Understanding Epilepsy: Causes, Symptoms, and Treatment

Epilepsy is a chronic neurological disease in which neuronal electrical discharges of abnormal intensity occur that are repeated over time. Single seizures are not included within the concept of epilepsy.

It is a frequent disease with a prevalence of 500-1000 cases per 100,000 inhabitants. It appears more frequently in the first decade of life and in the seventh.

It is a disease of variable severity that requires medications that are not without side effects and continuous monitoring by medical teams.

How is it produced?

Epileptic seizures are secondary to a brain injury or dysfunction, but this aspect is not demonstrable in many cases.

Epileptic syndromes are classified into three large groups:

• Primary or idiopathic epilepsies. No known cause and with a higher genetic component
• Symptomatic or secondary epilepsies: Of known and demonstrable cause
• Cryptogenic epilepsies: without demonstrable cause, but symptomatic

There are many causes of epileptic seizures that vary depending on the different ages of life.

Thus, neonatal and early childhood epilepsies have their causes in congenital anomalies, metabolic disorders or meningencephalitis; in children up to three years of age, the most frequent epileptic seizures are febrile seizures and infections; in children and adolescents, idiopathic epilepsies; in young adults, trauma and tumors and in older adults and the elderly, cerebrovascular diseases and toxins (alcohol).

There is a known role of genetic influence in epilepsies, either in such a way that among relatives there is an ease to suffer epileptic seizures in the same situations such as fever or stress, due to a properly genetic disease with a known hereditary transmission, or finally, in which epilepsy is one more element of a known inherited disease.

Symptoms

The symptoms of epilepsy will vary depending on the type of seizure. These are classified in different ways. The most accepted classification is the one that differentiates two large groups of epileptic seizures: partial seizures and generalized seizures.

The partial seizures (or focal or localized) are those in which there is no loss of consciousness or it is incomplete. Depending on the affected brain region, motor, sensory, vegetative or psychic symptoms will occur.

Sometimes partial seizures become generalized, then being called secondarily generalized partial seizures.

In the generalized crises there is loss of consciousness from the first moment and if there are motor manifestations they occur in all four extremities.

These are also divided into absence crises (petit mal) that can be typical when the clinical picture consists of a loss of consciousness lasting 5-10 seconds without loss of muscle tone and spontaneous recovery, and atypical ones in which the alteration predominates. of the muscular tone with beginning and end of the most larvae crisis. Generalized seizures also include clonic, tonic, tonic-clonic, myoclonic, and infantile spasms.

Tonic seizures are brief, predominantly in childhood in which sudden muscle contractions occur for seconds, usually causing the patient to fall. Clonic seizures are characterized by bilateral clonies (violent movements). Tonic-clonic seizures (grand mal) present episodes of tonic contractions followed by clonic jerks of the four extremities, lasting approximately two minutes and with post-seizure stupor. They are usually accompanied by urinary incontinence, tongue biting, and disorders such as hypertension, tachycardia, sweating, and cyanosis. Myoclonus are brief muscle jerks of a single or multiple muscles that occur spontaneously or after sensory or sensory stimuli. It is not uncommon for patients to throw the objects they hold in their hands due to these myoclonus. Infantile spasms (West syndrome) occur in infants between 4 and 6 months of age with flexion spasms of all four limbs. If not treated early, they are associated with psychomotor retardation.

Epileptic seizures can be preceded by nonspecific symptoms such as mood swings, irritability, appetite or sleep disturbances, which can appear hours to days before the seizure.

Diagnosis

It is a clinical diagnosis, since both the physical examination and the complementary tests may be normal. It is necessary to obtain information from relatives or people close to the patient who may have experienced the attacks since the patient is not able to describe them in their entirety.

The main points of the interrogation are the patient's history in order to get to know the cause of the seizures, the description of the seizure and the changes that the patient has previously undergone, and the evolution over time of the seizures and the treatments. employees.

A complete blood test should be done routinely, along with a urinalysis, an EKG, and a chest X-ray.

The electroencephalogram (EEG) is the complementary examination that has helped the most in the study of epilepsies and has allowed in many cases their diagnosis. However, its use is limited, partly because the diagnosis of epilepsy has sometimes been questioned due to a normal EEG, without taking into account that up to half of epileptic patients have a normal EEG and, on the other hand, there are alterations nonspecific on EEGs in up to 15% of the population without being epileptic.

The neuroimaging techniques used are brain CT and brain MRI. They make it possible to objectify focal lesions that act as the cause of the disease. It should be performed in those patients who present generalized seizures and when they present focal seizures without cause, especially with abnormal physical examination and EEG alterations.

PET (posttron emission tomography) and SPECT (single photon emission tomography) are capable of objectifying metabolic and blood perfusion lesions in the areas of the epileptic focus. They are not techniques for systematic use.

Treatment

The epileptic patient needs, in addition to pharmacological treatment, a multidisciplinary approach to his disease due to the influence that it may have on his life both fundamentally socially and psychologically.

Drug treatment is essential. Up to half of the patients require simple treatment for the management of epilepsy.

In specific cases, surgical treatment may be necessary (in cases of drug-resistant patients) and in others, the management of the different drugs is complex.

Classical anticonvulsant drugs include phenytoin, carbamazepine, valproic acid, phenobarbital, primidone, and clonazepam. The newer drugs are lamotrigine, gabapentin, vigabatrin, topiramate, tiagabine, and oxcarbazepine. Drugs from both groups are currently used.

Regarding the duration of the medication, withdrawal can be considered in the absence of seizures for a period of more than three years and with an EEG without specific irritative signs. The withdrawal is done gradually over a year and with EEG controls. Approximately 25% of the patients will present recurrences, starting the medication again.