The epilepsy Is a neurological disorder that affects the central nervous system characterized by the presence of recurrent episodes called seizures or seizures (Fernández-Suárez, et al., 2015).
Seizures or epileptic seizures occur as a result of unusual neural activity that is altered causing seizures or periods of unusual behavior and sensations and may sometimes lead to loss of consciousness (Mayo Clinic, 2015).
The symptoms of seizures and seizures can vary considerably depending on both the brain area in which it occurs and the person who has them. Some people only appear to be absent during attacks, while others have a severe seizure episode.
In addition, abnormal neuronal activity can be transmitted to different brain areas so that both the location of the event and much of the brain may be affected by convulsive events. In this way, seizures can have important consequences and neurological sequelae (National Institute of Neurological Disorders and Stroke, 2016).
Usually, pharmacological treatments are used to control the frequency of seizures. However, many medications can impair the development of other activities of daily living (Mayo Clinic, 2015).
Pharmacological treatment or surgical procedures are effective in approximately 80% of cases. In the case of the child population, the symptoms of the disease may disappear with development (Mayo Clinic, 2015).
Characteristics of epilepsy
Epilepsy is a neurological disease characterized by a long-standing predisposition to epileptic seizures that will produce a wide variety of neurobiological, cognitive, psychological and social consequences (International League Against Epilepsy, 2014).
In addition, the World Health Organization (2016) stresses that it is a chronic disease that can affect anyone in the world and is defined by the development of recurrent seizures as a result of seizures or seizures.
Currently, common definitions of epilepsy include the need to have had at least two unprovoked attacks with more than 24 hours difference (International League Against Epilepsy, 2014).
What is an epileptic seizure or seizure?
The International League Against Epilepsy and the International Bureau for Epilepsy offers the following definition:
An epileptic seizure (EC) is a transient event of signs and / or symptoms due to abnormal, excessive or non-synchronous neuronal activity (Andalusian Epilepsy Guide, 2015).
Therefore, epileptic seizures occur as a result of the presence of abnormal patterns of excitability and synchrony between neurons in specific brain areas (Andaluza Guide to Epilepsy, 2015).
It is common for epileptic seizures to be associated with the occurrence of seizures, however, epilepsy may present with a very varied symptomatology.
In addition, not all types of seizures are due to epilepsy, can present for other reasons: diabetes , heart diseases , etc. (Epilepsy Society, 2013)
How many people have epilepsy?
Approximately 50 million people suffer from epilepsy worldwide (World Health Organization, 2016).
Currently, the prevalence of epilepsy is estimated between 4 and 10 cases per 1,000 inhabitants Fernández-Suárez, et al., 2015). However, some studies in low-middle-income countries suggest that the proportion of epilepsy is higher, around 7-14 cases per 1,000 people (World Health Organization, 2016).
In general, the annual incidence of epilepsy is about 500 cases per 100,000 inhabitants each year (Fernández-Suárez, et al., 2015). According to different estimates, approximately 2.4 million new cases of epilepsy are diagnosed (World Health Organization, 2016).
With respect to age, two peak peaks have been identified, one in the first decade of life and another in the seventh decade (Fernández-Suárez, et al., 2015).
symptom
Symptoms of epilepsy vary in a large proportion from one individual to another. Some people may develop episodes of absences, while others may lose consciousness or convulsions characterized by violent jolts (National Institutes of Health, 2015).
Because of the abnormal activity of neurons in different areas, seizures can affect any part of our brain and therefore some of the signs and symptoms they can produce are (Mayo Clinic, 2015):
- Temporary confusion.
- Epileptic absence: temporary disconnection of the medium.
- Uncontrollable shaking of upper and lower extremities.
- Loss of consciousness.
Symptoms of the affected person will vary from the type of seizure that is present. Typically, a person suffering from epilepsy will have the same type of seizure, therefore, the symptoms between episodes will be similar (Mayo Clinic, 2015).
Depending on the onset and expansion of epileptic discharge, seizures can be classified as focal and generalized (Mayo Clinic, 2015).
Focal convulsions (Mayo Clinic, 2015)
Epileptic events are the product of abnormal activity in a single specific area of the brain. These seizures are called focal or partial seizures and can be divided into two categories:
- Focal convulsions without loss of consciousness or simple partial seizures : These types of events do not cause a loss of consciousness but can alter emotions, smell, touch, taste, hearing, among other things. They can also cause involuntary and uncontrolled movements of some body parts (arm or legs) and sensory symptoms (tingling, dizziness, light perception).
