Epilepsy: What Is It?

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Epilepsy: What Is It?
Epilepsy: What Is It?
Video: Epilepsy: What Is It?
Video: What is Epilepsy? 2023, February
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Epilepsy: what is it?

Most of the time, an attack is associated with twitching and loss of consciousness. But the appearance is much more diverse. Disturbances of consciousness, movements, perceptions, thinking or behavior occur, among other things. Epilepsies are a common neurological disease and can be treated with drugs. If this does not result in freedom from seizures, there are further therapy options. These range from surgical removal of the affected brain area to nerve or brain stimulation.

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  • Epilepsy is not uncommon
  • Provoked and unprovoked seizures
  • Definition of epilepsy
  • Forms of epileptic seizures
  • Causes of Epilepsy

Epilepsy is not uncommon

Epileptic seizures and epilepsies occur equally frequently in all peoples, cultures and social classes. Many prominent personalities, for example Napoleon, Charles Dickens or Vincent van Gogh, suffered from epilepsy. Five to ten percent of all people will have an epileptic seizure at least once in their life. The likelihood of developing epilepsy in the course of life is over five percent. It is estimated that there are currently 65,000 people suffering from epilepsy in Austria. Epilepsy is one of the most common neurological diseases.The incidence rate as a function of age (age-dependent incidence) shows a two-peak course with a first maximum in childhood (one third of epilepsy begins in childhood) and a second maximum in old age (one third of epilepsy begins after the age of 60). In fact, more people develop epilepsy for the first time at the age of over 70 than in the first ten years of life, ie it is not uncommon for new epilepsy to occur in old age.

Provoked and unprovoked seizures

Epileptic seizures can occur as provoked or acutely symptomatic seizures, as well as unprovoked seizures.

  • Provoked or acutely symptomatic seizures: Provoked or acutely symptomatic seizures are caused by a recognizable, immediate trigger, e.g. a brain disease (inflammation of the brain, brain injury, stroke, etc.) or arise as part of a general disease or disorder (e.g. alcohol / drug withdrawal, Sleep deprivation, hypoglycaemia, high fever). These seizures have a favorable prognosis. If the triggering cause is rectified, eliminated or avoided, no further seizures generally occur. Therefore, in most cases, no drug therapy has to be started here.
  • Unprovoked seizures: In the case of unprovoked seizures, no immediate trigger for the seizures can be determined. Risk factors for the occurrence of further seizures are the presence of epilepsy-typical changes in the EEG and the presence of a change in the magnetic resonance tomography that caused the attacks.

Definition of epilepsy

One speaks of epilepsy if

  • an unprovoked seizure has occurred and the EEG shows changes typical of epilepsy and / or magnetic resonance imaging shows a change that caused the seizures, or
  • You have had at least two unprovoked seizures.

In these cases, there is a very high risk of further seizures occurring, so that in this case the indication for long-term medical therapy with seizure-suppressing drugs, so-called anti-epileptics, is present.

Forms of epileptic seizures

The symptoms of an epileptic seizure depend on the function of the affected brain area. Epileptic seizures can therefore look very different.

Focal seizures

Approx. 2/3 of the seizures occur in a more or less circumscribed place on one side of the brain and are therefore referred to as focal seizures. The following phenomena can occur:

  • Auras. Changes in perception, such as a strange rising feeling from the stomach area (epigastric aura), unfounded feeling of fear (emotional auras), feeling of familiarity or foreignness (déja vu or jamais vu), changed sensory perceptions of seeing (visual auras), hearing (auditory auras)), Smell (olfactory auras) or taste (gustatory auras), tingling or abnormal sensations in a part of the body (somatosensory aura)
  • focal motor seizures. Jerks or spasms of the face, arms, or legs while conscious (twitches - focal clonic seizures; spasms - focal tonic seizures)
  • dyscognitive seizures. Limitation of consciousness combined with decreased or no responsiveness or ability to react. Sometimes strange behaviors such as nestling, smacking, swallowing, chewing movements (automatisms), of which the person concerned does not notice anything.
  • hypermotor seizures. Wild thrashing and screaming with a sudden beginning and ending.

When the epileptic discharges spread to the other hemisphere of the brain, focal seizures can also develop into bilateral convulsive seizures (with tonic, clonic, or tonic and clonic components).

Generalized seizures

About 1/3 of the seizures are generalized seizures. The epileptic activity records nerve cell associations in both hemispheres at the same time from the start. These seizures can also look very different:

  • generalized tonic-clonic (convulsive) seizures. They are characterized by loss of consciousness, falling, cramping all over the body, twitching of the arms and legs for a period of one to two minutes and a subsequent state of exhaustion or confusion. These seizures can also result in a bite of the tongue or cheek, loss of urine and subsequent headache and muscle pain - similar to sore muscles.
  • Absence. They express themselves in a short absence lasting only a few seconds with motionless staring in front of you, sometimes with eyelid flutter.
  • myoclonic seizures. They consist of a brief twitch of the arms, less often of the legs or face - as if one were frightened.
  • tonic seizures. They are characterized by brief cramps in the arms, legs, face and trunk that last a few seconds. These seizures often lead to falls with corresponding injuries.
  • atonic seizures. They cause a brief loss of muscle tension, which can also lead to a fall.

Unclassifiable seizures (e.g. newborn seizures) cannot be assigned to any scheme.

Causes of Epilepsy

Epileptic seizures can have different causes. The nerve cells in the brain normally discharge in a synchronized manner - that is, in a coordinated manner. This coordination does not work in epileptic seizures. For more information on the healthy transmission of nerve impulses, see Neurotransmitters - messenger substances in the brain.

A distinction is made according to the cause:

  • genetic epilepsies,
  • Epilepsies due to structural or metabolic causes and
  • Epilepsies of unknown cause.

Genetic epilepsies

These epilepsies have an inherited tendency to have epileptic seizures. That is, the seizures are caused by one (or more) known or suspected genetic defects. In some, albeit rare, forms of epilepsy, the underlying genetic defect has already been clarified. Most types of genetic epilepsy are likely to be caused by multiple simultaneous genetic defects that are currently unknown.

Epilepsies due to structural or metabolic causes

Different brain diseases or damage can cause epilepsy. These include, for example:

  • Developmental disorders of the cerebral cortex during embryonic development (malformations of cortical development),
  • Birth defects,
  • complicated febrile seizures,
  • Inflammation of the brain
  • Brain injuries,
  • Tumors,
  • Strokes or
  • Metabolic diseases.

In particular, scar formation in the temporal lobe (mesial temporal lobe sclerosis) and developmental disorders of the cerebral cortex (focal cortical dysplasia) that develop in the womb are common causes of epilepsies. In these forms of epilepsy, too, genetic factors play a role in the manifestation of the disease. Ultimately, in many cases there is a combination of genetic and structural or metabolic causes.

Epilepsies of unknown cause

In some cases, despite all diagnostic efforts, a definitive cause of the epilepsy cannot be found. One then speaks of epilepsy of unknown cause.

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