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Epilepsy

What you should know about epilepsy

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Epilepsy sufferers typically experience frequent seizures. These seizures are due to a disruption in the brain’s electrical activity, which momentarily disrupts the messaging systems between brain cells.

This article discusses the various forms of epilepsy, including symptoms, options for treatment, and prognoses.

Definition

Epilepsy is defined as “a common brain condition that causes repeated seizures,” by the Centers for Disease Control and Prevention (CDC).

Symptoms

Epilepsy lady
A person with epilepsy may experience short blackouts or confused memory.

Recurrent seizures are the primary symptom of epilepsy. When a person experiences one or more of the following symptoms, however, they should seek medical attention, as epilepsy may indicate:

  • a convulsion with no fever
  • short blackouts or confused memory
  • intermittent fainting spells, during which they lose bowel or bladder control, frequently followed by extreme tiredness
  • temporary unresponsiveness to instructions or questions
  • sudden stiffness for no apparent reason
  • sudden falling for no apparent reason
  • sudden bouts of blinking without apparent stimuli
  • sudden bouts of chewing without any clear reason
  • temporarily seeming dazed and unable to communicate
  • repetitive movements that seem involuntary
  • fearfulness for no apparent reason
  • panic or anger
  • peculiar changes in senses, such as smell, touch, and sound
  • jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies

When any of those symptoms arise regularly, it is important to seek treatment with a doctor.

The following conditions can cause similar symptoms to those mentioned above, and some people can confuse them for epileptic ones:

  • high fever with epilepsy-like symptoms
  • fainting
  • narcolepsy, or recurring episodes of sleep during the day
  • cataplexy, or periods of extreme muscle weakness
  • sleep disorders
  • nightmares
  • panic attacks
  • fugue state, a rare psychiatric condition in which a person forgets details about their identity
  • psychogenic seizures, or seizures with a psychological or psychiatric cause

Treatment

Some types of epilepsy do not actually receive cure.

A doctor can prescribe antiepileptic drugs (AEDs) to help in seizure prevention. If such medications do not function, then some other possible treatments include surgery, stimulation of the vagus nerve, or a special diet.

The goal of doctors is to prevent further seizures. They also seek to prevent side effects so that the individual can have a healthy and active life.

AEDs

According to the American Epilepsy Community, AEDs tend to help control seizures in around 60–70 percent of cases. The type of seizure a person has will determine which drug the doctor prescribes.

People take most AEDs by mouth. Popular epilepsy-treatment medicines include:

  • valproic acid
  • carbamazepine
  • lamotrigine
  • levetiracetam

It is important to remember that certain drugs in one person can prevent seizures but not in another. Also, even when a person finds the right medication, finding the optimal dose may take some time.

Surgery

If at least two medications were ineffective in controlling seizures, a doctor might consider prescribing surgery for epilepsy. A Swedish study in 2013 found that 62 per cent of adults and 50 percent of children with epilepsy had no seizures following epileptic surgery for around 7 years.

Some surgical options, according to the National Institute for Neurological Disorders and Stroke, include:

  • Lobectomy: During this procedure, a surgeon will remove the section of the brain in which seizures start. This is the oldest type of epilepsy surgery.
  • Multiple subpial transection: During this procedure, a surgeon will make several cuts to limit seizures to one part of the brain.
  • Corpus callosotomy: A surgeon will cut the neural connections between the two halves of the brain. This prevents seizures from spreading from one side of the brain to the other.
  • Hemispherectomy: In extreme cases, a surgeon may need to cut out a hemisphere, which is one half of the cerebral cortex of the brain.

Many people may undergo surgery to reduce the frequency and severity of seizures they have. Sometimes however, it is necessary to continue taking antiseizure medication after the procedure for several years.

Another surgical option is to have a device implanted in the chest to stimulate the lower neck vagus nerve. The device sends electrical stimulation preprogrammed into the brain to help reduce seizures.

Diet

Diet may be a part of raising seizures. A research review published in the journal Neurology in 2014 indicated that high-fat, low-carbohydrate diets could support children and adults with epilepsy.

