What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent, unprovoked seizures.
It is one of the most common disorders of the nervous system and affects people of all ages, races, and ethnic background. Almost 3
million Americans live with epilepsy.
Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, low
blood sugar, high blood sugar, alcohol or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have one or
more seizures. However, when a person has two or more unprovoked seizures, he or she is considered to have epilepsy. There are
many possible causes of epilepsy, including an imbalance of nerve-signaling chemicals called neurotransmitters, tumors, strokes, and
brain damage from illness or injury, or some combination of these. In the majority of cases, there may be no detectable cause for
epilepsy.
What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that
communicate with each other through electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical
brain function.
What are the different types of seizures?
The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The two broad
categories of epileptic seizures are generalized seizures (absence, atonic, tonic-clonic, myoclonic) and partial (simple and complex)
seizures. Within these categories, there are several different types of seizures, including:
Focal or partial seizures. Focal seizures take place when abnormal electrical brain function occurs in one or more areas of
one side of the brain. Focal seizures may also be called partial seizures. With focal seizures, particularly with complex focal
seizures, a person may experience an aura, or premonition, before the seizure occurs. The most common aura involves feelings,
such as deja vu, impending doom, fear, or euphoria. Visual changes, hearing abnormalities, or changes in the sense of smell can
also be auras. Two types of focal seizures include:
Simple focal seizures. The person may have different symptoms depending on which area of the brain is involved.
If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), sight
may be altered, but muscles are more commonly affected. The seizure activity is limited to an isolated muscle group, such as
the fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The person may also
experience sweating, nausea, or become pale.
Complex focal seizures. This type of seizure commonly occurs in the temporal lobe of the brain, the area of the
brain that controls emotion and memory function. Consciousness is usually lost during these seizures. Losing consciousness
may not mean that a person passes out--sometimes, a person stops being aware of what's going on around him or her. The
person may look awake, but may have a variety of unusual behaviors. These behaviors may range from gagging, lip
smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, he or she may complain of
being tired or sleepy after the seizure. This is called the postictal period.
Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal
state after the seizure occurs. Types of generalized seizures include the following:
Absence seizures (also called petit mal seizures). These seizures are characterized by a brief, altered state of
consciousness and staring episodes. Typically, the person's posture is maintained during the seizure. The mouth or face
may twitch or the eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the
person may not recall what just occurred and may go on with his or her activities, acting as though nothing happened. These
seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral
problem. Absence seizures almost always start between ages 4 to 12 years.
Atonic (also called drop attacks). With atonic seizures, there is a sudden loss of muscle tone and the person may
fall from a standing position or suddenly drop his or her head. During the seizure, the person is limp and unresponsive.
Generalized tonic-clonic seizures (GTC or also called grand mal seizures). The classic form of this kind of
seizure, which may not occur in every case, is characterized by five distinct phases. The body, arms, and legs will flex
(contract), extend (straighten out), and tremor (shake), followed by a clonic period (contraction and relaxation of the muscles)
and the postictal period. Not all of these phases may be seen in everyone with this type of seizure. During the postictal
period, the person may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.
Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles. These
seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
Infantile spasms. This rare type of seizure disorder occurs in infants before six months of age. There is a high
occurrence rate of this seizure when the child is awakening, or when he or she is trying to go to sleep. The infant usually has
brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures
a day. This can be a serious problem, and can have long-term complications that affect growth and development.
Febrile seizures. This type of seizure is associated with fever and is not epilepsy, although a fever may trigger a
seizure in a child who has epilepsy. These seizures are more commonly seen in children between six months and five years of
age, and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called simple,
and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called complex and there
may be long-term neurological changes in the child.
What causes a seizure?
A person may experience one or many different types of seizures. While the exact cause of the seizure may not be known, the more
common seizures are caused by the following:
Birth trauma
Fever or infection
Alcohol or drugs
Head trauma
Infection
Congenital conditions
Genetic factors
Alzheimer's disease
Stroke
Unknown reasons
Other possible causes of seizures may include the following:
Brain tumor
Neurological problems
Drug withdrawal
Medications
Staring
Loss of consciousness
Falling suddenly for no apparent reason, especially when associated with loss of consciousness
Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness
Blood tests
Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes
attached to the scalp.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies,
and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of
X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows
detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general Xrays.
Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around
the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF)
can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain
and spinal cord.
Treatment of a seizure
Specific treatment for a seizure will be determined by your doctor based on:
Medications. There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the
type of seizure, age of the patient, side effects, the cost of the medication, and the adherence with the use of the medication.
Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally
(into the person's rectum). If the person is in the hospital with seizures, medication may be given by injection or intravenously by
vein (IV).
It is important to take your medication on time and as prescribed by your doctor. Different people use up the medication in their
body differently, so adjustments (schedule and dosage) may need to be made for the most effective seizure control.
All medications can have side effects, although some people may not experience certain side effects. Discuss your medication's
possible side effects with your doctor.
While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may
include the following:
Blood work. Frequent blood draws testing is usually required to check the level of the medication in the body.
Based on this level, the doctor may increase or decrease the dose of the medication to achieve the desired level. This level is
called the therapeutic level and is where the medication works most efficiently. Blood work may also be done to monitor the
effects of medications on body organs.
Urine tests. These tests are sometimes performed to see how the person's body is responding to the medication.
Electroencephalogram (EEG). An EEG is a procedure that records the brain's continuous, electrical activity by
means of electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems
in the brain.
Vagus nerve stimulation (VNS). Some people, whose seizures are not being well-controlled with seizure medications, may
benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most commonly used for people over age 12
who have partial seizures that are not controlled by other methods.
VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in
the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and
placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to
the brain. When the person feels a seizure coming on, he or she may activate the impulses by holding a small magnet over the
battery. In many cases, this will help to stop the seizure.
There are some side effects that may occur with the use of VNS. These may include, but are not limited to, the following:
Hoarseness
Change in voice
Surgery. Another treatment option for seizures is surgery. Surgery may be considered in a person who:
Make sure you or your child (if age appropriate) understand the type of seizure that is occurring and the type of medication(s)
that are needed.
Consult your doctor before taking other medications. Medications for seizures can interact with many other medications,
causing the medications to work improperly and/or causing side effects.
Young women of childbearing age who are on seizure medications need to be informed that seizure medications are harmful
to a fetus, and the medication may also decrease the effectiveness of oral contraceptives.
Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle.
If a person has good control over the seizures, only minimal restrictions need to be placed on activities, in most cases.
Medications for seizures may not be needed for the person's entire life. Some people may be taken off their medications if
they have been seizure-free for one to two years. This will be determined by your doctor.
http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/epilepsy_and_seizures_85,P00779/
Epilepsy - overview
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Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of disturbed brain activity that
cause changes in attention or behavior.
Causes
Epilepsy occurs when permanent changes in the brain cause it to be too excitable or irritable. As a result, the brain sends out abnormal
signals. This leads to repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.)
Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown (idiopathic).
Common causes of epilepsy include:
Brain tumor
Epileptic seizures usually begin between ages 5 and 20. But they can happen at any age. There may be a family history of seizures or
epilepsy.
Symptoms
Symptoms vary from person to person. Some people may have simple staring spells. Others have violent shaking and loss of alertness.
The type of seizure depends on the part of the brain affected and cause of epilepsy.
Most of the time, the seizure is similar to the one before it. Some people with epilepsy have a strange sensation before each seizure.
Sensations may be tingling, smelling an odor that is not actually there, or emotional changes. This is called an aura.
Your doctor can tell you more about the specific type of seizure you may have:
Generalized tonic-clonic (grand mal) seizure (involves the entire body, including aura, rigid muscles, and loss of alertness)
Partial (focal) seizure (can involve any of the symptoms described above, depending on where in the brain the seizure starts)
Wear an EEG recorder for days or weeks as you go about your everyday life.
Stay in a special hospital where brain activity can be watched on video cameras. This is called video EEG.
Blood chemistry
Blood sugar
Head CT or MRI scan often done to find the cause and location of the problem in the brain.
Treatment
Treatment for epilepsy includes medications, lifestyle changes, and sometimes surgery.
If epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures
stop.
Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures:
These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have.
Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects.
Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Do not stop taking or
change medications on your own. Talk to your doctor first.
