptic syndromes are defined as separate, independent forms of epilepsy, characterized by a limited age of onset of seizures, the presence of a special type of seizures, specific changes in the EEG (characteristic of this syndrome), patterns of course and prognosis. For example, one type of seizures – absences – can be included in the structure of a number of epileptic syndromes: childhood and youthful absence epilepsy, juvenile myoclonic epilepsy, epilepsy with myoclonic absences, and others, and the course and prognosis for all these syndromes are different.

A fundamentally new step in the development of epileptology was the creation of a modern classification of “epilepsies, epileptic syndromes and diseases associated with seizures.” This classification was adopted by the International Epilepsy League in October 1989 in New Delhi and is now generally accepted by epileptologists around the world.

The classification of epileptic syndromes is based on the following principles

1. Localization principle:

• Localized (focal, local, partial) forms of epilepsy
• Generalized forms
• Forms having both partial and generalized features

2. Principle of etiology:

• Symptomatic
• Cryptogenic
• Idiopathic

3. Age of onset of attacks:

• Forms of newborns
• Infant
• Baby
• Youth
• In adults

4. The main type of seizures that determine the clinical picture of the syndrome:

• Absences
• Myoclonic absences
• Infantile spasms, etc.

5. Features of the course and prognosis:

• Benign
• Severe (malignant)

The principles of localization and etiology in the classification require clarification. The classification is based on classical concepts of focal and generalized forms of epilepsy.

Localized forms are determined if the nature of the seizures, EEG data and neuroradiological examination confirm the local origin of the seizures. This applies not only to forms with a clearly identified structural defect of the brain (temporal, frontal epilepsy), but also to syndromes in which the nature of seizures and EEG indicate a local onset, but changes are usually absent on CT (rolandic epilepsy, benign occipital epilepsy). It is also possible the existence of multifocal forms of epilepsy, in which seizures come from several foci within one or both hemispheres.

In generalized forms of epilepsy, seizures should be generalized from the very beginning, which is also confirmed by EEG data (bilaterally synchronous spread to both hemispheres). The pathogenesis of generalized forms of epilepsy is still not clear enough. The cortico-thalamic hypothesis of the occurrence of primary generalization is assumed.

In cases where the nature of the seizures and the examination data do not allow us to state with certainty the local or primary generalized onset of paroxysms, these epileptic syndromes are defined as not amenable to clear classification, that is, having signs of both localization and generalization.

Classification subdivides all epileptic syndromes into symptomatic, idiopathic and cryptogenic.

Symptomatic forms are epileptic syndromes with known etiology and verified morphological disorders (tumors, scars, gliosis, cysts, dysgenesis, etc.).

In idiopathic forms, there are no diseases that can cause epilepsy, and epilepsy is, as it were, an independent disease. Currently, the genetic determinism of idiopathic forms of epilepsy has been established.

The term “cryptogenic” (hidden) refers to those syndromes, the cause of which remains hidden, unclear. These syndromes do not meet the criteria for idiopathic forms, but there is no evidence of their symptomatic nature. For example, in the case of a combination of epilepsy with hemiparesis or oligophrenia, the symptomatic nature of the disease is assumed, but CT and MRI studies do not visualize changes in the brain. This case is classified as cryptogenic. Obviously, with the improvement of the technical capabilities of neuroimaging (for example, PET), most cryptogenic forms will be transferred to the category of symptomatic ones.

General principles for the treatment of epilepsy

Currently, generally accepted international standards for the treatment of epilepsy have been developed, which must be observed in order to improve the effectiveness of treatment and improve the quality of life of patients.

Treatment of epilepsy can only be initiated after an accurate diagnosis has been established. The terms “pre-epilepsy” and “prophylactic treatment of epilepsy” are invalid. Paroxysmal neurological disorders are divided into epileptic and non-epileptic (fainting, sleepwalking, night terrors, etc.), and the appointment of AED is indicated only in the case of epilepsy. According to most neurologists, treatment of epilepsy should be started after a second attack. A single paroxysm may be “accidental”, due to fever, overheating, intoxication, metabolic disorders and not related to epilepsy.