Six of the study experiments used the ketogenic diet, while a further six used a modified version of Atkins. Typical foods in these diets include eggs, bacon, avocados, cheese, nuts, fish, and some vegetables and fruits.

The analysis showed that 32 per cent of research participants adhering to the ketogenic diet and 29 per cent of those adopting the modified Atkins diet reported at least 50 per cent decrease in seizure regularity. Many participants, however, had difficulty sustaining such diets.

Specific diets may be beneficial in some cases, but more research is needed to confirm this.

Causes

Messaging systems control every function in the human body inside the brain. Epilepsy occurs as a result of a disruption in the system that may arise from brain dysfunction.

For certain cases the exact cause would not be clear to health care professionals. Many people inherit genetic factors which are more likely to cause epilepsy. Other factors which may increase the risk include:

  • head trauma, such as from a vehicle accident
  • brain conditions, including stroke and tumors
  • infectious diseases, such as viral encephalitis
  • cysticercosis
  • AIDS
  • prenatal injury or brain damage that occurs before birth
  • developmental conditions, including autism and neurofibromatosis

Epilepsy is most likely to occur in children under 2 years of age, and adults over 65 years of age, according to CDC.

Is epilepsy common?

In 2015, the CDC estimated that about 1.2 percent of the U.S. population was affected by epilepsy. That’s around 3.4 million people including 3 million adults and 470,000 children.

World Health Organization (WHO) reports about 50 million people worldwide are affected by epilepsy.

Types

Occasionally, physicians may determine the cause of a person’s seizures. There are two major categories of seizures that depend on whether they can determine the cause or not:

  • Idiopathic, or cryptogenic: There is no apparent cause, or the doctor cannot pinpoint one.
  • Symptomatic: The doctor knows what the cause is.

There are also three generalized seizure descriptors — partial, generalized, and secondary — depending on which region of the brain the seizure originates in.

The experience of a person during a seizure will depend on the region of the brain affected and how quickly and rapidly the electrical activity in the brain spreads from that initial location.

The sections below deal in more detail with generalized partial, primary, and secondary seizures.

Partial seizure

A partial seizure happens in one part of a person’s brain when the epileptic activity happens. Partial seizure has two subtypes:

  • Simple partial seizure: During this type of seizure, the person is conscious. In most cases, they are also aware of their surroundings, even when the seizure is in progress.
  • Complex partial seizure: During this type, the seizure impairs a person’s consciousness. They will generally not remember the seizure. If they do, their memory of it will be vague.

Generalized seizure

A generalized seizure happens when both halves of the brain are impaired by epileptic activity. Usually the person will lose consciousness while the seizure is in progress.

There are many subtypes of generalized seizure, including: tonic-clonic seizures: Maybe the best-known type of generalized seizure, tonic-clonic seizures cause loss of consciousness, body stiffness, and shaking. Such grand mal seizures have been called by doctors previously.

  • Absence seizures: Previously known as petit mal seizures, these involve short lapses of consciousness wherein the individual appears to be staring off into space. Absence seizures often respond well to treatment.
  • Tonic seizures: In tonic seizures, the muscles become stiff, and the person may fall.
  • Atonic seizures: A loss of muscle tone causes the individual to drop suddenly.
  • Clonic seizures: This subtype causes rhythmic, jerking movements, often in the face or one arm or leg.
  • Myoclonic seizures: This subtype causes the upper body or legs to suddenly jerk or twitch.

Secondary generalized seizure

A secondary generalized seizure happens when the epileptic activity starts as a partial seizure but spreads to both brain halves. The person will lose consciousness as this seizure progresses.

Diagnosis

To diagnose epilepsy, a doctor must review the medical history of an patient and the symptoms they have encountered, including a summary and timeline of past seizures.

They can also ask for testing to assess the severity of epilepsy and the number of seizures the patient has. The doctor will be able to prescribe treatment choices based on these tests, such as antiseizure drugs.

Testing for epilepsy

An EEG can help doctors test for epilepsy.
An EEG can help doctors test for epilepsy.

