What is Epilepsy? The word Epilepsy comes from a Greek word
which means, to seize, possess, or afflict It is classified by
having at least 2 seizures within the timespan of 24 hours with
unknown causes Seizures are the only visible symptoms of epilepsy
Next to migraines, its the most common neurological disorder
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Within the Nervous System
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What is wrong in the brain? When you have a seizure there may
be too much or too little activity which causes an imbalance of
excitability and stopping. Most of the time the cells in the brain
are too excitable which produces a sudden surge of electrical
activity in the brain. Normally the brain has a homeostatic balance
of cells that can excite and those that can stop messages.
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Neurological Activity
http://www.chm.bris.ac.uk/webprojects2002/wrigglesworth/brainimaging.htm
https://www.youtube.com/watch?v=THOdtXlQXPU&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrY-YeWM&index=45
-Epilepsy is the disorder of the central nervous system,
specifically the brain -A person with epilepsy experience glitches
in their neurological channels - The body runs on electrical
signals and with seizures the electrical homeostasis is all over
the place -Signals either act when they should not or do not act at
all
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Neurological Activity -depends on how many cells are signaling
and which area of the brain is involved -also, depends on the
seizure threshold which is the balance between the excitatory and
inhibitory -the hippocampus is susceptible to epilepsy.
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Neurological Activity -Glutamate is the brains prominent
excitatory neurotransmitter in the body and its receptors are in
charge of the neural communication. As well as indicating for GABA.
-Glutamate is a ligand, which is an ion that binds to the central
metal atom, that signals Ca 2+ and Na channels so open -The
prolonged excitability causes the glutamate to become toxic to the
body. All of this due to the overwhelming messages and can cause a
stroke which could lead to epilepsy or lead straight to
Epilepsy
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Neurological Activity -GABA the brains primary inhibitory
neurotransmitter -Studies show that abnormalities in this
neurotransmitter can initiate the symptoms of epilepsy -Also, there
is research that reasoned that since there was not a sufficient
uptake of GABA, then the next demand lacks any power. -This lack of
power causes the overproduction of excitable neurotransmitters
http://medicine.yale.edu/neurology/people/ognen_petroff-3.profile
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History of Epilepsy
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Timeline
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Timeline continued...
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Timeline continued...again
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Timeline continued...
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21st Century
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How would one diagnosis someone with Epilepsy? All
epileptologists are neurologists, but not all neurologists are
epileptologists.
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Epilepsy Syndromes The type of Epilepsy is classified in
categories depending on: 1.Type of seizure (ex. twitching or still)
2.How severe and how frequent 3.Genetic History 4.Which part(s) of
the brain is involved 5.Cause of seizure 6.Age 7.EGG, MRI, CT scan
images https://www.youtube.com/watch?v=kJOC_ZGKDr8
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Types of Epilepsy Idiopathic - there is no apparent cause (ex
genetics) Cryptogenic - there is a cause but it hasn't been
identified Symptomatic - the cause has been identified
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Triggers -Genetics -A scar, a tangle of blood vessels or
anything that interrupts the flow of electricity in the brain -Head
injury, brain tumor, birth trauma and stroke -Abuse of substances
-Aftermath of diseases like measles -brain damage that has not been
identified
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Generalized v.s. Partial Generalized widespread electrical
discharge across both sides of the brain Partial occur in one part
of brain 60% of people with epilepsy have this type
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Generalized Epilepsy -mostly idiopathic which means they have
no apparent cause -both sides of the brain are affected by the
abnormal electrical activity -many have loss of consciousness
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Benign Rolandic Epilepsy of Children (BREC) -seizures start
around the central sulcus or Rolandic fissure (a fold in the
cerebral cortex) -age 3-13 - typically involves twitching,