Many epilepsy medications cause birth defects. Women who plan to become pregnant should tell their doctor in advance in
order to adjust medications.
Many epilepsy medicines may affect the health of your bones. Talk to your doctor about whether you need vitamins and other
supplements.
Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy." In this
case, the doctor may recommend surgery to:
Place a vagus nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures.
Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in
carbohydrates, such as the Atkins diet, may also be helpful in some adults. Be sure to discuss these options with your doctor before
trying them.
Lifestyle or medical changes can increase the risk of a seizure in adults and children with epilepsy. Talk with your doctor about:
Emotional stress
Lack of sleep
Pregnancy
Other considerations:
Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.
Persons with poorly controlled epilepsy should not drive. Check your state's law about which people with a history of
seizures are allowed to drive.
Do not use machinery or do activities that can cause loss of awareness, such as climbing to high places, biking, and
swimming alone.
Support Groups
The stress of having epilepsy or being a caretaker of someone with epilepsy can often be helped by joining a support group. In these
groups, members share common experiences and problems.
Outlook (Prognosis)
Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years.
Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s.
For many people, epilepsy is a lifelong condition. In these cases, anti-seizure drugs need to be continued. There is a very low risk of
sudden death with epilepsy.
Possible Complications
Difficulty learning
Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia
Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure
A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do)
In the case of someone who has had seizures before, call 911 for any of these emergency situations:
This is a longer seizure than the person normally has, or an unusual number of seizures for the person
Repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus)
Loss of hair
Nausea or vomiting
Rash
Prevention
There is no known way to prevent epilepsy. Proper diet and sleep, and staying away from illegal drugs and alcohol may decrease the
likelihood of triggering seizures in people with epilepsy.
Reduce the risk of head injury by wearing helmets during risky activities. This can lessen the likelihood of a brain injury that leads to
seizures and epilepsy.
Alternative Names
Temporal lobe epilepsy; Seizure disorder
References
Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's
Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 67.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11-41.
Harden CL, Hopp J, Ting TY, et al. Practice Parameter update: Management issues for women with epilepsy - Focus on pregnancy (an
evidence-based review): Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee
and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy
Society. Neurology. 2009;73;126-132
Wiebe S. The epilepsies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders;
2011:chap 410.
Update Date: 2/10/2014
Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by
VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm
Epilepsy is a condition of the brain causing seizures.
A seizure is a disruption of the electrical communication between neurons
Someone is said to have epilepsy if they experience two or more unprovoked seizures separated by at least 24 hours
The Epilepsy Foundation is your unwavering ally in the fight against epilepsy and seizures. You don't walk alone.
What is epilepsy? Will I have seizures forever?
You may have a lot of questions about epilepsy. We will help you understand the basics, answer the most common questions, and help
you find resources and other information you may need. However, information alone wont help you manage your epilepsy and find a
way to cope with the effects on your daily life. Youll need to learn how to use the information and make it work for you.
What is Epilepsy?
Epilepsy is a neurological condition which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually
diagnosed after a person has had at least two seizures that were not caused by some known medical condition.
What are Seizures?
Seizures seen in epilepsy are caused by disturbances in the electrical activity of the brain. The seizures in epilepsy may be related to a
brain injury or a family tendency, but most of the time the cause is unknown
Seizures are caused by disturbances in the electrical activity of the brain.
6 OUT OF 10: Number of people with epilepsy where the cause is unknown.
Authored by: Patricia O. Shafer, RN, MN on 1/2014
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014
Not everyone who has a serious head injury (a clear cause of seizures) will get epilepsy.
When seizures begin from both sides of the brain at the same time it's called generalized epilepsy.
Epilepsy is more likely to occur in a brother or sister if the child with epilepsy has generalized seizures.
Having seizures and epilepsy doesnt mean you or your child are any different or less important than anyone else!
Heredity (genetics or the physical traits we get from our parents) plays an important role in many cases of epilepsy.
For instance, not everyone who has a serious head injury (a clear cause of seizures) will get epilepsy. Those who do develop
epilepsy may be more likely to have a history of seizures in their family. This family history suggests that it is easier for them to
develop epilepsy than for people with no genetic tendency.
When seizures begin from both sides of the brain at the same time it's called generalized epilepsy. Generalized epilepsy is
more likely to involve genetic factors than partial or focal epilepsy.
