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Epilepsy

 

Epilepsy Introduction

Epilepsy is not a psychological disorder, but rather a neurological condition that periodically produces short-lived disturbances, or seizures, in the normal electrical conductivity of the brain. [1] Normal brain function involves millions of tiny electrical charges between nerve cells in the brain to different parts of the body. Normally, electrical activity occurs in an orderly way, allowing a smooth flow of information to be transmitted. With epilepsy, this pattern is interrupted by sporadic bursts of electrical energy that are much more intense than usual. On a detailed level, this disruption is due to improper concentrations of salts within the cell, or over activity of brain chemicals known as neurotransmitters at the site of nerve conduction. [2] This activity results in altered consciousness, irregular bodily movements, or heightened and unusual sensations, for brief periods of time.

There are several different ways this disorder can manifest. It is important to note that having one seizure does not necessarily mean that one has or will develop epilepsy. Some can have a single episode and never experience symptoms again. High fever, lack of oxygen to the brain, episodes of intense stress, over consumption of alcohol, or severe head trauma can all cause seizures. In order to classify someone as epileptic, the reoccurrence of seizures must be due to some underlying issue that needs to diagnosed. The triggers for these episodes may be present from birth and result from physiological irregularities such as a congenital abnormality. Triggers may also develop later in life, and be secondary to trauma, injuries, infection, toxic agents, stroke, metabolic disturbances, and sometimes, in approximately 7-10% of people, for reasons that don’t have a definitive cause. It is often recommended to carefully monitor the individual and wait and see if they have another episode, before doing a more extensive workup. Often thought of as a condition that manifests during childhood, a person can develop epilepsy at any age. In fact, there is an increasing prevalence of this condition in those over 65 years old. [3, 4, 5]

Seizures can occur in one of multiple parts of the brain. Where they occur determines the symptoms associated with the episode. Commonly, there are three phases of an episode, each with associated signs and symptoms. First, the aura phase, which is pre-seizure, then the ictal phase which is the actual event, and lastly, the postictal phase. The postical phase follows the seizure where the brain recovers from the event. [6] There are also different classifications of seizure types, depending on which part and the extent of the brain affected. The two main categories are partial, affecting just one area of the brain, and general, affecting activity throughout the brain. Within these main categories there are subcategories. Described below are the most common subcategories:

  • Partial Seizures- The site of origin is a localized area in one side of the brain. Most commonly, these seizures are classified as simple or complex in nature.
  • Simple Partial: the manifestation of this type of seizure depends on which part of the brain is affected. For example, if in the motor area of the brain, the person could experience a jerking of the extremities. There is no affect on consciousness in this type of seizure.
  • Complex Partial: with this type of episode, there is impairment of consciousness, resulting in the inability to respond to, or carry out, simple commands or to execute willed movement, and a lack of awareness of one’s surroundings and events. Automatisms may occur. An automatism is a more, or less coordinated, involuntary motor activity. A simple complex seizure may begin as a simple partial seizure.
  • Generalized Seizures- Seizure activity occurs concurrently in large areas of the brain, often in both sides. Seizures can be convulsive or non-convulsive. The two most common types are tonic-clonic and absence.
  • Tonic-clonic or grand mal Seizure: During this seizure there is increased muscle tone (rigidity) known as the tonic phase, and then jerking of the extremities known as the clonic phase. There is loss of consciousness during this type of seizure.
  • Absence or petit mal Seizure: Occurring most often in children, the loss of consciousness is so brief that it could go unnoticed by the child and the parent. They usually last about 10 seconds, and while there is no postictal stage, the person is commonly unaware of what happens during the seizure. It is common from children the ‘grow out’ of this type of seizure by adolescence.
  • Myoclonic Seizure: These seizures are very brief to the point that they may go unnoticed. They are often confused with tics in that they consist of rapid muscle contractions, but are much quicker that clonic activity. These seizures occur in all age groups and are associated with other epileptic syndromes.

A thorough medical history can provide a lot of insight into determining risk factors and the likelihood of reoccurrences. Age, family history, and possible causes of the seizure are all taken into consideration when deciding who receives aggressive intervention. In addition, there are also diagnostic tests that can be used to examine brain activity and give insight into the cause of the irregular brain activity. Brain function can be monitored by an electroencephalograph (EEG), which involves connecting wires to the skull and monitoring the electrical activity of the brain between episodes. Scans, such as computerized tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), can be used to identify growths, scars or other conditions that could be the cause of recurrent episodes. About 30 percent of the 125,000 new cases every year begin in childhood, particularly in early childhood and around the time of adolescence. Another period of relatively high incidence is in people over the age of 65.