numbness, or tingling of the face or tongue -lasts no more than 2
minutes and child remains fully conscious -usually happens at night
-common trigger is sleep deprivation -almost all outgrow by age 15
-15% of all epilepsy in children -most common in children who have
a close relative with epilepsy -the cause is genetics there is a
theory that there is a link with the mutation of chromosome 15q14
which is involved in excitability of nerve cells
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How is BREC Diagnosed Diagnosed with a MRI (magnetic resolance
imaging) or EEG (electroencephalogram) -usually the MRI appears
normal - on the EGG the child will have spikes in the temporal lobe
and motor area *Since most experience less than 10 seizures in the
2 - 4 years of the BRECs peak most children do not take any
medication* **Medication is optional if seizures are frequent or
during the day (neurontin, tegretol, keppra, vimpat, zonegran,
trileptal are most common)**
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Childhood Absence Epilepsy (petit mal) -child has a staring
spell and is unaware and unresponsive -lasts about 10 seconds
-episodes can occur 1 to 50 times per day -begin between ages 4-8
-2%-8% of people with epilepsy **predominantly genetic** 10% chance
of a child developing if a close relative has a past - treatment
includes Zarontin and Depakote -65% of children with CAE respond to
the treatment and the seizures disappear by mid adolescence
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Myoclonic -myo means muscle and clonic means jerk -three
specific types (juvenile, progressive, and Lennox- Gastaut
syndrome) -they happen due to an increase in muscle tone -the rapid
change from relaxing to contracting in a muscle -usually cause
abnormal jerking or twitching movements on both sides of the body
but can be only one sided -genetic
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Continued react as they have been hit by a single jolt of
electricity often drop the objects in their hands mistaken for
clumsiness or tremors because they last only for a second
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Juvenile Myoclonic (JME) -emerge from mid to late childhood
-they can have staring spells or full on convulsions seizures
-involved neck, shoulders, and upper arms -usually after they wake
up -genetically determined -controlled with medication but
continued throughout life -the most common triggers are flashing
lights, stress, and sleep deprivation -important to have an outlet
for stress and get plenty of rest to reduce chances of
seizures
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Clonic -Clonic means jerking -Rare; varies in age, even
newborns can develop this -sometimes the seizures are brief and
disappear on their own or some may last into adulthood -Causes
constant, rhythmic jerking of the arms and legs -Sometimes it
affects both sides of the body -Cannot be stopped if the person is
restrained -Dont mistake it with jitteriness because a person with
clonic is less alert than a person who is jittery -Different from
Tonic-Clonic because a period of tiredness or confusion doesnt
follow the episode
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Tonic -Muscle tone is the muscles normal tension at rest but a
tonic seizure causes the tension to increase in the body, arms and
legs, thus everything stiffens. -Occurs most often during sleep and
involves all or most of the brain, which affects both sides of the
body -Can last < 20 seconds -Common in people who have
Lennox-Gastaut syndrome but can occur in anyone -After an episode
the person can be either sleepy or confused
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Tonic Continued... -Some people might have one seizure per
episode or back to back seizures in one episode -EEGs are used to
diagnose the seizures -Medicines can be used to treat these.
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Tonic-Clonic (Grand Mal) -First: Tonic Phase- All muscles
stiffen, air is being forced out so a groan or cry is heard, person
loses consciousness, may turn blue, and there might be blood due to
biting of the tongue or cheek, -Second Phase: Clonic- the rapid and
rhythmic jerking of the limbs, causes one to relieve themselves
involuntarily, consciousness returns and person maybe drowsy,
depressed or irritated -Can last for 1 to 3 minutes
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Tonic-Clonic (Grand Mal) -affects both adults and children -the
severity of the illness depends on the person (add a little tidbit)
-The only way to truly tell if a person has Tonic-Clonic is through
video EEGs -Special medicines can be used in preventing further
seizures -VNS can help with this type of epilepsy
https://www.youtube.com/watch?v=BvqA3vbNYPc&index=12&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrY-YeWM
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Atonic (Akinetic) -Muscle tone = normal muscle tension -Atonic
means without tone so during a seizure the muscles lose strength.