A doctor can be able to detect epilepsy through different forms of imaging tests. These measures cover:

  • an EEG, to look for abnormal brain waves
  • CT and MRI scans, to detect tumors or other structural irregularities
  • functional MRI scans, which can identify normal and abnormal brain function in specific areas
  • single-photon emission CT scans, which may be able to find the original site of a seizure in the brain
  • a magnetoencephalogram, which can identify irregularities in brain function using magnetic signals. p

The doctor can also use blood testing to determine any problems underlying the epilepsy may be causing. Neurological tests can also help a doctor assess the type of epilepsy the patient has.

Is epilepsy genetic?

Approximately 70–80 percent of cases of epilepsy occur as a result of genetics, according to one 2015 research study.

A 2017 research review related more than 900 genes to epilepsy. As more studies take place, the number continues to rise.

Genes may directly contribute to epilepsy, brain anomalies that may lead to epilepsy, or other seizure-causing genetic conditions.

For certain cases genetic factors are inherited. Nevertheless, in humans without a family history of the disease, other genetic abnormalities can also cause epilepsy.

A doctor might often ask for genetic testing to assess the cause of the epilepsy.

Triggers

Seizures can result from a variety of factors. One research in 2014 reported stress, sleep deprivation and exhaustion among 104 participants as the most frequent triggers. Flickering lights and high alcohol intake also can cause seizures.

Stress is a common cause of seizures but it’s unclear why. This cause was the focus of 2016 study in the journal Science Signaling. The team found that the reaction to stress in the brain worked differently in epileptic rats than in those without.

The study has found that instead the molecule, which normally suppresses brain activity in response to stress, has increased activity. Which can aid in seizures.

Epilepsy vs. seizures

The primary symptom of epilepsy is seizures. In fact, epilepsy is described by Johns Hopkins Medicine as having “two or more unprovoked seizures.” Some people may have a single seizure, or they may have seizures not triggered by epilepsia.

Doctors may also misdiagnose nonepileptic seizures as epilepsy. Nonepileptic seizures however are not caused by irregular electrical activity in the brain. The causes of these may be physical, psychological or emotional.

There are also various forms of epilepsy that can vary among people suffering from epilepsy. For example, in two people with epilepsy the disorder can look different.

For this reason, the CDC describe epilepsy as a spectrum disorder.

Is it a disability?

The Americans with Disabilities Act (ADA) bans discrimination against disabled people, including epilepsy. This applies whether the person is able to use medicine or surgery to treat their seizures or not.

Persons with epilepsy are protected under the ADA by some occupational protections, including the following:

  • Employers may not ask about job applicants’ medical conditions, including epilepsy.
  • Job applicants do not need to inform an employer that they have epilepsy unless they need reasonable accommodation during the application period.
  • Employers may not cancel a job offer if the person can complete the primary functions of the job.

People with epilepsy can be eligible for disability compensation according to the Social Security Administration. This allows people to record the form and frequency of their seizures by taking all the prescribed medications.

Warning devices

Some devices can control seizures and alert caregivers, possibly improving treatment and preventing sudden unexpected epileptic death (SUDEP).

One such multimodality device, the Nightwatch, was compared to an Emfit bed sensor by a small 2018 study involving 28 participants, the findings of which appeared in the journal Neurology. The Nightwatch recorded 85 percent of all serious seizures compared to the bed sensor’s 21 percent. Every 25 nights it also missed only one serious attack.

According to one report in 2017, approximately 70 percent of SUDEP cases occur during sleep. This means that the use of accurate nighttime warning systems may be of potential benefit.

Is it contagious?

All may develop epilepsy but it is not contagious. A research review in 2016 illustrated several misconceptions and stigma about epilepsy, including the false belief that epilepsy would spread amongst people.

The authors of the study note that people with lower rates of education and socioeconomic status had a high rate of misconceptions, as did those who did not encounter any individuals with epilepsy.

As a consequence, therapies and other educational initiatives can be useful in reducing epileptic stigma and improving awareness of the disorder.

Prognosis

Epilepsy will affect a person’s life in several ways and the outlook may depend on various factors.

Sometimes, seizures can be fatal, depending on the circumstances. However, many people with epilepsy use antiseizure drugs to treat their seizures.

