EPILEPSY AND SEIZURE TRIGGERS

Introduction

Epilepsy is a neurological disorder characterized by recurrent and unpredictable seizures. It is caused by abnormal electrical activity in the brain, which can result in a variety of symptoms including convulsions, loss of consciousness, and altered sensations.

A seizure, on the other hand, is a sudden and temporary disturbance in brain function that occurs when there is abnormal electrical activity in the brain. Seizures can be caused by a variety of factors such as fever, head injury, brain tumors, drug or alcohol withdrawal, and other neurological conditions.

While seizures can occur in people without epilepsy, epilepsy is diagnosed when a person experiences recurrent seizures that are not related to a specific cause, such as fever or brain injury. In other words, epilepsy is a chronic condition characterized by recurrent, unprovoked seizures.

 

Etiologies of Seizure Disorders

Seizure disorders, also known as epilepsy, can have a variety of causes. Some common etiologies of seizure disorders include:

1. Genetic factors: Certain types of seizures may run in families, and mutations in specific genes may increase the risk of seizures.
2. Brain injuries: Traumatic brain injuries, strokes, and other types of brain damage can cause seizures.
3. Infections: Certain viral and bacterial infections, such as meningitis or encephalitis, can cause seizures.
4. Brain tumors: Tumors in the brain can cause seizures, especially if they are located in areas of the brain that control movement, sensation, or consciousness.
5. Metabolic disorders: Disorders that affect the body’s metabolism, such as low blood sugar, electrolyte imbalances, or liver failure, can cause seizures.
6. Developmental disorders: Conditions that affect brain development, such as cerebral palsy or autism, can increase the risk of seizures.
7. Medications and drugs: Certain medications or illegal drugs can lower the seizure threshold and increase the risk of seizures.
8. Alcohol withdrawal: Abruptly stopping heavy alcohol use can cause seizures, which can be life-threatening.
9. Febrile seizures: Young children may experience seizures when they have a high fever.

It’s important to note that in many cases, the exact cause of seizures is unknown. If you or a loved one experiences seizures, it’s important to seek medical attention to determine the underlying cause and receive appropriate treatment.

 

Epilepsy Classification System

The International Classification of Epilepsies and Seizure Disorders (ICESD) is a classification system developed by the International League Against Epilepsy (ILAE) to standardize the diagnosis and classification of seizures and epilepsy worldwide. The most recent version is the 2017 ILAE classification, which replaced the previous 1981 and 2010 classifications.

The 2017 ILAE classification organizes seizures and epilepsy into several categories, including focal onset, generalized onset, combined focal and generalized onset, and unknown onset. Each category is further divided into specific subtypes based on the characteristics of the seizures or epilepsy syndrome.

Focal onset seizures are those that begin in a specific area of the brain and may or may not spread to other areas. They are further classified based on whether they involve impaired awareness or not, and whether they have motor, sensory, autonomic, or psychic features.

Generalized onset seizures involve both sides of the brain from the beginning and include subtypes such as absence seizures, myoclonic seizures, clonic seizures, tonic seizures, atonic seizures, and tonic-clonic seizures.

Combined focal and generalized onset seizures include those that have both focal and generalized features, such as epileptic spasms and focal seizures evolving to generalized seizures.

Finally, seizures of unknown onset are those in which the initial site of seizure onset is unclear, such as in some cases of sudden unexpected death in epilepsy (SUDEP).

The ICESD also includes specific epilepsy syndromes, which are groups of seizures and other clinical features that often occur together and are believed to have a common underlying cause. Examples include genetic generalized epilepsy syndromes, such as juvenile myoclonic epilepsy and Lennox-Gastaut syndrome, as well as focal epilepsy syndromes, such as temporal lobe epilepsy.

Overall, the ICESD provides a standardized system for diagnosing and classifying seizures and epilepsy, which is essential for effective treatment and research.

 

Simple vs complex seizures

Seizures are caused by abnormal electrical activity in the brain and can be classified into two main types: simple and complex seizures.

A simple seizure, also known as a focal seizure, begins in one area of the brain. The person experiencing the seizure may have unusual sensations, such as tingling, numbness, or a feeling of fear. They may also experience jerking movements or muscle contractions on one side of the body. Simple seizures usually last less than 2 minutes and do not cause loss of consciousness.

A complex seizure, also known as a focal impaired awareness seizure, also begins in one area of the brain but can spread to other areas. The person experiencing the seizure may have a blank stare, appear confused or dazed, and may not be able to respond to questions or instructions. They may also perform repetitive movements, such as lip smacking or picking at their clothes. Complex seizures can last for several minutes and can cause loss of consciousness.

