A seizure or epileptic attack is the consequence of a paroxysmal uncontrolled discharge of neuron within the central nervous system.
The clinical manifestations range from a major motor convulsion to a brief period of lack of awareness.
- 5% of the population suffer a single seizure.
- 0.5% of the population have recurrent seizures.
- 10% -well controlled with drugs with few seizures and prolonged remissions.
- 30%- epilepsy at least partially resistant to drug treatment.
Possible causes include-
- Traumatic brain injury.
- Scarring on the brain after a brain injury ( post traumatic epilepsy)
- Serious illness or very high fever
- Other vascular disease
- Lack of oxygen to the brain
- Brain tumour or cyst
- Dementia or Alzheimer’s disease
- Maternal drug use , prenatal injury,brain malformation or lack of oxygen at birth
- Infectious disease such as AIDS and meningitis
- Genetic or development disorder or neurological diseases
- Hereditary plays a main role in some type of epilepsy.
CLASSIFICATION OF SEIZURE TYPE:-
A) PARTIAL SEIZURE:– (affect just one part of brain)
1)According to severity:-
- Tonic/clonic attacks
2) Site of onset :-
a) Frontal lobe seizure:– there are a number of seizure types:-
- Jacksonian motor seizures:-
- Consist of march of involuntary movement from one muscle group to the next.
- Movementis clonic shaking and usually beings in- hand or face.
- Advesive seizures:-
- The patient’s eyes and head turn away from the site of the facal origin.
- Supplementary motor area seizure:-
- More complicated stereotyped movements often arising from sleep.Ex.-cycling movement
b) Parietal lobe seizure:- this arise in the sensory cortex ( parietal lobe)
c) Temporal lobe seizures:-
- These attacks are characterized by a complex aura ( initial symptoms) often with some impairment of consciousness.
d) Occipital lobe seizure:-
Uncommon typically there is an elementary visual hallucination.
B) GENERALISED SEIZURE:- (affect the whole brain)
- Absences (induced by hyperventilation)
- Absence status
- Myoclonic seizures
- Tonic seizures
- Atonic seizures
- Tonic / clonic seizures
a) Frontal lobe seizure:
- involuntary movement from one muscle group to the next.
- Movement is clonic or tonic
- Todd’s paralysis-after a motor for some hours before return of function occurs.
- Loss of consciousness.
b) Partial lobe seizure:-
- Paraesthesia or tingling in an extremity or on the face sometimes.
- Limb appears weak without involuntary movement.
c) Temporal lobe seizure:-
- Visceral disturbance-
- Olfactory (smell) hallucinations
- Lip smacking
- Epigastric fullness
- Choking sensation
- Papillary changes(dilation)
- Memory disturbance:-Something has happened before-
- Feeling of unfamiliarity
- Formed visual or auditory hallucinations
- Motor disturbance:-
- Fumbling movement
- Semi-purposeful limb movement
- Affective disturbance:-
- Confusion and headache after an attack are common.
d) Occipital lobe seizure
- visual hallucination
f) Tonic/clonic attack – loss of consciousness falls to the ground.
- Tonic phase (10sec)
- Eyes open- elbow flexed
- Arms pronated- legs extended
- Teeth clenched-pupils dilated
- Bowel/bladder control may be lost at the end of this phase.
- Clonic phase(1-2)
- Tremor gives way to violent generalized shaking.
- Eyes roll backward and forwards.
- Tongue may be bitten
- Tachycardia develops
- Breathing recommence
B) Generalized seizure:-
- Absence seizures( petit mal seizures)- This type of seizures may also cause-
- Repetitive movement like lip smacking or blinking .
- Usually a short loss of awareness.
- Myoclonic seizures – spontaneous quick twitching of the arms and legs.
- Tonic seizures – muscle stiffness with immediate loss of consciousness.
- Atonic seizures- loss of muscle contraction and can make you fall down suddenly.
A) Idiopathic :-
- primarily genetic with generalized seizure.
- sometimes grouped as more specific syndromes.
- 10-20% of cases.
B) Symptomatic:-partial onset seizures associated with structural lesion such as –
- Cortical dysplasia
- Head injury or trauma
- 30-40% of cases.
C) Cryptogenic :-
- partial onset seizure for which no cause has been found.
- 50% of patients.
- CT scan
- Advanced investigations
- Positron emission tomography(PET)
- Single photon emission computerized tomography (SPECT)
Anticonvulsant (Antiepileptic drug therapy):-
- Treatment aim to prevent seizures without side effect though this is not always achieved.
- Sugery is an option in a small number on non-responsers.
Anti-epileptic ( anticovulsant, antiseizure drug):-
- Idiopathic generalized epilepsy-
- Sodium valproat
- Partial (focal) epilepsy:-
- Sodium valproate
- More than half of people who don’t respond to medication, benefits from this high fat low carbohydrate diet.
Life style issues:-
- Generally there should be as few restrictions as possible ( see driving regulation).
- patient should be made aware of potential triggers to avoid-sleep deprivation, excess alcohol, and where relevant flashing lights. (thought most patient are not photosensitive)
Sensible precaution:- showering rather than taking a bath . Avoiding heights should be suggested.
Operation is contraindicated in patient with severe mental retardation or with an underlying psychiatric problem.
- Extra-temporal cortical resection
- Anterior temporal lobectomy
- Corpus callosal section
- Selective amygydalo-hippocampectomy
- Hemispherectomy / hemispherotomy :-
Vagal nerve stimulation(VNS):-
- Involves periodic stimulation of the left vagal nerve by an implanted stimulator.
- VNS appears to reduce neuronal excitability but the exact mechanishm remains obscure.
- About 30% of patients show a 50% seizure reduction within two years.
EXERCISE AND SEIZURES:-
- Most patient with epilepsy do not need physiotherapy, but some do have limited mobility and other disorder.
- To enhance the mobility and co-ordination.
- Weight bearing stimulus through the feet-encourage extension and counteract flexion.
The patient and their parents should be educated about the nature of illness and condition.
- Overall fitness and felling of well being have been shown to help reduce seizures frequency.
People feel better and may improve their seizure control with regular exercise.