The alleged relationship between seizures and brain damage needs to be confirmed by further studies.

Is epilepsy fatal?

Seizures can lead to drowning, falling, car accidents or other fatal injuries. Although it is uncommon, it may also occur at SUDEP.

Cases of SUDEP usually occur during or immediately after a seizure. For instance, the seizure could cause the person to go too long without breathing, or it could lead to heart failure.

SUDEP’s exact cause is unknown but a 2018 animal study indicated that it could be explained by acid reflux.

SUDEP did not occur in the rats which the researchers examined after blocking acid from entering the esophagus. However, it’s not obvious if this has any significance to humans.

Individuals are at higher risk of SUDEP if they have had epilepsy for several years, or if they have frequent seizures, according to the CDC. Following those steps can help to reduce SUDEP’s risk:

  • taking all doses of antiseizure medication
  • limiting alcohol intake
  • getting sufficient sleep

Taking the prescribed medication daily can also help avoid epileptic status, a disorder in which seizures last longer than 5 minutes.

A research carried out in 2016 showed that treating the epileptic condition within 30 minutes decreased the risk of death.

Will seizures continue?

A research review in the Brain journal in 2013 found that 65–85 percent of people may experience long-term seizure remission.

Nevertheless, seizures with an apparent cause are more likely to occur.

Other factors which affect remission chances include:

  • access to treatment
  • response to treatment
  • other health conditions a person may have

The majority of people with epilepsy will be able to control their seizures with the proper use of antiseizure drugs.

Can epilepsy lead to brain damage?

Research into whether seizures can cause brain damage or not has provided mixed findings.

A 2018 study examined at postoperative brain tissue from people with recurrent seizures. The authors identified no signs of brain damage in people with other forms of epilepsy.

Several other studies, however, have indicated that serious, long-lasting seizures may cause brain injury. For example, one study in 2013 showed that seizures may lead to anomalies in the brain, with epileptic status causing permanent brain lesions.

Many studies have explored cognitive changes in children as they mature, with or without epilepsy. Results suggest that epilepsy is associated with worse cognitive outcomes.

However, it is unclear whether:

  • epilepsy causes the impairment
  • a similar structural change causes both epilepsy and the impairment
  • antiepileptic drugs have an effect

This is an area that needs further research.

Other effects

Epilepsy can affect various aspects of a person’s life, including their:

  • emotions and behavior
  • social development and interaction
  • ability to study and work

The scale of impact on these areas of life will depend largely on the frequency and severity of their seizures.

Life expectancy of people with epilepsy

Researchers from Oxford University and University College London, both in the UK, reported in 2013 that people with epilepsy are 11 times more likely to suffer premature death than those without it.

When the individual also has a mental health disorder, the risk tends to be greater. Suicide, injuries, and attacks were responsible for 15.8 percent of early deaths. Most individuals affected by these have had been diagnosed with a disease of mental wellbeing.

Lead researcher Seena Fazel says, “Our findings have important public health consequences, as about 70 million people worldwide have epilepsy, and they emphasize that actively identifying and treating psychiatric conditions as part of routine tests in [people] with epilepsy may help to minimize the risk of premature death in these patients.”

“Our study,” he adds, “also highlights the importance of suicide and nonvehicle accidents as major preventable causes of death in people with epilepsy.”

Risk factors

Several factors may have correlations with an increased risk of epilepsy. Such factors include, according to a research review in the journal NeuroToxicology in 2017,:

  • age, with new cases occurring more frequently in young children and older adults
  • brain injuries and tumors
  • genetics and family history
  • alcohol consumption
  • perinatal factors, such as stroke and preterm birth
  • central nervous system infections, such as bacterial meningitis, viral encephalitis, and neurocysticercosis

Some risk factors, such as alcohol intake, can be changed when attempting to prevent epilepsy from developing.

Is it curable?

There is currently no treatment for epilepsy but it is generally possible for people with the condition to control their symptoms.

According to the WHO, antiseizure drugs will reduce their seizure frequency and severity by up to 70 percent in people with epilepsy. After 2 years without a stroke, about half of all people with epilepsy will be able to avoid taking medicine.