In this case, it is possible to refrain from prescribing AEDs, since these drugs cannot be a preventive treatment due to their toxicity.

Thus, AEDs can only be used in cases of recurrent unprovoked epileptic seizures (ie epilepsy by definition).

Diagnosis of epilepsy is based on electroencephalographic data, patients undergo routine EEG and EEG monitoring of night or daytime sleep.

Once the diagnosis of epilepsy is established, the question must be decided whether or not to prescribe AED? However, in some benign epileptic syndromes of childhood (primarily Rolandic epilepsy) and reflex forms of epilepsy (reading epilepsy, primary photosensitivity epilepsy, etc. ), patients can be managed without the use of AEDs. Such cases must be strictly reasoned.

Since the 1980s, the principle of monotherapy has been firmly established in clinical epileptology: the use of a single drug for treatment, since according to research, many anticonvulsants have mutual antagonism, and their simultaneous use can significantly weaken the anticonvulsant effect of each. In addition, the use of monotherapy avoids the occurrence of severe side effects and teratogenic effects, the frequency of which increases significantly when several drugs are administered simultaneously. Polytherapy is justified only in the case of resistant forms of epilepsy and no more than 3 AEDs at the same time.

AEDs are prescribed strictly in accordance with the form of epilepsy and the nature of the seizures. The success of epilepsy treatment is largely determined by the accuracy of syndromic diagnosis.

AEDs are given starting at a low dose and increasing gradually until therapeutic efficacy is achieved or the first signs of side effects appear. In this case, the determining factor is the clinical efficacy and tolerability of the drug, and not its content in the blood!

If one drug fails, it should be gradually replaced with another AED effective in this form of epilepsy. If one AED is ineffective, it is impossible to immediately add a second drug to it, that is, switch to polytherapy without using all the reserves of monotherapy.

AEDs can be discontinued 2.5-5 years after the absence of seizures. The clinical and electroencephalographic criterion (absence of seizures and normalization of the EEG pattern) is taken as the basis. For this, video-EEG monitoring is carried out.

(Materials of the publication by K.Yu. Mukhin, A.S. Petrukhin, Moscow)

Treatment of epilepsy in the NET clinic

Definition
diseases

Epilepsy is a chronic disease characterized by
periodic seizures. Seizures occur due to excessive discharge
cells in different areas of the brain.

Many people think of epilepsy as
called Generalized tonic-clonic seizures, which look like
loss of consciousness and convulsions, but there are about sixty types in total
seizures, which can be very diverse and sometimes very hard
guess that the child has epileptic seizures.

There are bouts of crying, bouts of laughter, bouts of
short fading (the child stops moving), seizures with periodic
shuddering in the limbs, seizures in the form of averting the eyes to the side and
similar.

Causes of disease
Epilepsy can be very different. There is a so-called, “symptomatic
epilepsy” – with this form of epilepsy, seizures occur due to
damage to the brain. These forms of epilepsy may occur against the background of
infections with damage to the medulla, severe brain injury, against the background of
tumor formation or severe brain damage during childbirth
(traumatic or lack of blood). These forms of epilepsy have an earlier
onset, are more severe and are treated worse. In addition, in the case when
epilepsy is caused by brain damage the patient has additional problems:
developmental delay, weakness in the limbs, gait disturbances.

There are so-called idiopathic
forms of epilepsy – they are not associated with a visible lesion of the brain substance, as
as a rule, patients with idiopathic forms of epilepsy develop well, they have
no neurological symptoms other than seizures.

The disease, in this case, flows less aggressively and well
being treated. In some cases, these forms of epilepsy go away on their own.
towards the transition period.

Sometimes it happens that the doctor does not have enough information
in order to make an accurate diagnosis and identify a specific form of epilepsy.
This usually occurs in cases where the patient is not further examined, or
enough data to establish a specific form of epilepsy. In this
case of epilepsy is called “unspecified”
or “cryptogenic” old
classification.

In some cases, the disease can occur due to the incorrect structure of the gene or a breakdown in the structure of the chromosomes. With such disorders, epilepsy will be called genetic .

