The epileptic seizure.

The epileptic seizure

Epilepsy is a neurological disease that causes abnormal electrical activity in the brain.

It mainly affects children, adolescents and the elderly to varying degrees. The causes are in some cases genetic, but in most cases they are not identified.

epileptic seizure

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Definition of Epilepsy

Epilepsy is characterized by a sudden increase in electrical activity in the brain, causing a temporary disruption of communication between neurons.

It is usually of short duration. They can occur in a specific area of the brain or in the brain as a whole.

These abnormal nerve impulses can be measured during an electroencephalogram (EEG), a test that records brain activity.

The epileptic seizure: understanding everything in 2 minutes

Contrary to popular belief, epileptic seizures are not always accompanied by sudden movements or convulsions.

They can be less spectacular. They are manifested by unusual sensations (such as olfactory or auditory hallucinations, etc.) with or without loss of consciousness, and by various manifestations, such as staring or involuntary repetitive gestures.

Important fact: the seizures have to happen again for it to be epilepsy. So, having had a seizure in your life does not mean you have epilepsy.

It takes at least two to be diagnosed with epilepsy.

An epileptic seizure can occur in several circumstances: a head injury, meningitis, a stroke, a drug overdose, drug withdrawal, etc.

It is not uncommon for young children to have seizures during a fever outbreak.

These are called febrile seizures and usually stop around age 5 or 6. This is not a form of epilepsy. When such seizures occur, it is still important to see a doctor.

Causes

In about 60% of cases, doctors cannot determine the exact cause of the seizures.

It is assumed that about 10% to 15% of all cases have a hereditary component, as epilepsy seems to be more common in some families.

Researchers have linked certain types of epilepsy to the malfunction of several genes. For most people with epilepsy, genes are only part of the cause of epilepsy.

Some genes may make a person more sensitive to environmental conditions that trigger seizures.

Rarely, epilepsy can be caused by a brain tumor, the aftermath of a stroke or other trauma to the brain.

This is because a scar can form in the cerebral cortex, for example, and affect the activity of the neurons.

It is important to note that several years may elapse between the accident and the onset of epilepsy. And remember that for epilepsy to occur, seizures must occur repeatedly, not just once.

Stroke is the leading cause of epilepsy in adults over 35.

Infectious diseases. Infectious diseases, such as meningitis, AIDS, and viral encephalitis, can cause epilepsy.

Prenatal injury. Before birth, babies are susceptible to brain damage that can be caused by several factors, such as infection in the mother, poor nutrition or poor oxygen supply.

These brain injuries can lead to epilepsy or cerebral palsy.

Developmental disorders. Epilepsy can sometimes be associated with developmental disorders such as autism and neurofibromatosis.

Who is injured?

In North America, about 1 in 100 people have epilepsy.

Among the neurological diseases, it is the most common, after migraine. Up to 10% of the world’s population may have a single seizure at some point in their lives.

Although it can occur at any age, epilepsy usually appears during childhood or adolescence, or after age 65.

In the elderly, the increased incidence of heart problems and strokes increases the risk.

Types of crises

There are two main types of epileptic seizures:

  • Partial seizures, limited to a specific area of the brain; the patient may be conscious during the seizure (simple partial seizure) or consciousness may be affected (complex partial seizure) In the latter case, the patient usually does not remember the seizures.
  • generalized seizures, which extend to all areas of the brain. The patient loses consciousness during the seizure.

Sometimes a seizure, at first partial, extends to the whole brain and thus becomes generalized. The type of sensation felt during a seizure gives the doctor an indication of where it is coming from (frontal lobe, temporal lobe, etc.).

Seizures can be caused by

  • Idiopathic. That means that there is no apparent cause.
  • Symptomatic. That means the doctor knows the cause. He may also suspect a cause, but not identify it.

There are three descriptions of seizures, depending on the part of the brain where the epileptic activity began:

Partial crises

They are limited to a small area of the brain.

Simple partial crises (formerly called “focal crises”) These seizures usually last a few minutes. During a simple partial seizure, the individual remains conscious.

The symptoms depend on the area of the brain affected. The person may experience tingling, uncontrollable tension in one part of the body, hallucinations of smell, sight or taste, or an unexplained emotion.

The symptoms of simple partial seizures can be confused with other neurological disorders, such as migraine, narcolepsy, or mental illness.

Comprehensive examinations and tests are needed to distinguish epilepsy from other disorders.

Complex partial seizures (formerly called “psychomotor crises”). During a complex partial seizure, the individual is in an altered state of consciousness.

He does not respond to stimuli and his gaze is fixed. They may have automatisms, that is, they may perform involuntary repetitive actions such as pulling clothes, clicking teeth, etc.

