Epilepsy

Epilepsy Topic Outline I. History and Background A. History B. Causative Agent C. Characteristics and Symptoms II. Knowing and Treating the Disease A. Effected Populations and Transmission of Disease B. Diagnosis C. Treatment III. Complications and Control A. Complications B. Prevention/Control Epilepsy is nothing new to the medical world. Records of the disease date back as far as 2000 B.C. Symptoms of the disease are even mentioned in the Bible, in the gospel of Mark. However, for a very long time epilepsy was a very misunderstood condition. It was thought of as a spiritual disease. The great Hippocrates wrote a book on the condition, On the Sacred Disease, explaining how the seizures were not related to spirituality and religion. He went on to explain that it was all connected to a neurological disorder. In the 1600s, seizures were mistaken for possession by demonic forces. Sadly, many women were mistakenly condemned as witches when they had seizures. From then until now, science has developed in some of the most unbelievable ways. Epilepsy is now better understood and is able to be treated to minimize symptoms in order to allow a person to live more comfortably. In order to explain the outer condition, however, one must understand what goes on in the mind first. Epilepsy mainly effects the part of the brain called the cerebral cortex. The job of the cerebral cortex is to regularly receive “messages,” known as neurons. Neurons are what control a person’s everyday activities. In the normally functioning brain, neurons are rhythmically sent to the cerebral cortex. The brain then processes the neurological “messages” and the body functions normally. For a person with epilepsy, the neurons are sent in abnormal bursts and the cerebral cortex cannot process them correctly. Epileptic episodes can be triggered by several things. Some of these things include flickering lights, stress, lack of sleep, high fevers, poor diet, illegal drugs, and alcohol. Sometimes epilepsy can even be idiopathic1. This leads to the normal characteristics and symptoms of epilepsy. The common trait to epilepsy is seizures2. In a minor epileptic episode, you notice such things as the smacking of lips, staring out into space, the twitching of arms and legs, strange sensations and behavior, and muscle spasms. In more serious cases one would notice convulsions3, blurry vision, temporary loss of hearing, loss of balance, whole-body stiffness, vomiting, and sometimes loss of consciousness. In the case of an epileptic seizure, one should immediately find a cushion and put it under the victims head. Also, one should turn the victim on their side in order to prevent choking on saliva or vomit. It is very important not to hold the victim down during a seizure. This may cause them injury. Medical services should be notified immediately. The usual epileptic seizure lasts only a few seconds to a few minutes at the most. Prior to these episodes, neurons return to their normal rhythms. But who is effected by this life-altering disease' Epilepsy is not uncommon in Americans. According to The Epilepsy Foundation, 2.3 million Americans have epilepsy and about 300,000 of those people are children ages 14 and younger. It has been discovered that 68% to 93% of children grow out of the disease within 20 years of their first epileptic seizure. About 181,000 people are diagnosed with the disease per year. Also, epilepsy is more common in males than in females. This information still has doctors baffled. Epilepsy is also more common in African Americans and people of the lower social class. There are 8.7% of children who get the disease from the mother. The likelihood of getting it from the father is 2.4%. There is good news for those with epilepsy, though. It has been found that 70% of people with epilepsy can be expected to enter remission. All 2.3 million people that have epilepsy have to have been diagnosed. Diagnosing epilepsy is a tedious process. Many neurological examinations have to be scheduled. These include electroencephalograms4 (EEG) and magnetic resonance5 imaging (MRI). An EEG measures and records the electrical activity in the brain. Since epilepsy effects the electrical activity in the brain, an EEG is necessary in the diagnosis. The EEG shows when a seizure is likely to happen by the radically moving waves, as you can see in the example to the right. These show the extreme electrical activity happening in the brain at the moment. Unlike an EEG, an MRI takes pictures of the brain in order to visually show any changes or abnormalities that may exist. Other diagnostic procedures include blood tests, genetics tests, lab tests, and medical history evaluations. After diagnosis is complete and the presence of the disease is confirmed, the next course of action is treatment. The point of treatment is to minimize or stop the occurrences or severity of epileptic seizures. There are three possible options in the treatment of epilepsy. The first option would be drug therapy. A doctor will prescribe a regular regimen of medications and dosages for a person to take. Not everyone will react to the medications in the same way, so it is normal for a patient to revisit a doctor for a change is doses. About 80% of people with epilepsy find treatment by medications to be effective. There is a list of possible medications in the appendix. The second option of treatment is natural treatment. Simple