Some parents do not understand the meaning of the word genetic
epilepsy and suggest that if epilepsy is called genetic, then it
inherited from one of the relatives. This is not a correct judgment. Term
“genetic” means that epilepsy is due to a malfunction of the genes, and
this breakdown can occur only in a child at the stage of laying it
body inside the womb.

Disease frequency

Epilepsy is a fairly common disease. Eat
data that about 50 million people suffer from epilepsy in the world. Necessary
It should be noted that epilepsy begins before the age of 20 in 75% of patients.
It is known that women are affected less often than men, probably due to the fact that in
men are more likely to develop diseases that are accompanied by damage to the substance
brain (stroke, traumatic brain injury, high blood pressure)
pressure). In total, the incidence of epilepsy among the child population is 1%, which is
very high frequency. Moreover, seizures against the background of temperature develop in
5% of children, however, this type of seizure cannot be attributed to epilepsy. It is important to note,
that there are certain groups of children among whom epilepsy occurs
much less often, these are children with cerebral palsy, children with the syndrome
Down, children with mental retardation.

It is also important that patients with epilepsy are more likely to
have comorbidities such as Attention Deficit Disorder
hyperactivity, anxiety, depression, intellectual impairment. According to some authors, children with
epilepsy in 40% of cases have mood disorders, concentration disorders
and attention.

Development mechanisms
diseases .

All brain cells have a membrane that carries a certain
electric charge. Normally, the current on the surface of the brain cell is stable. At
epilepsy brain cells are overly excitable, it is due to this that large groups
cells give a massive electrical discharge and in the corresponding area of ​​the brain
arousal occurs. It is believed that the excitability of the brain is regulated
special substances – neurotransmitters.
These substances include glutamate and Gamma-aminobutyric acid. Glutamate
excites brain cells, while Gamma aminobutyric acid calms the brain,
so with an imbalance of these substances, seizures can occur and most
antiepileptic drugs affect the content of these substances in
brain.

In some cases, the disease may occur due to not
proper functioning of the genes that are responsible for pumping potassium and sodium out and
inside the cell, which creates hyperexcitability of the cell membrane and causes
attacks. Sometimes hyperexcitable cells are localized at the edges of the affected areas
brain (post-traumatic scars, areas around the focus that arose after a stroke
or other brain damage).

Manifestations
diseases

Most people, when they say epilepsy, are
seizures with loss of consciousness and convulsions. In fact, all seizures
epilepsy can be globally divided into two groups, these are seizures that are exciting
one part of the brain (frontal, occipital, parietal, temporal) – such attacks
are called focal and seizures,
synchronously capturing the entire surface of the brain – generalized . Generalized
seizures are characterized by impaired consciousness, while during focal
attacks, the patient can remain conscious and remember the details of the attack. Except
this, when an attack occurs from one part of the brain, the patient can
anticipate the onset of an attack and experience the so-called epileptic
aura . The epileptic aura is
in essence, an incipient attack that does not completely disturb the patient’s consciousness.
The aura may consist of a tingling sensation in one half of the body, a feeling of swelling
thoughts, dizziness. Epileptic seizures according to their manifestations
are very diverse, in total there are more than 60 types of seizures. That is why it is difficult to separate
epileptic states from non-epileptic seizures. Main
characteristics of an epileptic seizure are: sudden onset
symptoms (impaired consciousness, convulsions, eye aversion to the side, vomiting,
distortion of the visual fields), the occurrence of an attack without any specific
provocations (suddenly, “out of the blue”), lateral bite of the tongue during an attack,
the presence of tension in the muscles (the body is pulled into a string) and convulsive
body contractions, gradual recovery of consciousness after an attack (for
patients are characterized by confusion after an attack), the occurrence
sleep attacks.

Examination

Order
To make a diagnosis of epilepsy, a doctor needs certain data.
The process of making a diagnosis is like a puzzle, and each study carried out
are the pieces of the puzzle. If you do not do all the necessary research puzzle
will not work out (the doctor will not be able to make a diagnosis).