Akinetic means without movement -Called drop seizures or drop
attacks since they become limp as they fall -Person usually remains
conscious and it lasts < 15 seconds -Begins in childhood and can
last into adulthood -Can be treated by surgery or medicines and
devices - EEGs are used but checking blood pressure and BPM is
needed
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Partial Epilepsy -partial seizures may affect one small part
(simple) of the brain or the whole hemisphere (complex)
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Simple Partial Simple Partial seizures can either be motor or
sensory Motor seizures involve abnormal twitching or stiffening of
the muscles Sensory seizures involve smelling and tasting things
that are not there. Clicking and ringing are the most common
experiences during a sensory seizure but visual hallucinations may
happen as well. Anyone can get them but more likely after a head
injury Lasts no more than 2 mins and the person remains fully
aware
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Complex Partial -start in one specific area (ex. frontal lobe)
and spread to other areas of that hemisphere that can affect
awareness and memory -lasts up to 2 minutes and the person may feel
tired or confused afterwards in extreme cases they may not return
to feeling normal for hours -during the seizure most people start
to lose awareness and smack their lips or do other meaningless
movements
https://www.youtube.com/watch?v=WP4NZcfadIk&index=11&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrY-
YeWM
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Temporal Lobe -most common of partial epilepsy -auras or
warnings often are the first sign (up to one minute long) might
experience hallucinations of people, music, voices, smells or
tastes -most common form of temporal epilepsy is medial -internal
structures of temporal lobe -begins with hippocampus and
surrounding structures -resistant to medications so surgery is the
best way to go -mostly found by an MRI -hippocampal sclerosis is
considered a factor in the development of this type of
epilepsy
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Frontal Lobe Epilepsy -2nd most common form of epilepsy -Lasts
for less than a minute -These are considered partial but the
symptoms vary depending on the area -someone could be experiencing
a tonic-clonic seizure, while someone else could be laughing or cry
or not be able to speak -Often occurs during sleep and can cause
them to unconsciously scream, do bicycle movements et cetera
-Treatment is dependent on what symptoms are exhibited
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Occipital Lobe Epilepsy -Accounts for 5-10 % of epilepsy
syndromes -occurs in both adults and children -Can be either
idiopathic or symptomatic -Begin with visual hallucinations
(flickering, colored light or anything that is related to eyes or
vision -Usually spontaneous but can be triggered by flashing lights
or a repeating pattern -Symptoms: nausea/ vomiting, partial
blindness, eye jerking, pain in the eyes, et cetera
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Parietal Lobe Epilepsy -Considered a rare form of epilepsy
-Occurs at any age and any gender -since this part deals with
touch, sensory information and planned movements, these operations
are affected -Can last for a few seconds and up to a few minutes
-Somatosensory seizures: patients feel numbness, tingling, heat,
pressure and on rare occasions pain. Sometimes they experience
involuntary marching -Somatic illusions: Feel like posture is
abnormal, or that they are missing body parts
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Parietal Lobe Epilepsy -Vertigo: the environment begins to spin
or its their body that is moving -Visual Illusions/ Hallucinations:
objects being too far or too close while other objects appear to be
there but are nonexistent -Language Disturbances: difficulty
understanding words and language, reading and doing basic math
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Treatments Besides the common treatments include:
1.Antiepileptic Drugs 2.Bromides 3.Barbiturates 4.Ketogenic Diet
5.Vagus Nerve Stimulator (VNS) 6.Responsive Neuropace Stimulator
7.Surgery
Slide 43
Anti-epileptic Drugs -There are around 26 AEDs used to treat
seizures, and different AEDs work for different seizures. -There
are around 4 generations of AED, some were mentioned in the
timeline -they help to decrease the severity of the seizures and/or
the frequency of these seizures -They attack the Na channels, Ca 2+
channels as well as enhancing the GABA mechanisms in the body.