- Complex partial crises: This type of events does not imply a loss of consciousness as such. When a complex partial crisis occurs, it is possible to observe how the person does not respond normally to environmental stimulation, performs repetitive movements or looks at the void.
Generalized seizures (Mayo Clinic, 2015).
Generalized seizures are those in which the epileptic event resulting from abnormal neuronal activity will affect all or most of the brain areas.
Within generalized seizures we can distinguish six subtypes:
- Absence crisis: In this type of events, the person who suffers from it presents with fixed gaze or with subtle movements like blinking. When they occur in a group and in succession, they can cause loss of consciousness. They are usually produced in greater proportion in children.
- Tonic convulsions: The tonic events are characterized by the development of a great muscular rigidity, especially in the back, arms and legs. In many cases they cause falls to the ground.
- Atonic seizures: Atonic seizures produce a loss of muscle control, therefore it can cause falls.
- Clonic convulsions: The clonic events are characterized by the presence of rhythmic, repetitive and / or abrupt muscular movements. Clonic seizures often affect the neck, face, and arms.
- Myoclonic seizures: Miclonic crises or events develop as sudden and sudden jerks in the arms and legs.
- Tonic-clonic convulsions Tonic-clonic events, previously known as epileptic seizures, can cause loss of consciousness, muscle stiffness, tremors, loss of sphincter control, etc. Tonic-clonic seizures are the most serious type of epileptic event.
Causes
In the study of epilepsy, many possible casings have been identified. Despite this, in more than half of the cases the specific cause that leads to the development of this type of pathology has not been achieved. (National Institute of Neurological Disorders and Stroke, 2015).
In other cases, genetic factors, abnormalities in brain development, infections, Stroke Or brain lesions as an etiological factor of epilepsy (National Institute of Neurological Disorders and Stroke, 2015).
Therefore, epilepsy may appear due to different brain wiring alterations, various imbalance in nerve-transmitting substances, or different combinations of these epilepsy factors (National Institute of Neurological Disorders and Stroke, 2015).
Among the most important factors are (National Institute of Neurological Disorders and Stroke, 2015):
- Genetic factors : Genetic mutations play an important role in the development of some types of epilepsy. Epilepsies have been identified that can affect several members of the same family, highlighting a hereditary component.
- Other Disorders : Epilepsy can also occur as a result of different brain damage related to other types of pathologies; Brain tumors , Cranioencephalic trauma , Alcoholism or abstinence syndrome Alcohol, stroke, Disease of Alzheimer's , Arteriovenous malformations , Encephalic inflammation, infections or viral processes.
Risk factor's
Different investigations have identified some factors that are related to the development of epilepsy (Mayo Clinic, 2015):
- Age : Commonly epilepsy begins during the period of early childhood or after 60 years of age. Despite this, it is possible to develop this pathology in any age range.
- Family history : When you have a family history of epilepsy, you may have a higher chance of developing epilepsy events.
- Cranio-encephalic lesions : Several cranial or encephalic lesions may be responsible for the development of seizures.
- Cerebrovascular diseases : Cerebrovascular disorders and other diseases that affect blood circulation may increase our chance of having seizures.
- Dementia : Some studies have identified an increased likelihood of developing convulsive episodes in older adults who are depressed dementia.
- Infections : Some infections such as meningitis that will produce an inflammation of the brain or spinal cord may also increase the risk of developing epilepsy.
- Child seizures : Fever of high fevers during childhood is associated with seizures. Generally, children who develop this type of seizure do not usually develop epilepsy, although the risk increases considerably, if they present recurrent attacks, present other pathologies at the nervous system level or have a family history of epilepsy.
Consequences
The development and suffering of convulsive processes at certain times or circumstances can be dangerous for both the sufferer and others (Mayo Clinic, 2015):
- Risk of falls : A fall in a seizure episode can cause bruises and fractures both at the cranial level and in other body areas.
- Risk of drowning : May increase the risk of drowning when having a seizure episode in an aquatic environment.
- Risk of traffic accidents : A convulsive process can cause loss of muscle control and consciousness, so it can be really dangerous when driving a vehicle.
- Risk of complications in pregnancy : Seizures during pregnancy can cause harm to both the mother and the baby. In addition, the use of Antiepileptic drugs Increase the risk of developing embryonic abnormalities.