In recent years, genetic links to some forms of partial epilepsy have been found.
Are the brothers and sisters of children with epilepsy more likely to develop it?
Their risk is slightly higher than usual, because there may be a genetic tendency in the family for seizures and epilepsy.
Even so, most brothers and sisters will not develop epilepsy. Epilepsy is more likely to occur in a brother or sister if the child
with epilepsy has generalized seizures.
Remember, epilepsy is not contagious and people cant catch it like a cold.
If I have epilepsy, will my children also have it?
Most children of people with epilepsy do not develop seizures or epilepsy. However, since genes are passed down through families, it
is possible. Here are a few general points to remember.
Less than 2 people out of every 100 develop epilepsy at some point during their lifetime.
The risk for children whose father has epilepsy is only slightly higher.
If the mother has epilepsy and the father does not, the risk is still less than 5 in 100.
If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of
inheriting some types of epilepsy is higher.
Learning the facts and understanding the risks of passing it along to your children can help.
If you have epilepsy, you may be afraid that your children will have epilepsy, too. However, its important to know the facts.The risk
of passing epilepsy on to your children is usually low. Epilepsy shouldnt be a reason not to have children. Medical testing may help
people who have a known genetic form of epilepsy understand their risks.
If a child does develop epilepsy, remember that many children can get complete control of seizures. For some, the epilepsy may go
away.
Most importantly, having seizures and epilepsy doesnt mean you or your child are any different or less important than anyone else!
Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MD
Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 7/2013
Some people may find that seizures occur in a pattern or are more likely to occur in certain situations. Sometimes these connections
are just by chance, but other times its not. Keeping track of any factors that may precipitate a seizure (also called seizure triggers) can
help you recognize when a seizure may be coming. You can then be prepared and learn how to lessen the chance that a seizure may
occur at this time.
Some people will notice one or two triggers very easily, for example their seizures may occur only during sleep or when waking up.
Other people may notice that some triggers bother them only when a lot is going on at once or it is during a 'high risk' time for them
(for example when under a lot of stress or when sick).
What are some commonly reported triggers?
Sleep deprivation overtired, not sleeping well, not getting enough sleep
Stress
Specific foods, excess caffeine or other products that may aggravate seizures
For example, one type of reflex epilepsy is photosensitive epilepsy where seizures are triggered specifically by flashing
lights.
Other types of reflex epilepsies may be seizures triggered by the act of reading or by noises.
These reflex epilepsies are not common, but knowing if you have this form of epilepsy will help you learn how to manage
them!
How can I tell if something is a trigger?
Great question and a common one too! Sometimes people think just because a situation happened once or twice, its a trigger to all
their seizures. Its important to realize that a trigger is something that occurs fairly consistently before seizures and more often than by
chance. To identify triggers, try a few of these strategies:
Whenever you have a seizure, note what time of day it occurs, special situations surrounding it, or how you felt. Note if any
of the commonly reported triggers were present.
Write these in your seizure diary. Do this consistently, for each seizure.
If you notice that a situation or event is happening pretty consistently before seizures, now you need to know if it also
happens at other times.
o
For example, you note that you were sleep deprived before 2 out of 3 seizures in the past 3 months. But when you
look at your sleep patterns, you didnt have seizures all the other times you were sleep deprived. And you dont sleep well
most of the time. In this situation, sleep deprivation isnt good for you, but probably doesnt trigger seizures all by itself.
You still need to work on improving your sleep, but there may be other things going on too.
o
Track a suspected trigger in your diary. Note whenever it happens and not just when you have a seizure. Then you
can see how often it happens with seizures as compared to other times.
If you have a form of reflex epilepsy, talk to your doctor about the trigger. Knowing the type of epilepsy and trigger can help
you build in ways to avoid the triggers whenever possible or find ways to lessen their effect on you.
For more information:
Syncope
The ANS automatically controls many functions of the body such as breathing, blood pressure, heart rate and bladder. In most
situations, we are unaware of the workings of the ANS because it functions in an involuntary, reflexive manner.