Basic
studies that are necessary for diagnosis are:

• Magnetic resonance
  tomography (brain/picture).
• Electroencephalography
  (recording of brain cell activity in graphical form/printouts of curves)
• Clinical
  examination and description of the attack – the doctor conducts an attentive examination of the patient
  neurological examination in order to assess the nuances of the functioning of the nervous system and
  collects a detailed description of the attack.

I would like to emphasize separately that it is very important for a doctor to have a detailed
description of an epileptic seizure, so it is important that an eyewitness to the seizure
came with the patient for an appointment, it is even better to film the attack on video and provide
doctor’s note.

Vo
while shooting an attack, you must follow some rules:

• constantly test the patient’s consciousness,
  (ask questions to the patient in order to assess his consciousness, ask
  perform simple commands to assess speech comprehension)
• it is necessary to film the entire body and face of the patient
• before recording, make sure that the room
  enough light

• Genetic testing – some
  cases require a blood test
  of the patient (fence from a vein) in order to exclude genetic disorders
  (DNA mutations), which can lead to the development of epilepsy.

Magnetic resonance imaging
must be of good quality. We recommend doing research on
apparatus with a power of at least 1.5 Tesla, while children under 6 years old must
is under anesthesia. The study should be reviewed by a specialist who has passed
training in the diagnosis of epilepsy, and children have many nuances and a doctor,
should have additional expertise specifically in pediatric MRI. Upon receipt
results, it is imperative to obtain a study on disk, in order to
so that the expert doctor can view the original study on his computer.

Electroencephalography – is a method
which allows you to trace the presence of pathological outbreaks (epileptic
discharges) in the brain. The presence of discharges in the brain is very specific to
epilepsy and if the patient has epileptiform activity on the EEG and seizures,
this confirms the diagnosis almost 100%.

Many
patients believe that a short EEG recording (15 minutes) is sufficient for epilepsy.
In public clinics for the diagnosis of epilepsy in most cases
use just such short studies.

B
clinic “NEO” we use the gold standard of electroencephalographic
research – video-EEG monitoring.

Video-EEG monitoring (VEM) is a method
which allows you to get a long record of brain activity, which is written
synchronized with the video recording of the patient’s behavior. Thus, only during
this study, we can not only see discharges in the cerebral cortex,
but also to prove that these discharges in the patient are associated with the onset of an attack.

Video EEG monitoring allows us to:

• Assess the severity of epileptiform activity
• depends on the patient’s diagnosis)
• Understand which areas of the brain the seizures originate from
• Record latent seizures
• In case of non-epileptic seizures, understand that
  for attacks the patient has (fainting, tics, hysterical attacks, obsessive
  movement)

We recommend EEG recording
(especially in children under 5 years old) with mandatory fixation of a fragment of sleep. The thing is,
that young children are very mobile and when conducting short studies in
while awake, their encephalogram will be significantly distorted. In addition, at
epilepsy children often have severe behavioral disorders, mental
retardation, autism spectrum disorders, in this regard, children are very
react negatively to the EEG in the waking state, tense up and
trying to take off their hat, these problems can be avoided by recording EEG during
sleep. Another reason for EEG recording during sleep is
the fact that epileptiform activity is most pronounced in the second stage of sleep.
Therefore, in some patients, when recording EEG in the waking state, we can
just find nothing and the conclusion will be false positive.

Genetic
study

In some cases, we need to
a blood test to detect possible genetic diseases in a child.
This is especially true for children. The fact is that epilepsy is often
is one of the symptoms of a genetic disease. If we see that
the child was born from an uncomplicated delivery, the patient did not have any injuries
brain (infection, injury, tumor, brain defect), while the child is detained,
he has prolonged attacks that occur on the temperature, the child has defects
development of organs, staggers when walking – all this makes the doctor direct
patient for genetic testing. This is done by taking blood
the blood is sent to the laboratory, after which after a while (usually
30-90 days) the result is obtained.

