Epilepsy symptoms, causes, treatment & Association with pregnancy

Epilepsy is a neurological disorder in which brain activity suddenly becomes abnormal and causes unprovoked and recurrent seizures. Epilepsy symptoms include involuntary, recurrent seizures, loss of consciousness, unusual behavior and sensation. Anybody can have epilepsy. It affects both males and females of all ages. Epilepsy affects 65 million people all over the world. The prevalence of epilepsy in developing countries is 5 times higher than in developing countries. It can be caused by congenital or acquired.

SEIZURES AND EPILEPSY

Seizures during epilepsy attack can vary widely. The seizure is an abnormal, paroxysmal, excessive discharge of CNS neurons. A single seizure is not epilepsy. It may be mild or severe. Mild seizures are difficult to recognize and last for a few seconds while strong and severe seizures last for a few seconds to several minutes. These seizures can cause muscle spasm, involuntary and uncontrolled muscle twitches. Many people lose consciousness during this attack and return to the normal conscious state as it ceases.

The seizure is a symptom of epilepsy. It may also cause some conditions such as

  • Low blood sugar level
  • Hypokalemia
  • High fever
  • Meningitis
  • Encephalitis
  • Head trauma
  • Any CNS infection
  • Head injury

WHAT CAUSES EPILEPSY?

Two major causes of epilepsy symptoms include

1- Genetic Causes

Epilepsy can be caused by genetic or acquired. Only one percent population have epilepsy before the 20 years of age. But the parents having epilepsy in their genetics, enhance your risk to 2 to 5 percent. Therefore, genetic can cause epilepsy before the 20 years of age.

2- Acquired causes

People of any age of all races can develop epilepsy if they have

  • Very high fever
  • traumatic head injury
  • Stroke after the age of 30
  • Autoimmune
  • brain scarring after a brain injury
  • Dementia
  • Idiopathic
  • Neoplasma
  • Poor oxygen supply to brain cells
  • Any vascular diseases like atreovenous malformations
  • brain tumor
  • Alzheimer’s disease
  • Meningitis
  • AIDS
  • Lack of oxygen during birth
  • prenatal brain injury

WHAT ARE THE EPILEPSY SYMPTOMS & HOW IT AFFECTS?

Seizures are the main symptom of epilepsy. Its frequency, durability and intensity vary from patient to patient and according to the type of seizure.

  1. Partial Seizures
  2. Generalized Seizures

PARTIAL (FOCAL) SEIZURES

Simple partial seizures

It involves a part of cerebral hemisphere and doesn’t involve the loss of consciousness. It includes

Dizziness

Alteration in special senses such as alteration in hearing, speech or taste

Tingling in limbs

It may be motor, sensory or autoimmune.

Example

Jacksonian seizure

Todd’s palsy

Complex Partial Seizures

It name indicates the complex form of partial seizures which involve loss of consciousness and awareness. Furthermore it includes

  • Repetitive, involuntary movements
  • Staring blankly
  • Loss of consciousness
  • No response
  • No loss of postural tone
  • Post-ictal confusion

2- Generalized Seizures

This involves the whole part of brain. It has six types.

Absence seizures (Petit Mal)

This type of generalized symptoms involve the repetitive, involuntary movements like blinking of eye or lip smacking. It is also called as “petit mal seizures.” There is a short loss of consciousness but not loss of postural tone. It always starts in childhood.
No post-ictal confusion. Its duration is (5-10 seconds).
Diagnosis
EEG: It is diagnose by 3 per second spike and wave electrical activity.

Tonic seizures

It name shows , this type of seizure cause the muscle spasm and muscles stiffness.

Atonic seizures

Muscles Atony leads to sudden loss of muscle power or Muscle control lasting 1-2 seconds which make you fall down suddenly.

Clonic seizures

This type of seizures characterized by repeated, involuntary, jerky muscle movements of the face, neck, and arms.

Myoclonic seizures

This type can cause sudden, brief and quick muscle contraction of the arms and legs.

Tonic Clinic Seizures (Grand Mal)

It is a type of generalized seizure in which there is loss of awareness with loss of postural tone.

Tonic Phase of this type is characterized by

Loss of consciousness, rigidity and loss of postural tone

  • Eye roll back during this stage
  • Central cyanosis

Clonic Phase is characterized by 

  • Tongue biting during this attack
  • Urinary incontinence
  • Fecal incontinence
  • Rhythmic contractions alteration with muscle relaxation

Post-ictal phase

  • Headache and confusion
  • Patients is afraid and wants to sleep sound
Diagnosis

It can be diagnosed with

  1. History
  2. EEG

HOW YOU CAN INVESTIGATE AND CONFIRMED THE EPILEPSY SYMPTOMS?

Epilepsy can be confirmed by following investigation

  • Clinical history
  • Examination
  • Draw blood for CBC, UCE, serum glucose and calcium.
  • EEG: Sleep EEG

Standard EEG

  • CT scan (after age of 20 years)
  • MRI (after age of 20 years)

HOW EPILEPSY SYMPTOMS CAN BE TREATED?

Anti-epileptic drugs are the drug of choice for epilepsy these include carbamazepine, sodium valporate, ethusuximide in first line agent. Lamotrigine, topiramate, clonazepam in second line agents. While phenytoin, gabapentin, lamotrigine in 3rd line agents.
PROPER GUIDELINES FOR STARTING ANTI-EPILEPTIC DRUGS
All the physicians dealing with epilepsy symptoms must know the following points.
First start with one first line drug.

First starting dose must be low, then increase the dose until seizures are managed.
If first line agent fails, start second line drug with low dose.
If second line drug fails then start combination of both first line and second line drugs.

WITHDRAWING ANTI-EPILEPTIC DRUGS

You can withdrawal your medication after the complete control of seizures for greater than 2 years. Recurrence rate of seizure after drug withdrawal is 35 to 40 percent. Withdrawal should be undertaken gradually.

EPILEPSY & PREGNANCY

Pregnant women who have had epilepsy attacks in previous life, are at higher risk to develop epilepsy symptoms during 3rd trimester. Seizures become more frequent during pregnancy. All anti-convulsant drugs are associated with the increase risk of fetal congenital malformations except GABAPENTIN. Risk of complications is high, if treatment is given during first trimester

STATUS EPILEPTICUS

Status epilepticus is characterized by continuous, repeated tonic clonic seizure lasting greater than 30 minutes. It is a life threatening emergency therefore need for emergency medical treatment. ANTI-EPILEPTIC drugs are used to treat this medical emergency but dose varies.