Types of Syncope
Vasovagal syncope (also called cardio-neurogenic syncope)
Vasovagal syncope is the most common type of syncope that occurs when the blood pressure drops suddenly, reducing blood flow to
the brain. When you stand up, gravity causes blood to settle in the lower part of your body, below the level of the diaphragm. In
response, the heart and autonomic nervous system (ANS) react to maintain your blood pressure.
Vasovagal syncope may occur in patients who have a condition called orthostatic hypotension. In this condition, the blood vessels do
not constrict normally when the patient stands, causing blood to pool in the legs and the blood pressure to drop quickly.
Situational syncope
Situational syncope is a type of vasovagal syncope that occurs only during particular situations that cause unusual patterns of
stimulation to certain nerves. The stimulus that triggers an exaggerated neurological reflex can be a wide range of different events
such as dehydration, intense emotional stress, anxiety, fear, pain, hunger or use of alcohol or drugs. Hyperventilation (breathing in too
much oxygen and getting rid of too much carbon dioxide too quickly) associated with panic or anxiety also can cause syncope. Other
stimuli include coughing forcefully, turning the neck or wearing a tight collar (carotid sinus hypersensitivity), or urinating (miturition
syncope).
Postural syncope (also called postural hypotension)
Postural syncope occurs when the blood pressure drops suddenly due to a quick change in position, such as from lying down to
standing. Postural syncope can be related to certain medications or dehydration.
Cardiac syncope
Cardiac syncope is the loss of consciousness due to a heart or blood vessel condition that interferes with blood flow to the brain. These
conditions may include an abnormal heart rhythm (arrhythmia), obstructed blood flow in the heart or blood vessels, valve disease,
aortic stenosis, blood clot, or heart failure.
Neurologic syncope
Neurologic syncope is the loss of consciousness due to a neurological condition such as seizure, stroke, transient ischemic attack
(TIA) or other rare causes including migraines and normal pressure hydrocephalus.
In about one-third of cases, the cause of syncope is unknown.
How common is syncope?
Syncope is a common condition, affecting 3 percent of men and 3.5 percent of women at some point in life. It becomes more prevalent
with advancing age, occurring in as many as 6 percent of people over age 75. Syncope affects patients of all ages, both with and
without other medical conditions.
How is syncope diagnosed?
All patients with syncope should be evaluated by a doctor. Your primary care physician can provide a referral to the Center for
Syncope and Autonomic Disorders for a complete evaluation to determine the cause of your syncope.
The Center for Syncope and Autonomic Disorders combines experience, expertise and a team approach to diagnosing syncope. There
are several tests that can be performed to find the underlying cause of syncope. The initial evaluation includes a screening tilt table
test, blood volume determination, hemodynamic testing and autonomic nervous system testing.
The syncope evaluation begins with a careful review of your medical history and a physical exam. The doctor will ask you detailed
questions about your symptoms and syncope episodes, including whether you have any premonitory symptoms and the circumstances
in which your symptoms occur.
Your heart rate and blood pressure will be measured and recorded while you are in different positions including lying down, sitting
and standing.
Involves twitching, numbness or tingling of the child's face or tongue (a partial seizure).
Seizures last no more than 2 minutes.
Child remains fully conscious.
The syndrome represents about 15 percent of all epilepsies in children.
Because the seizures may be infrequent and usually occur at night, many children do not take medication.
In almost every case, the seizures stop on their own by age 15.
What is it like?
A typical attack involves twitching, numbness, or tingling of the child's face or tongue (a partial seizure), which often interferes with
speech and may cause drooling. These seizures last no more than 2 minutes and the child remains fully conscious. Sometimes the
child also may have tonic-clonic seizures, usually during sleep. The seizures are usually infrequent, but they may occur in widely
spaced clusters.
The name derives from the rolandic area of the brain, which is the part that controls movements. As noted below, benign does not
refer to the degree of intensity of the seizures but of the universal tendency to outgrow having seizures. The official modern name is
benign epilepsy with centro-temporal spikes or BECTS.
Who gets it?
This syndrome represents about 15% of all epilepsies in children. The seizures begin at an average age of about 6 to 8 years (range 313) and are a bit more likely to affect boys. The children generally have normal intelligence, which is not affected by the seizures. The
syndrome is more common in children who have close relatives with epilepsy.