After
receiving the results of a genetic study, the doctor evaluates the changes,
detected by molecular genetic analysis. If in the study
certain gene breakdowns are detected, the doctor correlates the detected changes with
external manifestations of the child’s illness and decides whether the detected
genetic damage to be the cause of the disease.

Only
by comparing the results of all three studies, we can get an accurate diagnosis,
that is why the patient with epilepsy must undergo a thorough examination.

Very
it is important to understand the cause of the disease (determine the etiology of epilepsy).

B
30% of epileptic seizures patients do not respond to treatment
pills, in this case, if a specific disorder in the brain is determined,
causing seizures, and it coincides with the epileptiform activity on the EEG we
we can try to remove the modified section by contacting our colleagues
neurosurgeons.

Treatment

For
in order to stop a patient from epileptic seizures, doctors use
antiepileptic drugs (AEDs). There are drugs of older generations, there are
drugs are new. As a rule, new drugs are more convenient to take (they can be
take 1-2 times a day). In addition, new antiepileptic drugs are less likely to
cause side effects. “Ideal”
Unfortunately, the drug does not exist. Some drugs are better for
one type of seizure and not at all suitable for another. It also happens that
the drug should not be prescribed for a specific form of epilepsy, as it can
increase the number of seizures (cause aggravation).

B
pediatric practice has limitations, as some drugs may be
allowed for use only from a certain age. Part of drugs
are allowed to use only from the age of 16, while we can use other forms from
birth.

Yes
drugs that can be used as a duotherapy (administered as a second
drug), but it should not be administered alone.

Selection
therapy is a very delicate moment and when choosing a drug, the doctor must take into account:

• Form of epilepsy (Epileptic Syndrome)
• Type of seizures in the patient
• Age of the patient
• Mental state of the patient
• Presence of somatic diseases
• Sex of the patient
• Financial possibilities of the patient

900 29 Combination with other drugs

Based on evaluation of all these parameters, the doctor prescribes a specific drug to the patient.

Unfortunately, in some cases, the patient’s seizures
do not respond to medical treatment. If seizures do not respond
for the appointment of two adequate antiepileptic drugs within 18
months, while the frequency and severity of seizures remains high, we say
that the patient ( drug resistant epilepsy). Epilepsy,
who does not respond to drugs. Such patients 30% of the entire patient population
with epilepsy.

In case
if the patient does not respond to drug treatment, we try to move on,
to help a person get rid of seizures no matter what.

Next
options are used in patients in whom discontinuation cannot be achieved
seizures with tablets:

• Surgical treatment
• Ketogenic diet
• Vagus stimulation

Surgical
treatment

In case
if the patient has a well-defined area in the brain that gives seizures
(epileptogenic focus), and this focus is in a relatively accessible area
the brain of such a patient can be referred for neurosurgical treatment. During
surgery, surgeons will remove the area in the brain that gives seizures and this will allow the patient
get rid of epilepsy.

On paper
it sounds simple, but the path to surgery is not easy, the patient must have strict
criteria for him to be helped by neurosurgeons.

1. Antiepileptic drug resistant
   seizures
2. Have a clear focus, clearly visible on MRI, which
   produces seizures
3. Localization of the focus should not affect the vital
   important areas of the brain, that is, the focus must be potentially removable.

To prepare for surgery often
special high-quality MRI examinations are required and
special long-term continuous video EEG monitoring with mandatory
fixation in the patient of two or more seizures.

Ketogenic diet

Often
the patient cannot solve the issue of seizures with the help of surgery, this happens,
when there is more than one focus in the brain, when the focus is in the area that
cannot be removed when MRI cannot find a focus, when seizures are associated with
genetic disease and cannot be stopped by surgery.

If the patient cannot resolve the issue of seizures with
with a surgical operation, we can resort to application of the ketogenic diet.

Ketogenic
diet is a special diet in which the ratio of proteins and fats to
carbohydrates is 3:1. With this proportion, the content of ketones in
blood, this leads to an increase in the level of gamma-aminobutyric acid in the brain and
seizures become less frequent.

Introduction
ketogenic diet requires strict medical supervision, this diet is introduced,
predominantly in a day hospital setting.