- Risk of development of emotional disturbances : The likelihood of developing depressive or anxiety disorders may increase. In many cases, some of these problems are secondary to the use of some medications.
Also one of the most important factors is the development of neurological sequelae. Abnormal neuronal activity and epileptic discharges will cause significant brain damage in both focal and generalized forms.
Depending on the areas that are affected, several deficits and alterations to the cognitive functions will occur: memory , Attention , Executive function , etc.
All these deficits can significantly affect both the overall intellectual performance and the performance of ordinary day-to-day tasks.
What is epilepsy status?
With the term epileptic status, we refer to a condition in which it gives continuous convulsive activity lasting more than 5 minutes or the development of recurrent seizures without full recovery of consciousness (Mayo Clinic, 2015).
People in this state are both more likely to develop permanent brain damage and death (Mayo Clinic, 2015).
Diagnosis
To perform a diagnosis of epilepsy, at present, there is no single test or test that determines its existence (National Institute of Neurological Disorders and Stroke, 2015).
In clinical research, various techniques can be used to determine whether a person has epilepsy and what type of seizure (National Institute of Neurological Disorders and Stroke, 2015).
Some of the methods used are: electroencephalogram , Magnetoencephalogram, brain imaging, clinical history, blood tests and other
Behavioral tests, neurological functioning and development (National Institute of Neurological Disorders and Stroke, 2015).
Regarding the diagnostic criteria, the International League Against Epilepsy (2014), points out some of the criteria that must be presented to consider a person suffering from epilepsy:
- At least two unprovoked seizures with more than 24 hours difference.
- An unprovoked seizure and a probability of at least 60% of presenting a future seizure after two unprovoked seizures.
- Diagnosis of epilepsy syndrome.
Treatments
There are several therapeutic interventions to control seizures. In this sense, the specific diagnosis of the type of epilepsy that the person suffers will be essential to find the most effective treatment (National Institute of Neurological Disorders and Stroke, 2015).
For the treatment of epilepsy, the application of therapeutic approaches can be considered through medications, surgery, devices or dietary modifications (National Institute of Neurological Disorders and Stroke, 2015).
Most people with epilepsy can gain control, including the disappearance of seizures with anticonvulsive drugs or antiepileptic drugs (Mayo Clinic, 2015).
Some of the anticonvulsant drugs are: carbamazepine, clobazam, diazepan, divalproex sodium, scarbazepine acetate, ezogabine, felbamate, gabapentin, lacosimide, lamotrigine, levetiracetam, lorazepam, ozcarbazepine, parampanel, phenobarbital, phenytoin, pregabalin, primodone, rufinamide, Tiagabine, topiramate, valproic acid, vigabatrin, etc. (National Institute of Neurological Disorders and Stroke, 2015).
On the other hand, interventions have also been used on dietary and eating habits in people with epilepsy who have been shown to be effective. It is usually used a Ketogenic diet , With a high fat content and low Carbohydrates , For the symptomatic treatment of people with pharmacoresistant epilepsies (National Institute of Neurological Disorders and Stroke, 2015).
In addition, in cases where no pharmacological intervention is operative, surgical procedures may be used to determine the epileptic focus or area of origin of the chrysalis and to remove or inactivate it (National Institute of Neurological Disorders and Stroke, 2015).
References
- Epilepsy Foundation. (2016). What is epilepsy? Obtained from Epilepsy Foundation.
- Epilepsy Society. (2013). What is epilepsy? Obtained from Epilepsy Society.
- Fernández-Suárez, E., Villa-Estébanez, R., García-Martínez, A., Fidalgo-González, J., Zanabili Al-Sibbai, A., & Salas-Puig, J. (2015). Prevalence, type of epilepsy and use of antiepileptic drugs in primary care. Rev Neurol, 60 (2), 535-542.
- ILAE. (2014). The 2014 Definition of Epilepsy . Obtained from International League Against Epilepsy.
- Mayo Clinic. (2015). Epilepsy . Obtained from Mayo Clinic.
- NIH. (2015). Epilepsy - overview . Obtained from MedlinePlus.
- NIH. (S.f.). The Epilepsies and Seizures: Hope Through Research . Retrieved from the National Institute of Neurological Disorders and Stroke.
- WHO. (2016). Epilepsy . Obtained from World Health Organization.