Once the seizure is over, you will have little or no memory of what happened. You may be confused or fall asleep.

Widespread crises

This type of seizure involves the entire brain.

Widespread absences. This is what was once called the “little evil”. The first attacks of this type of epilepsy usually occur during childhood, between 5 and 10 years.

They last a few seconds and may be accompanied by a brief fluttering of the eyelids. The person loses contact with their environment, but retains muscle tone. More than 90% of children with epileptic seizures go into remission by age 12.

Tonic-clonic seizures. They used to be called “grand mal”. These are the types of seizures usually associated with epilepsy because of their dramatic appearance.

The seizure usually lasts less than 2 minutes. These are generalized seizures that occur in 2 phases: tonic and then clonic. –
During the tonic phase, the person may have a scream and then pass out.

Then the body hardens and the jaws tighten.

This phase usually lasts less than 30 seconds. Then, in the clone phase, the person goes into convulsions (uncontrollable and spasmodic muscle jerks).

Breathing, which is blocked at the beginning of the seizure, can become very irregular. This usually lasts less than a minute.
Once the seizure ends, the muscles relax, including those in the bladder and bowels.

Afterwards, the person may be confused, disoriented, have headaches and want to sleep. These effects can last from 20 minutes to several hours. Muscle aches sometimes persist for a few days.

Myoclonic seizures. More rarely, they are manifested by sudden shaking of the arms and legs.

This type of seizure lasts from one to a few seconds, depending on whether it is a single tremor or a series of tremors. They usually do not cause confusion.

Atonic seizures. During these rare attacks, the person suddenly collapses due to a sudden loss of muscle tone. After a few seconds, the person regains consciousness.

He or she is able to get up and walk.

Possible consequences

Seizures can cause physical injury if the person loses control of his or her movements.

Individuals with epilepsy can also suffer significant psychological repercussions caused by the unpredictability of seizures, prejudice, adverse drug reactions, etc.

Prolonged crises or those that do not end in a return to normal must be treated urgently. They can cause significant neurological sequelae at any age.

During a prolonged seizure, certain areas of the brain lack oxygen.

In addition, damage to neurons may occur due to the release of excitatory substances and catecholamines associated with acute stress.

Some seizures can even be fatal. The phenomenon is rare and unknown. It is called “sudden and unexpected death in epilepsy” (SUDEP).

It is believed that a seizure can alter the heartbeat or stop breathing. The risk is believed to be greater in people with epilepsy whose seizures are not well treated.

Having a crisis at certain times can be dangerous for oneself or others.

Fall. If you fall during a seizure, you could injure your head or break a bone.

Drowning. If you have epilepsy, you are 15 to 19 times more likely to drown while swimming or in the bathtub than the rest of the population because of the risk of having a seizure in the water.

Car accidents. A seizure that results in loss of consciousness or control can be dangerous if you are driving a car. Some countries impose licensing restrictions related to your ability to control your seizures.

Emotional health problems.

People with epilepsy are more likely to have psychological problems, particularly depression, anxiety and, in some cases, suicidal behavior.

Problems can result from difficulties related to the disease itself, as well as side effects of the medication.

A woman with epilepsy who is planning a pregnancy should take special precautions.

You should consult a physician at least 3 months before conception.

For example, the doctor may adjust the medication due to the risk of birth defects from certain anti-epileptic drugs.

Also, many anti-epileptic drugs are not metabolized in the same way during pregnancy, so the dose may change. It should be noted that the seizures themselves can endanger the fetus by temporarily depriving it of oxygen.

Practical considerations

In general, if the person is well cared for, he or she can lead a normal life with certain restrictions. For example, at the beginning of treatment, driving and the use of technical equipment or machinery in the course of employment may be prohibited.

If the person with epilepsy has not had a seizure for a certain time, the doctor may re-evaluate his or her situation and issue a medical certificate that ends these prohibitions.

Epilepsy Canada reminds epileptics that epileptics have fewer seizures when they lead an active life. “This means that they should be encouraged to look for work,” the website says.

Long-term evolution

Epilepsy can last a lifetime, but some people with epilepsy will eventually stop having seizures. Experts estimate that about 60% of untreated people are seizure-free for 24 months after their first seizure.

Having had the first seizures at a young age seems to promote remission. About 70% go into remission for 5 years (no seizures for 5 years).

Between 20 and 30 percent develop chronic epilepsy (long-term epilepsy).

For 70% to 80% of people with persistent illness, the medication is successful in eliminating seizures.

British researchers have reported that death is 11 times more common in people with epilepsy than in the rest of the population.

The authors added that the risk is even greater if a person with epilepsy also has a mental illness.

Suicides, accidents, and assaults accounted for 16% of early deaths; most had been diagnosed with a mental disorder.

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