Epilepsy - Seizure Symptoms

Seizures are the symptoms of epilepsy; the type of seizure can define the type and degree of epilepsy.

Early seizure symptoms (AURA phase)

Sensory/Thought: Emotional: Physical: No warning:
Deja vu Fear/Panic Dizziness Sometimes seizures come with no warning
Smell Pleasant feeling Headache
Sound Lightheadedness
Taste Nausea
Visual loss or blurring Numbness
Racing thoughts
Strange feelings
Tingling feeling

Seizure symptoms (ICTAL phase)

Sensory/Thought: Emotional: Physical:
Black out Fear/Panic Chewing movements
Confusion Convulsion
Deafness/Sounds Difficulty talking
Electric Shock Feeling Drooling
Loss of consciousness Eyelid fluttering
Odors Eyes rolling up
Spacing out Falling down
Out of body experience Foot stomping
Visual loss or blurring Hand waving
Inability to move
Incontinence
Lip smacking
Making sounds
Shaking
Staring
Stiffening
Swallowing
Sweating
Teeth clenching/grinding
Tongue biting
Tremors
Twitching movements
Breathing difficulty
Heart racing

After-seizure symptoms (POSTICTAL phase)

Thought: Emotional: Physical:
Memory loss Confusion Bruising
Writing difficulty Depression and sadness Difficulty talking
Fear Injuries
Frustration Sleeping
Shame/Embarrassment Exhaustion
Headache
Nausea
Pain
Thirst
Weakness
Urge to urinate/defecate

*This chart was adapted from epilepsy.com

Epilepsy Statistics

Incidence:

  • In the United States, 181,000 new cases of epilepsy are diagnosed every year.
  • 45,000 children under the age of 15 develop epilepsy each year.
  • Incidence is highest under the age of 2 and over 65, greater in African American and socio-economically underprivileged populations. The conditions also affects males more often than females.
  • The trend shows an increase in elderly populations and a decrease in children.
  • In 70 percent of new cases, the cause is unknown.
  • Generalized seizures are more common in children under the age of 10; after this age group, more than half of all new cases will suffer from partial seizures.

Prevalence:

  • Prevalence of active epilepsy is about 2.5 million persons in the United States. (Active epilepsy is defined as a history of the disorder including a seizure or use of antiepileptic medicine in the past 5 years).
  • Prevalence tends to increase with age.
  • More common in racial minorities than the Caucasian population.
  • Epilepsy can develop among anyone regardless of age, race or socioeconomic status. [7]
  • There are roughly 315, 000 school children through age 14 with epilepsy.
  • There are 600,000 people over the age of 65 with epilepsy. [8]

Epilepsy - Seizure Treatment

Epilepsy Medications: About 3/4 of people with epilepsy will control their condition with various anti-epileptic medications. [9] Although these medications will prevent seizures from reoccurring, they don’t cure the condition. Some will be able to taper off the medication, while others will have to take them indefinitely, regardless of whether the episodes have stopped. There are many interactions between anticonvulsant medication and other drugs. It is very important to keep all health care practitioners aware of the treatments that a person with epilepsy engages in so that drug interactions are avoided. [10]

Surgery: For those that cannot be managed with anti-epileptic medication, surgery may be an option. Most often, a surgical candidate is one whose seizures arise from the same part of the brain. In addition, there are other types of surgeries that can diminish the seizure activity if removing the area is not appropriate.[11]

Vagus nerve stimulation (VNS): A relatively new treatment, VNS aims to reduce the amount, duration and severity of seizures a person has. This procedure involves providing a mild electrical stimulation of the left vagus nerve, a large nerve in the neck. Due to the fact that VNS doesn’t cure epilepsy, a person would still need to take their anti-epileptic medication. [12]

Supplements helpful for Epilepsy

Magnesium: Magnesium has extensive effects in the body. It is involved in energy production, immune function, nervous system function, and circulation. Because of its pervasive effects and involvement with electrolyte balance, it is congruent that imbalances can be connected to seizure activity.

