Epilepsy Symptoms and Treatment
Epilepsy is defined as any condition causing recurrent seizures (fits). People with epilepsy are not subnormal, not retarded, not violent, not abnormal in any way - except for the fact that they have a disease which can affect their bodies in a most unpleasant and unpredictable way. It is unusual for epileptics to have a fit in public these days, as most sufferers can be very well controlled by some of the many forms of medication available.
Some people are born with epilepsy, while others acquire the disease later in life after a brain infection, tumor or injury. Brain degeneration in the elderly can also cause epilepsy to develop. An excess or lack of certain chemicals in the body may also cause epilepsy. If the kidney fails, waste products can build up in the blood to the point where fits occur. Removing alcohol from an alcoholic or heroin from an addict may also result in epilepsy.
Epilepsy can affect people in many different ways, and can vary from very mild absences in which people just seem to loose concentration for a few seconds, to uncontrolled bizarre movements of an arm or leg, to the grand mal convulsion in which an epileptic can thrash around quite violently.
It is a disease which can affect anyone, and once stricken, most people are ashamed of the affliction - it is not as socially acceptable as high blood pressure or diabetes. But in epilepsy the treatment is much the same in that tablets are taken regularly throughout life, and these normally prevent most of the attacks.
Epilepsy can be explained most easily by an analogy to a computer that develops a short circuit. Parts of the brain are able to short- circuit after very minor and localized damage. This can stimulate another part of the brain, and then another, causing the responses that we see.
After the first convulsion the patient is naturally extremely anxious to find out why it is happening and to prevent a recurrence. Several tests are performed, including an electroencephalogram to measure the brain waves and find out exactly where the short circuit exists, and hopefully what is causing it. Other investigations will include blood tests and a CT scan of the brain. Unless there is some underlying disease to explain the epilepsy, blood test results are normal.
Grand mal epilepsy
Grand mal is the massive fit which most people associate with epilepsy. The patient becomes rigid, falls to the ground and stops breathing. The muscles in different parts of the body become alternately rigid and slack, causing gross abnormal movements and twitching of the arms, legs and trunk. The patient may urinate, pass feces and become blue.
The fits usually only last two or three minutes, but because of the violence of the attack, the victims must be protected from injuring themselves. It is possible for them to bite or 'swallow' their tongue, but attendants must NOT place their own hand in the mouth to protect the victim's tongue - they will only end up with badly bitten fingers. A piece of rubber or wood may be placed between the teeth, but do not attempt to prise the teeth apart to insert it. Merely placing the patient in the coma position and keeping the chin forward and neck extended will prevent the tongue from being bitten or from blocking the airway.
Epileptics who have grand mal fits have no knowledge of what happens during the attack. They may have a brief warning aura, but then they lose consciousness and wake up some time after the fit has finished, not knowing if they have been unconscious for a few seconds or an hour. After recovering from the fit, the patient is confused, drowsy, disoriented and may have a severe headache, nausea and muscle aches.
Status epilepticus is the condition where one grand mal attack follows another without the patient regaining consciousness between attacks. Urgent medical attention is required for these patients.
Petit mal (absences, drop attacks)
Petit mal attacks are periods of unconsciousness that may last from one or two seconds to a minute or more. There may be some unusual movements associated with them but nothing as violent as in a grand mal attack. The patient may appear totally normal during the attack, may stumble momentarily, or drop to the ground and rapidly recover. The attacks come without warning, and may appear merely as an unusual break of several seconds in a sentence while speaking. Patients are often unaware that they have had an attack.
Petit mal epilepsy is far more common in children and teenagers than adults.
Partial seizures (temporal lobe epilepsy)
Epilepsy may be restricted to only one part of the brain, usually the temporal lobe of the brain on one side. The seizures can vary greatly in their severity, and in some cases the patient remains conscious while one arm and/or leg contracts and relaxes, thrashing about outside the conscious control of the patient. The fit can vary from minor twitches of the fingers or eyelid, to apparent grand mal fits, but involving only one side of the body. In other cases they may present as difficulty in talking or swallowing, as an unexplained loss of memory, or an abnormal shift of mood and emotion (e.g. a sudden unexplained fear or terror, or ecstasy). At other times, partial seizures may be unnoticed by others but felt as abnormal sensations (e.g. tingling, burning) by the patient. Other manifestations include flashes of light, strange smells, buzzing noises, sweats, flushes and hallucinations.
Once diagnosed, treatment can be prescribed and regular blood tests ensure that it is adequate to control the disease. Medication to prevent further fits is the mainstay of the treatment. There are many different anti-epileptic drugs and the drug or combination of drugs used to control the condition will depend on the type of epilepsy present, the individual patient's reaction to that medication, and the side effects of the medication. These drugs are given as tablets or mixtures several times a day.
Medication must be continued for a long time, but after several years without fits, a trial without medication may be undertaken. Those who are mentally subnormal in association with epilepsy are less likely to be removed successfully from medication. Injections can be given by doctors to control an acute attack once it occurs, but there are no long-acting injections to prevent the fits.
Epileptic attacks can be triggered by outside factors in some patients. Flickering lights (e.g. poorly adjusted televisions, strobe lights at night clubs) can start some fits, while others may be precipitated by certain foods, emotional upsets, infections or stress. If an epileptic knows that exercise, alcohol, lack of sleep or other factors can trigger an attack, these must obviously be avoided.
Many, but not all, patients with epilepsy develop warnings that an attack will occur in the next few minutes or even hours. These warnings can be a particular type of headache, change in mood, tingling, lightheadedness or twitching. An aura is an extension of these feelings that is far more intense and precedes the attack by only a few seconds.
Epileptics must not put themselves in a position where they can injure themselves or others. They must never swim unsupervised, drive a car, or operate machinery until they have been free of fits for at least two years.
Convulsions in children due to a high fever are not true epilepsy and do not lead to epilepsy in later life. They are caused by a temporary short circuit in the brain when it is overheated.
Epilepsy is arbitrarily classified by the types of seizures that occur, but as there is a steady progression between one type and another and several different types of seizure may occur in the one person at different times, the groupings that follow cannot be exact or exclusive.
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