It’s important to note that seizures can vary widely in their presentation and can be caused by a variety of underlying medical conditions. If you or someone you know experiences a seizure, it’s important to seek medical attention to determine the underlying cause and receive appropriate treatment.

 

Common Seizure Types

Clinical description of the three most common types of seizures:

1. Generalized Tonic-Clonic Seizures (also known as Grand Mal Seizures): This type of seizure involves a sudden loss of consciousness and a convulsive seizure with violent muscle contractions. During the tonic phase, the muscles become stiff and the person loses consciousness, followed by the clonic phase, during which the person experiences violent jerking movements. This seizure can last for a few minutes, and afterward, the person may feel confused or tired.
2. Absence Seizures (also known as Petit Mal Seizures): Absence seizures are brief episodes of staring or staring spells, usually lasting less than 30 seconds. During the seizure, the person becomes unresponsive and may appear to be daydreaming or staring into space. They may also blink rapidly or make small movements such as lip smacking. After the seizure, the person usually resumes their previous activity without any memory of the event.
3. Complex Partial Seizures: Complex partial seizures (also called focal seizures with impaired awareness) typically involve altered consciousness or awareness. During the seizure, the person may stare blankly, repeat movements, or perform automatic behaviors such as chewing, lip-smacking, or walking in circles. They may also exhibit unusual emotional behaviors such as fear, anger, or euphoria. The seizure usually lasts for 1 to 2 minutes, and after the seizure, the person may feel tired or confused. These seizures may originate from a specific area of the brain and may spread to other parts of the brain, causing different symptoms in each person.

 

Seizure history and examination

A thorough history and physical examination are crucial in the diagnosis and management of seizure disorders. Here are some important aspects to consider:

a) History:

1. Age of onset: Seizure disorders can develop at any age, but they are more common in children and older adults.
2. Duration and frequency of seizures: How often and how long the seizures last can provide important information about the type and severity of the seizure disorder.
3. Description of the seizure: A detailed description of the seizure and associated symptoms can help classify the type of seizure disorder.
4. Triggers: Certain factors such as sleep deprivation, stress, alcohol use, or medications can trigger seizures in some individuals.
5. Family history: A family history of seizure disorders can increase the risk of developing a seizure disorder.
6. Past medical history: Certain medical conditions, such as brain tumors, head injury, or stroke, can increase the risk of developing a seizure disorder.

 

b) Physical examination:

1. Neurological examination: This involves testing reflexes, muscle strength, coordination, sensation, and vision to assess any signs of neurological dysfunction.
2. Vital signs: Blood pressure, heart rate, and temperature should be monitored to rule out any underlying medical conditions that may contribute to seizures.
3. Skin examination: A careful skin examination can identify any signs of trauma or injury that may have triggered seizures.
4. Head and neck examination: This can help identify any abnormalities in the brain or neck that may be associated with seizure disorders.
5. Mental status examination: Assessing mental status, cognitive function, and behavior can provide important information about the severity of the seizure disorder.

In summary, a detailed history and physical examination are essential in the evaluation of patients with seizure disorders. They can help identify the type and severity of the disorder, potential triggers, and any underlying medical conditions that may contribute to seizures.

 

Seizure Patient Investigations

Important investigation tools for a seizure patient, such as brain MRI and electroencephalography (EEG).

1. Brain MRI (Magnetic Resonance Imaging): This is a non-invasive imaging technique that uses a powerful magnetic field and radio waves to create detailed images of the brain. It can help identify structural abnormalities, such as tumors, malformations of cortical development, or damage due to injury, stroke or infection that may be causing the seizures.
2. EEG (Electroencephalography): This is a test that records the electrical activity of the brain using electrodes attached to the scalp. EEG can help diagnose seizures and determine the type of epilepsy a patient may have. It can also help to identify the location in the brain where seizures originate.
3. Video EEG Monitoring: This involves recording a patient’s EEG and video of their behavior during a seizure. It can provide more detailed information about the type of seizure and help to localize the origin of the seizure.
4. CT (Computed Tomography) Scan: This is a diagnostic imaging test that uses X-rays to create detailed images of the brain. It is used to identify structural abnormalities, such as tumors or hemorrhages that may be causing seizures.
5. PET (Positron Emission Tomography) Scan: This imaging test uses a small amount of radioactive tracer to create images of the brain’s metabolic activity. It can help identify areas of the brain that are more active during seizures, which may help locate the origin of the seizures.
6. SPECT (Single Photon Emission Computed Tomography) Scan: This is a nuclear imaging test that uses a radioactive tracer to create 3D images of blood flow in the brain. It can help identify areas of the brain with abnormal blood flow, which may be causing seizures.
7. Neuropsychological testing: This is a series of tests designed to evaluate a patient’s cognitive abilities, memory, and behavior. It can help identify any cognitive or behavioral problems associated with seizures or epilepsy.

