Epilepsy is a neurological disease that is manifested by repeated epileptic seizures. Epilepsy cases have been described even by ancient historians, one of the most known people suffering from the epilepsy was Gaius Julius Caesar himself.
Before speaking about epilepsy itself, it is important to have at least some basic information about the brain. The brain is an organ located within skull that consists of billions of neurons that are interconnected by nerve fibers. The neurons communicate by electric signals that are transmitted by the nerve fibers. This forms an extremely complex network that makes even the most modern computers look like primitive toys.
The actual cause of epilepsy is a group of neurons that under certain circumstances sends an errant electric impulse that spreads through the brain and temporarily disrupts its function. In a simplified way, we could compare it to a short circuit.
The cells causing epilepsy are somehow damaged or impaired and their existence is linked to many brain diseases and disorders. We distinguish congenital and acquired epilepsy. The congenital epilepsy is related to a defective intrauterine brain development. The acquired epilepsy occurs because of a brain damage or disease occurring during the patient's. The causes of this damage are numerous. Already during childbirth the newborn may suffer form a short-term lack of oxygen damaging the brain. This can lead to cerebral palsy, mental retardation and epileptic seizures. Brain cells can be further damaged by a head injury, a stroke, infections (meningitis, encephalitis), brain tumors, chronic alcoholism, etc. However, in many cases the reason of epilepsy remains unclear.
In addition to the primary cause, there are also many “triggering factors” that can increase the risk of a sudden seizure. These factors include lack of sleep, alcohol excess, watching light flashes, physical and mental exhaustion, etc.
Symptoms of epileptic seizures are very colorful and we distinguish more type of epileptic seizures according to their course. For an easy description of the symptoms I picked the most basic types of epileptic seizures.
This type of epileptic seizure is also known as the Grand mal. It is probably the most known type of epileptic seizure to the general public. The affected person loses consciousness and suffers from muscle convulsions. After the bout ends, the patient usually has no memory of the incident.
Partial convulsive seizures
These seizures manifest by tremor of certain body parts but the consciousness is usually preserved. These seizures can progress into a grand mal.
Petit mal seizures
This type of seizure is typical for a child's age. The affected child repeatedly loses attention, stares into space, he or she does not respond to outer stimuli and any objects fall out of his hand. The seizure lasts for a very short time, the child wakes up to a full consciousness without remembering the seizure.
In this state the affected person can carry out some activities that are, however, usually pointless and bizarre. The patient is unaware of his actions and suffers from memory loss of the situation. The neurologists at the university told us about a case of a manager suffering from epilepsy, who lost his job when he began to undress at a company meeting.
Epileptic seizures affecting sensory areas of the brain may evoke olfactory and visual hallucinations.
Aura is a special state that can occur for a few seconds before the attack. It is pretty hard to describe as it can have many shapes. The person sometimes feels "weird" and often complaints about olfactory hallucinations (typically the smell of burning rubber). There also exists a visual aura when the patient sees flashes, auditory aura with hearing strange sounds and voices, etc.
When the epilepsy is diagnosed, the patient should try to reduce the risk of further seizures. In addition to pharmacotherapy (see below), it is necessary to avoid the seizure-triggering situations by avoiding alcohol, regular sleep, healthy diet and sleep and by avoiding mental and physical exhaustion. In many countries, patient with recurring epileptic seizures are not allowed to drive a car.
If there is a patient with a first experienced seizure in his or her life, it is necessary to perform a neurological examination including computed tomography or magnetic resonance imaging of the brain. The goal is to diagnose any organic causative factor, especially a brain tumor. Electroencephalography (EEG) is another important examination that detects the electric impulses of the brain. Epileptic seizure may (but not necessarily) cause specific change of the EEG curve confirming the diagnosis. EEGs between the seizures may be completely normal and therefore, if possible, it is best to perform an EEG during the seizure.
We can not do much for patient with an acute epileptic seizure. It is best to remove any close objects that could cause an injury. It is not advisable to try to open the patient's mouth as his jaws are tightly clenched and there is a risk of sudden bite. As a more specialized first aid a medical worker can administer a benzodiazepine agent in intravenous form as a suppository.
The basic treatment consists of administration of antiepileptic drugs. These drugs have many possible side-effects and must be used regularly. In bad usage they may paradoxically increase the risk of further seizures. When the underlying cause is known, it must be treated preferably (if possible). In some special indications, neurosurgical approach may be chosen to destroy the epileptic focus in the brain. It is a complicated procedure which must be preceded by exact confirmation of its location.