Plus diet
is that it can be quite effective in genetic
diseases, in addition, this technique is not invasive, that is, it is not required
operations, incisions, etc. and, accordingly, the technique is reversible (with side effects
You can always get everything back by canceling the diet).

Minus
is that in Russia there are no special preparations for a ketogenic diet and we
mothers have to be trained to stick to a special menu for
maintaining a diet, which is very labor intensive.

According to
foreign studies, it is not easy for mother and child to adhere to a ketogenic diet
and up to 50% of patients leave it after a year.

Stimulation vagus nerve stimulation

In case
when a patient has seizures that start from one area of ​​the brain, but
there is no clear focus on MRI or seizures start from different areas – we
We may consider installing a vagus nerve stimulator. This device
is installed under the skin in the region of the collarbone from it there is a wiring to the wandering
nerve. The device responds to a sharp increase in heart rate (which occurs
during an attack of the patient) and begins to stimulate the vagus nerve. This
leads to interruption.

This
the technique has its advantages – first of all, it is a chance to help some children with
drug-resistant seizures.

Minus
technique is that it is invasive and the drug must be periodically
tune. The patient may have certain side effects: changes
voices, heartbeat, cough.

Required
It should be noted that in addition to seizures, patients with epilepsy often have many
combined disorders: attention deficit hyperactivity disorder, depression,
anxiety, headaches, tics, behavioral disorders, mental retardation.

Data
conditions should be identified by related specialists and neurologists and require
immediate correction.

In our
center, children receive a detailed diagnosis from a psychologist, consult and
are undergoing treatment by a psychotherapist, in addition, we carry out correction
behavioral and emotional problems of the child with the help of
psychological and pedagogical correction and hardware methods of treatment.

Disease prognosis

Very important
for our patients is the prognosis. At the appointment, our patients ask
predict the course of the disease in their child. Give a prognosis for the disease
and therefore, according to the development and quality of life of the child, the doctor can only after
comprehensive examination and final diagnosis.

In general,
It must be understood that epilepsy is a chronic disease – this means that
seizures, in most cases, accompany the patient throughout his
life.

exist,
so-called, self-stopping forms
epilepsy – are forms of epilepsy in which seizures are spontaneous
pass into adolescence. These forms of epilepsy occur in early
age (usually up to 7 years), are well treated and disappear at puberty.

Children with
these forms of epilepsy practically do not differ from healthy children, do not have
neurological and mental problems.

With symptomatic forms of epilepsy, the patient has a less favorable prognosis, as a rule, seizures can accompany the patient for a long time and do not respond very well to treatment.

In general, with
the first drug, seizures disappear in 50% of patients, the second drug
can add about 10% to the effectiveness of a third drug of 5%.

This rule says that the more drugs
you have to try, the less likely it is to stop the attacks.

Concepts
there is no cure for epilepsy. IN
In English there is a term “permission” – this is an analogue of a cure. We can
to say that the patient has recovered from seizures, if the patient has seizures
no for 10 years, while 5 of these 10 years the patient does not take drugs.
In general, seizure remission is said to occur if there are no seizures for 1 year.
Achieving remission indicates that the patient’s brain is well sedated by the drug.
and allows us to talk about a relatively favorable forecast for the future.

Negative
the prognosis is determined by pronounced organic foci in the brain (cases when
MRI shows an organic violation of brain tissue), in addition, genetic forms
epilepsy have a negative prognosis in terms of treatment, as impaired work
gene cannot be corrected, and such patients respond quite poorly to
a drug.

Main
The task of the doctor is to give the patient the maximum quality of life and go to
treatment to the end.

In case
when seizures cannot be completely controlled, we must find a treatment
in such a way as to save the patient from the most traumatic types of seizures,
violating the quality of life – these are generalized convulsive seizures with
disturbance of consciousness.

Frequently asked questions about epilepsy

• Who should look after a child with epilepsy?