 

It’s important to note that a combination of these diagnostic tests may be used to diagnose seizures and determine the underlying cause. The results of these tests can help doctors develop an appropriate treatment plan for the patient.

 

Managing Epilepsy Patient

Managing an epilepsy patient involves a multidisciplinary approach and may vary depending on the patient’s individual needs and severity of the condition. However, here is a general outline for managing an epilepsy patient:

1. Diagnosis: Obtain a thorough medical history and conduct a physical exam. Additional diagnostic tests may include EEG, MRI, and blood work.
2. Medication: Prescribe antiepileptic drugs (AEDs) to control seizures. The type and dosage of AEDs may vary depending on the type of epilepsy and the patient’s medical history.
3. Lifestyle changes: Encourage patients to adopt a healthy lifestyle, including regular exercise, healthy diet, and adequate sleep. Avoiding triggers that may provoke seizures is also essential.
4. Education: Educate patients about their epilepsy, including seizure recognition, first aid for seizures, and the importance of adherence to medication.
5. Monitoring: Regularly monitor patients for seizure control and medication side effects. Adjust medication dosages as needed.
6. Seizure management: Develop a seizure management plan that includes information on what to do in case of a seizure and emergency procedures.
7. Follow-up care: Schedule regular follow-up appointments with the patient to monitor progress and adjust treatment plans as needed.
8. Referral: Consider referral to a specialist, such as a neurologist or epileptologist, for further evaluation and treatment if necessary.

 

Anti-epileptic medication overview

1. Phenytoin: This medication is an anticonvulsant that works by slowing down the electrical activity in the brain. It is commonly used to treat various types of seizures, including partial seizures, generalized tonic-clonic seizures, and status epilepticus. Common side effects of phenytoin include drowsiness, dizziness, nausea, vomiting, and skin rash. Long-term use of this medication can lead to gum overgrowth, which can be managed with good oral hygiene.
2. Carbamazepine:This medication is also an anticonvulsant that works by reducing the abnormal electrical activity in the brain. It is used to treat various types of seizures, including partial seizures, generalized tonic-clonic seizures, and trigeminal neuralgia. Common side effects of carbamazepine include dizziness, drowsiness, nausea, vomiting, and skin rash. Long-term use of this medication can lead to bone loss, which can be managed with calcium and vitamin D supplements.
3. Valproic acid: This medication is an anticonvulsant that works by increasing the levels of a neurotransmitter called GABA in the brain. It is used to treat various types of seizures, including absence seizures, myoclonic seizures, and generalized tonic-clonic seizures. Common side effects of valproic acid include dizziness, drowsiness, nausea, vomiting, and hair loss. Long-term use of this medication can lead to weight gain, liver damage, and pancreatitis.
4. Topiramate: This medication is an anticonvulsant that works by increasing the levels of GABA in the brain and blocking the activity of another neurotransmitter called glutamate. It is used to treat various types of seizures, including partial seizures and generalized tonic-clonic seizures. Common side effects of topiramate include dizziness, drowsiness, nausea, vomiting, and difficulty concentrating. Long-term use of this medication can lead to kidney stones, which can be managed with increased fluid intake.
5. Lamotrigine:This medication is an anticonvulsant that works by blocking the activity of sodium channels in the brain. It is used to treat various types of seizures, including partial seizures and generalized tonic-clonic seizures. Common side effects of lamotrigine include dizziness, drowsiness, nausea, vomiting, and skin rash. Rarely, this medication can cause a serious skin rash called Stevens-Johnson syndrome, which requires immediate medical attention.
6. Levetiracetam: This medication is an anticonvulsant that works by binding to a protein called SV2A in the brain. It is used to treat various types of seizures, including partial seizures and generalized tonic-clonic seizures. Common side effects of levetiracetam include dizziness, drowsiness, irritability, and aggression. This medication is generally well-tolerated and has a low risk of serious side effects.

 

It is important to note that each individual may react differently to these medications and may experience different side effects. Always consult with a healthcare professional if you have any concerns or questions about your treatment.