Studies show evidence of magnesium deficiency as a trigger for seizures. [13] Although this is a rare trigger, it is thought to be due to provoking a metabolic imbalance, leading to improper nerve activity. One study followed a Thai girl at 10 weeks old presenting with low levels of magnesium and recurrent convulsions. After supplementation with magnesium, she was free of the convulsions. [14]

Taurine: Taurine is an amino acid found largely in the heart, brain, and skeletal muscle. Its role in the brain is to modulate brain chemicals (neurotransmitters) so that the cell membranes are stabilized, leading to more consistent activity. [15]

A study in mice showed that when given a taurine agonist there were increased occurrences of convulsive seizures, suggesting that depletion of taurine has triggering effect for improper brain activity. [16]

Gamma-aminobutyric acid (GABA): An amino acid produced in the brain, gamma-aminobutyric acid (GABA) is a neurotransmitter that fosters communication between nerve cells. Large amounts of research implicate its role in the provocation of seizure activity. GABA is an inhibitory neurotransmitter, and when not present in adequate amounts, the lack of inhibition can lead to over excitation, resulting in convulsive episode. [17] To this end, many standard epilepsy drugs, such as benzodiazepines and phenobarbital, aim to boost GABA levels in the brain. Supplementation with GABA may have a positive effect on reducing seizure activity.

For many, it will be necessary to be on anti-epileptic medication. However, many of these medications deplete the necessary vitamins and minerals in the body, and when depleted, may lead to a host of other problems. The following are some vitamins and minerals that could be affected:

Vitamin D Many anti-epileptic medications interfere with vitamin D metabolism. [18] For those taking such medications it is important to counteract these effects. It is equally important to note that vitamin D is involved with the absorption and metabolism of calcium, and its depletion could then lead to inadequate amounts of calcium absorption. Supplementing with Vitamin D will allow the body to maintain proper amounts of vitamin D and calcium, thereby preventing any deficiency states.

Folic acid Folic acid is involved in DNA metabolism, immune function, and central nervous system function. It reduces the risk of birth defects as well as decreasing the risk for heart disease by lowering homocysteine levels. [19] Because of its important function, it is crucial that it is not depleted. For those taking seizure medications, it is common for folic acid to be compromised. It should be noted that there is more of an involved interaction with these medications, in that folic acid in large amounts (more than 15mg/day) may interfere with the anticonvulsant effect of dilantin; but smaller doses of folic acid appears to improve the clinical condition. [20]

References

[1]Online document at: http://www.neuro.jhmi.edu/Epilepsy/info.html

[2] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[3] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[4] ibid

[5] Online document at: http://www.epilepsyfoundation.org/answerplace/statistics.cfm

[6] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[7] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[8] Online document at: http://www.epilepsyfoundation.org/answerplace/statistics.cfm

[9] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[10] Online document at: http://www.neuro.jhmi.edu/Epilepsy/meds.html

[11] Online document at: http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml

[12] ibid

[13] Weisleder P, Tobin JA, Kerrigan JF 3rd, Bodensteiner JB. Hypomagnesemic seizures: case report and presumed pathophysiology. J Child Neurol. 2002 Jan;17(1):59-61.

[14] Unachak K, Louthrenoo O, Katanyuwong K Primary hypomagnesemia in Thai infants: a case report with 7 years follow-up and review of literature. J Med Assoc Thai. 2002 Nov;85(11):1226-31..

[15] Online document at: http://www.darkdog.com/whatistaurine.html

[16] Shimada C, Tanaka S, Sano M, Araki H Drug-induced seizures in taurine-deficient mice. Yakubutsu Seishin Kodo. 1991 Aug;11(4):257-60.

[17] Treiman , David M, GABAergic Mechanisms in Epilepsy, Epilepsia Volume 42 Issue s3 Page 8

[18] Feldkamp J, et al. Long-term anticonvulsant therapy leads to low bone mineral density–evidence for direct drug effects of phenytoin and carbamazepine on human osteoblast-like cells. Exp Clin Endocrinol Diabetes. 2000;108(1):37-43.

[19] Voutilainen S, Lakka TA, Porkkala-Sarataho E, et al. Low serum folate concentrations are associated with an excess incidence of acute coronary events: the Kuopio Ischaemic Heart Disease Risk Factor Study. Eur J Clin Nutr 2000;54:424-8.

[20] Apeland T, et al. Folate, homocysteine and methionine loading in patients on carbamazepine. Acta Neurol Scand. 2001 May;103(5):294-9.

Epilepsy - Seizure Symptoms