Block any repetitive actions which causes inactivity -Examples:
Acetazolamide (partial,tonic-clonic & absence), Phenytoin
(everything but absence)
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Bromides -Sodium Bromide (NaBr) and Potassium Bromide (KBr) -
used as a sedative and anticonvulsant -used until replaced by
barbiturates -still used today but primarily by veterinarians -1st
medical treatment geared toward epilepsy
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Barbiturates (Phenobarbital) -comes from barbituric acid -it
suppresses the activity of the CNS -they enhance the activity of
GABA (inhibitory neurotransmitter) -used to treat all types of
seizures except for absence seizures Used to Treat -Temporal Lobe
Epilepsy -Clonic Seizures, Tonic Seizures and Tonic-clonic Seizures
-Simple Partial Seizures -Et Cetera
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Ketogenic Diet -ketogenic means that it produces ketones in the
body -ketones are what the body uses fat as its source of energy
instead of carbohydrates -successful mostly on children 2-12 with
difficult to control seizures or do not respond to medication -not
a cure justs reduces the chance for a seizure -the ratio of fat to
carbs and protien is 3:1 -the diet is very strict and hard to
follow
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Ketogenic Diet (continued) -the diet is not long term but
typically used for 2 years -mineral supplements are important (ex
calcium and vitamin d to prevent bone thinning) -one of the oldest
treatments
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Vagus Nerve Stimulator sends regular mild pulses of electrical
energy to the brain via the vagus nerve vagus nerve controls
involuntary functions like heart rate passes through neck as it
goes from between chest and abdomen and lower part of brain device
is placed under the skin on chest wire from the stimulator is wound
around the vagus nerve on the left side of neck alternates from
sending signals to resting lasts 5 - 10 years
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Responsive Neuropace Stimulator should be treated for people
who do not respond well to medicine and who cannot have surgery to
remove part of the brain device is placed onto skull when a seizure
is identified then the device tries to stop the seizure activity by
sending an electrical current not a cure just an aid
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Surgery -This option is here because sometimes the seizures
cannot be controlled by medicines -Also, it can reduce the
frequency of some seizures -The earlier a surgery is performed, the
better the outcome -Beneficial to those suffering from epilepsy
induced by brain tumors, strokes or blood vessels degradation
-Every surgery is tailored to the individual -At least single drugs
or 2 combinations must be tried before performing surgery
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Surgery: Types -Resection or resective surgery: removes the
part of the brain that causes the seizure to happen -most common
form is temporal lobectomy -frontal lobectomy -parietal and
occipital lobectomy
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Surgery: Types -Disconnection surgery: the surgeon interrupts
the nerve pathways that allow the seizures to spread -more of a
relief than a cure -Corpus callosotomy: severs the pathway that
seizure can travel on -Multiple subpial transections: great for
when some areas that the seizures begin are too important to remove
-Thermal Ablation: laser surgery which utilizes MRIs in order to
pinpoint where in the brain there will be an operation -has a very
high accuracy rate
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Florence Griffith Joyner (Flo-Jo) -Considered the fastest woman
in the world -suffered from the tonic-clonic form of epilepsy in
1990 -treated for it in 1993 and 1994 -she had a brain abnormality
which caused her to experience these seizures -Cavernous hemangioma
is what she suffered from -This was the malformation of blood
vessels and causes leakage in the brain -She died in 1998 due to
suffocation during an epileptic seizure
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Prince -He was born with epilepsy and suffered throughout his
infancy -These episodes lasted until he was 7 years old -Even
though he grew out of the seizures, the isolation that he felt made
him turn to music -He tried to restrict being flashy in his early
years -He tried to being flashy and loud in his later years in
order to make up for the illness -About of childhood epilepsy
disappears in childhood
https://www.youtube.com/watch?v=agD9qVUVHrI#t=23
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Organizations Organizations provide the tools to raise
awareness for epilepsy and raise money for further research.
http://www.epilepsy.com/ is the largest foundation geared to
helping this disorder but there are others such as
https://www.epilepsyct.com/ http://www.epilepsynewengland.org/
http://www.epilepsy.com/ https://www.epilepsyct.com/
http://www.epilepsynewengland.org/