things that could relieve stress or a change in the diet have also been found effective. Things such as yoga, hypnosis, meditation, and massage are all examples of ways to relieve stress. The ketogenic6 diet has also been found to work well. In this diet, the amount of fats found in meats, cheeses, butters, and creams is increased and the carbohydrates found in breads, cereals, and grains is decreased. This increases the amount of ketones in the body which has been found to suppress the number of seizures a person has. However, this diet change normally works in children under the age of 10 and there may be some negative side effects including stunted growth, low blood sugar, and excess fat in the blood. The third and final option is surgery. Surgery can cure seizures but it is often a last resort for epileptic patients. Commonly, the surgeries consist of removing the affected part of the brain. The portion of the brain being removed can range from the size of a child’s marble to entire sections of the brain. To the left is an example of a hemispherectomy7. These are sometimes used as the best approach to dealing with uncontrollable seizures. Almost all of the affected half of the brain is removed in this procedure. Sometimes, surgery doesn’t always work. If the affected area is too close to a crucial part of the brain used for motor or language skills, it cannot be removed. There may even be complications with the disease. Epilepsy is very uncommonly life-threatening. Being in the wrong situation during an epileptic seizure can be quite dangerous, though. Falling could cause head injury. Seizures during swimming or bathing could be dangerous. Also, seizures while driving can pose a great risk of accidents. Expecting mothers who have epilepsy put themselves and their baby at risk. Normally, a doctor will adjust the doses of an expecting mother in order to avoid seizures. Prolonged or high numbers of seizures put one at risk of brain damage or death. There is also a very small chance of sudden unexplained death in epilepsy (SUDEP). It is very important to stay on the mediations prescribed by doctors. The side effects must be taken into consideration though. Some medications may induce dizziness, drowsiness and fatigue. These may interfere with normal activities such as work and school. A person with epilepsy can function normally in these situations with the right precautions. Things such as avoiding all night study sessions or avoiding jobs that require driving aid in the process of choosing the right surroundings for daily life. Although this disease seems like a life altering struggle, there have been many who have graduated high school and gained degrees despite their condition. Some may see epilepsy as the end of a normal life, but in reality it is the beginning of a more aware and appreciative life. Don’t let epilepsy bring you to a stop. Take control of it before it takes control of you. Appendix Possible Medications (as suggested by Dr. Elaine Wyllie, M.D.) Adrenocorticotropin (ah-DREE-no-core-tih-co-tro-pin) Benzodiazepines (ben-zo-die-AYZ-ah-peens) Carbamazepine (car-bah-MAZ-uh-peen) Ethosuximide (ee-tho-SUX-ih-myde) Felbamate (FELL-buh-mate) Fosphenytoin (foss-FEN-ih-toe-in) Gabapentin (gab-uh-PEN-tin) Lamotrigine (la-MO-tra-gene) Levetiracetam (lev-ih-tir-ASS-ih-tam) Oxcarbazepine (ox-car-BAZ-uh-peen) Phenobarbital (fee-no-BAR-bit-all) Phenytoin (FEN-ih-toe-in) Pregabalin (pre-GAB-ah-lin) Primidone (PRIM-ih-doan) Tiagabine (tye-AG-a-been) Topiramate (toe-PIE-rah-mate) Valproate (VAL-pro-ate) Vigabatrin (vi-GAB-ah-trin) Zonisamide (zoe-NISS-ah-myde) Suggested Sources For Information Epilepsy Foundation www.epilepsyfoundation.org Citizens United for Research in Epilepsy (CURE) http://www.CUREepilepsy.org Epilepsy Institute http://www.epilepsyinstitute.org Glossary 1Idiopathic - no known cause 2Seizure - a sudden attack, as of epilepsy or some other disease 3Convulsion - contortion of the body caused by violent, involuntary muscular contractions of the extremities, trunk, and head 4Electroencephalogram - Electro~electricity Encephalo~inside the brain Gram~something written, drawn, or recorded 5Resonance - an excited state of a stable particle causing a sharp maximum in the probability of absorption of electromagnetic radiation 6Ketogenic - forming ketone bodies in the body 7Hemispherectomy - Hemisphere~either of the lateral halves of the cerebrum or cerebellum Ectomy~the surgical removal of Bibliography Books Wyllie, M.D., Elaine. Epilepsy: Information for You and Those Who Care About You. Cleveland Clinic. Cleveland, Ohio: Cleveland Clinic Press, 2008. Haugen, Hayley Mitchell. Epilepsy: Understanding Diseases and Disorders. San Diego, Calif.: Thomson Gale™, 2005. Wissmann, PhD, RN, CNE, Jeanne. Nursing Care of Children. RN 7.0. Assessment Technologies Institute® LLC, 2007. Internet Sources http://www.epilepsyfoundation.org/about/statistics.cfm http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm http://www.nlm.nih.gov/medlineplus/epilepsy.html http://www.webmd.com/epilepsy/electroencephalogram-eeg-21508 http://www.mayoclinic.com/health/epilepsy/DS00342/DSECTION=7 Picture Credits http://student.bmj.com/issues/01/09/news/epilepsy.JPG http://www.brainexplorer.org/brain-images/cortex.jpg http://www.epilepsymatters.com/english/images/convulsive.jpg http://hcigempowers.com/eeg_tracing.png http://pubpages.unh.edu/~jel/images/hemispherectomy.jpg