Epilepsy and Seizures
An epileptic seizure is a sudden dysfunction of a circumscribed region of the brain or of the entire brain. A single seizure may be triggered by many different things, without it necessarily being epilepsy. Only when a person experiences recurring seizures is the phenomenon described as a tendency of the brain towards epileptic seizures, i.e. epilepsy. Various symptoms are associated with different types of epilepsy. Epilepsy can develop at any age.
What is dangerous is the form referred to as Status epilepticus, which manifests in sequences of seizures lasting more than ten minutes and without any complete recovery between seizures. Status epilepticus can cause permanent brain damage or even be fatal. For this reason, immediate emergency medical attention is crucial!
An epileptic seizure is sometimes preceded by an “aura”. This may include unusual sensory impressions, such as a peculiar smell or taste or a false memory. Sometimes the aura symptoms provide signs of which brain region is causing the seizure.
Most people associate seizures with falling down, convulsions and a loss of consciousness. This does happen in the case of what are known as grand mal seizures. But how seizures are manifested is much more complex: Brief lapses in consciousness – or absences – are sometimes the only sign of epilepsy. Sometimes there are disturbances in a person’s consciousness, movements, perceptions, as well as cognitive or behavioral problems. Severe epileptic seizures pose a risk of injury due to falling.
There are three different types of seizures:
- Focal seizures: These seizures start in a very specific region of the brain, such as around a “brain scar” resulting from a stroke, for example. These attacks are sometimes also referred to as partial or focal seizures.
- Secondary generalized seizures: These start out as a focal seizure before they spread to affect the entire brain.
- Generalized seizures: These appear to affect the whole brain from the beginning. Generalized seizures usually also result in temporary impairments to the person’s consciousness. A specific cause for the epileptic seizure in these cases is harder to identify than with focal seizures.
What will the doctor want to know?
Can the patient remember events before the seizure or the seizure itself? When and how often have the seizures been occurring? What happened after the seizure? Did anyone witness the seizure? Observations from persons who witnessed the seizure are crucial to a diagnosis. In this day and age, it is easy record seizures with a mobile phone camera, for example, and then show the recording to the doctor. If the person is already being treated for epilepsy, it is important to have information about the current treatment, start of treatment and whether any side effects have been caused by the medication. Any past treatments that were ineffective also need to be discussed.
- Electroencephalogram (EEG) and sometimes outpatient EEG following sleep deprivation
- Cranial MRI and other specialized brain imaging will be performed in the Department of Neuroradiology of Hirslanden Klinik.
There are two main causes of epilepsy: an innate susceptibility to seizures or a brain trauma event. Prenatal maldevelopment, harm caused during pregnancy or at birth, as well as injuries, inflammation, extreme fever, brain tumors, circulatory disorders, drugs, poisoning and metabolic disorders can cause epilepsy. It is often impossible to identify one clear cause, however.
Epilepsy is a common neurological disorder and around two thirds of sufferers respond well to treatment with medication. If medication does not stop the seizures, there are other possible treatment options, ranging from surgical removal of the affected area of the brain to nerve or brain stimulation.
During the epilepsy consultation, the goal is to develop a personalized treatment plan for each patient. In addition to effectiveness, the focus is on how well the person will tolerate the therapy and their living situation (e.g. profession, desire to have children, ability to drive).
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