Epilepsy is a very specific
field of knowledge. Previously, patients with epilepsy were observed by psychiatrists, now
patients are being treated by neurologists. The disease has code G – 40. According to the classification of international
diseases, this means that the disease belongs to the section – Diseases of the nervous
systems. Given that neurologists are not always well versed in the diagnosis and
treatment of this disease, we would recommend contacting doctors
– neurologists with special studies in epileptology.

Such doctors are called
“Epileptologists”, but officially there is no such specialty, these are the same
neurologists with expertise in the treatment of epilepsy.

• Can children with epilepsy play
  sports?

patients with relatively mild forms of epilepsy.

It is necessary to exclude sports related
with possible trauma in case of impaired consciousness. First of all, these are classes
altitude: climbing, parachuting, gymnastics.

In addition, we recommend deleting
sports traumatic for the brain: boxing, martial arts, wrestling.

Group sports: basketball,
hockey, volleyball, football can be attended with certain precautions.
You can visit the pool with a coach (individual lessons). small and big
tennis, badminton are among the most suitable sports for patients with
epilepsy.

• 
  no one in the family had this disease?

In most cases, epilepsy has a so-called. sporadic character, i.e.
occurs in an individual patient with no prior history of epilepsy in the family. IN
9 out of 10 cases of epilepsy are not hereditary. Especially this
refers to children whose epilepsy is associated with impaired brain formation
even in the prenatal period (brain defects, focal cortical dysplasia).

• Is it possible to come to the EEG examination
  sleep with a sleeping child and put on a hat
  in a dream?

state of drowsiness (before going to sleep), during sleep and upon awakening. In the event that a child
brought sleepy, we can not assess the state of the child when falling asleep, so
we always recommend that the child be examined while awake and
fell asleep during the study.

• 
  whether a girl with epilepsy can get pregnant, and how epilepsy affects the fetus.

9-12 months before pregnancy, there is a high chance that seizures
will not be during pregnancy.

Women planning pregnancy recommended
discuss this with your doctor in order to repeat the study, clarify
diagnosis, receive recommendations on the type and dose of the drug. All these actions
must be made 6 months before pregnancy.

The doctor’s task is to prescribe the maximum
an effective drug for a patient planning a pregnancy, while the drug does not
should affect the fetus. It is very important for us to prevent seizures during
pregnancy because during an attack, fading of pregnancy may occur,
a child during a convulsive attack may experience hypoxia. There are even
evidence that children whose mothers had seizures during pregnancy
experienced learning problems later in life.

In most cases, women with epilepsy give birth
healthy children.

• Possibly
  whether breastfeeding after childbirth, for a woman with epilepsy.

At the moment it is considered that the HW interruption is not
required, because most drugs pass into milk, only in small
doses and cannot cause problems for the child. In addition, the child gets
the drug through the bloodstream and a small amount of the drug in the milk is no longer strong
affects the development of the child.

• 
  epilepsy?

prescribed drugs, skipping a drug can lead to
prolonged severe attack, it is necessary to have a stable sufficient
sleep duration (depending on age), without sharp sudden
awakenings. Work should exclude night shifts and stressful situations in
night time (firefighters, doctors on duty, dispatchers of round-the-clock services).
It is necessary to limit the intake of alcohol. alcohol causes drowsiness and
increases the likelihood of an attack. Maintain regular contact with
by the attending physician with constant monitoring of the EEG and the content of the concentration
drug in the blood.

• 
  epilepsy? When can you consider yourself healthy?

There is no term for recovery from epilepsy,
because epilepsy is a chronic disease. We can consider a person conditionally
recovered if there are no attacks within 10 years, while within 5 years
the patient is not taking the drug.

In addition, we can consider the patient healthy in
when he was diagnosed with a “self-limiting” form of epilepsy,
which ends without treatment in adolescence with brain maturation.

• Can
  can a person die of epilepsy?

In most cases, patients with epilepsy have
normal life expectancy, but in some cases may epilepsy
may cause disease

• Seizures,
  lasting more than 5 minutes (status epilepticus) can be life-threatening
  condition and cause disturbance of heart rhythm and breathing
• Traumatization
  during an attack can cause serious injury, including burns and severe
  traumatic brain injury incompatible with life.