Tell me more
Other tests, such as the neurologic examination and MRI (if performed), are normal. Some children will have learning difficulties and
behavioral problems during the period of time that they have seizures. The problems typically disappear once the seizures stop and the
EEG reverts to normal.
How is it treated?
Because the seizures may be infrequent and usually occur at night, many children do not take any seizure medicines for BRE.
Medication may be prescribed if a child has daytime seizures, a learning disorder, a mild mental handicap, or frequent seizures during
sleep. The seizures usually can be controlled by any of the common seizure medicines. Neurontin (gabapentin), Trileptal
(oxcarbazepine), Tegretol or Carbatrol (carbamazepine), Keppra (levetiracetam) or Vimpat (lacosamide) are most often prescribed in
the United States.
Diagnosing Epilepsy
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Evaluating patients with epilepsy is aimed at determining what type of seizures they are having (epileptic versus nonepileptic) and
their cause. Various seizure types respond best to specific treatments. The diagnosis ofepilepsy is based on:
The patient's medical history, including any family history of seizures, associated medical conditions, and
current medications. Also helpful to the doctor is the input of people who have witnessed a patient's seizures, especially if there is a
loss of consciousness. Some important questions a patient will be asked include:
A complete physical and neurological exam of muscle strength, reflexes,eyesight, hearing, and ability to detect various
sensations
Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI)
Blood tests to measure red and white blood cell counts, blood sugar, bloodcalcium, and electrolyte levels; and to
evaluate liver and kidney function; blood tests help rule out the presence of other illnesses.
Other tests, as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography ( PET) and single
photon emission computed tomography (SPECT)
*An important part of the diagnostic process is the electroencephalogram (EEG), because it is the only test that directly detects
electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small
metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain's electrical
activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.
A routine EEG only records about 20-30 minutes of brain waves (however, the entire EEG procedure takes about 90 minutes).
Because 30 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have
epilepsy. Therefore, prolonged EEG monitoring may be necessary. Some monitors allow the patient to stay at home and continue his
or her normal activities.
Prolonged EEG-video monitoring is another diagnostic method. During this type of monitoring, an EEG monitors the brain's activity
and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time
in a special hospital facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy.
http://www.webmd.com/epilepsy/guide/diagnosing-epilepsy
Types of Epilepsy
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In this article
Generalized Epilepsy
Childhood
absence
epilepsy - Benign focal epilepsy of
Juvenile
myoclonic
epilepsy childhood
- Epilepsy with grand-mal seizures on
awakening Others
West
Lennox-Gastaut
Partial Epilepsy
(brain or spinal cord) abnormalities, other than the seizures, can be identified on either an EEG or imaging studies ( MRI). The brain is
structurally normal on a brain magnetic resonance imaging (MRI) scan, although special studies may show a scar or subtle change in
the brain that may have been present since birth.
People with idiopathic generalized epilepsy have normal intelligence and the results of the neurological exam and MRI are usually
normal. The results of the electroencephalogram (EEG -- a test which measures electrical impulses in the brain) may show epileptic
discharges affecting a single area or multiple areas in the brain (so called generalized discharges).
The types of seizures affecting patients with idiopathic generalized epilepsy may include:
Myoclonic seizures (sudden and very short duration jerking of the extremities)
Electroencephalogram (EEG)
An EEG test can detect unusual brain activity associated with epilepsy by measuring the electrical activity of your brain through
electrodes placed on your scalp.
During the test, you may be asked to breathe deeply or close your eyes and you may be asked to look at a flashing light. The test will
be stopped immediately if it looks like the flashing light could trigger a seizure.
In some cases, an EEG may be carried out while you are asleep (sleep EEG) or you may be given a small, portable EEG recording
device to monitor your brain activity over 24 hours (ambulatory EEG).
Magnetic resonance imaging (MRI) scan
An MRI scan is a type of scan which uses strong magnetic fields and radio waves to produce detailed images of the inside of your
body.
It can be useful in cases of suspected epilepsy because it can often detect possible causes of the condition, such as defects in the
structure of your brain or the presence of a brain tumour.
An MRI scanner is a large tube that contains powerful magnets. You lie inside the tube during the scan.
http://www.nhs.uk/Conditions/Epilepsy/Pages/Diagnosis.aspx