In certain cases, surgery can also minimize or remove seizures where there is ineffectiveness of medications.

That can have benefits in the long term. In one study in 2018, 47 percent of participants reported no serious seizures 5 years after surgery, and after 10 years 38 percent reported the same.

Prevention

The WHO states that nearly 25 percent of cases of epilepsy are preventable. By following those steps, people can reduce the risk of developing epilepsy:

  • wearing a helmet when riding a bicycle or motorcycle, to help prevent head injuries
  • seeking perinatal care, to prevent epilepsy from birth injuries
  • managing risk factors for stroke and heart disease, which could cause brain damage that results in epilepsy
  • practicing good hygiene and preventative methods to avoid cysticercosis, an infection that is the most common cause of epilepsy around the world, according to the CDC.

A 2015 research review in the journal Seizure also indicated that routine physical activity could help prevent epilepsy development and that how often seizures occur.

Most forms of epilepsy are not preventable. Taking the above measures can however help to reduce the risk.

Complications

Seizures can result in negative outcomes, such as drowning or vehicle accidents, depending on the situation. Long lasting seizures, or epileptic status, can also result in brain injury or death.

Those with epilepsy are eight times more likely to suffer many other health disorders like dementia, migraine, heart disease and depression than those without it. Any of those conditions may even trigger seizures.

Many problems can occur because of the side effects of antiseizure drugs. For example, one study in 2015 showed that 9.98 per cent of people taking the lamotrigine (Lamictal) antiseizure drug developed a skin rash.

Many AEDs, like phenytoin (Dilantin) and phenobarbital, can also cause rash. The rash normally vanishes as soon as the person stops taking the medicine. However, 0.8 percent of adults –1.3 percent developed a severe rash that could be fatal.

Question:

Does a person with epilepsy typically experience one type of seizure, or multiple types?

Answer :

Most people who have epilepsy will experience only one type of seizure. However, some people with epilepsy experience more than one type of seizure — especially those who have seizures caused by epilepsy syndromes, which usually begin during childhood. Heidi Moawad, M.D.

Answers represent our medical experts’ opinions. All material is purely informational and the medical advice should not be considered.

Epilepsy

What to know about epilepsy and pregnancy:

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During pregnancy, people with epilepsy may have various symptoms. While some symptoms, such as hormonal changes and increased stress, are uncommon, they can be managed with the right medical care.

According to the Centers for Disease Control and Prevention (CDC), epilepsy affects around 3.4 million people in the United States. According to researchers, the majority of cases of the disease are caused by hereditary factors. There are, however, a variety of therapies available to help patients manage their epilepsy.

Individuals who have epilepsy and become pregnant should seek medical advice. They can have a healthy pregnancy and birth if they are given the necessary care.

Continue reading to learn more about epilepsy and pregnancy.

Epilepsy and conception 

Epilepsy and conception

There is no evidence that epilepsy makes it more difficult to conceive. Women with and without epilepsy who were trying to conceive were compared in a 2016 studyTrusted Source, and the researchers observed no difference in conception time between the two groups.

Another study published in 2016 in the journal Neurology looked at conception and pregnancy in women with and without epilepsy. There were no significant differences between the two groups, according to the study.

People with epilepsy who want to get pregnant should contact with their doctor for more information.

Epilepsy in a pregnant woman

Those who have epilepsy may have additional health issues during pregnancy. People with the syndrome may have more seizures during pregnancy in various circumstances because:

  • Changes in weight can have an impact on how the body reacts to drugs.
  • Seizures can be triggered by elevated stress levels.
  • Seizures can be exacerbated by hormonal changes.

This is, however, a rare occurrence. Approximately two-thirds of epilepsy people do not have more seizures during pregnancy.

However, it is critical to have regular check-ups with a medical practitioner; regular doctor’s appointments can help lower the risk of seizures.

Drugs and medicines for epilepsy

To treat epilepsy symptoms, a variety of medications are available. The following are some of the most commonly prescribed antiepileptic medications (AEDs):

  • phenytoin
  • phenobarbital
  • valproic acid
  • lamotrigine

Various AEDs have been connected by health professionals to certain hazards during pregnancy. Some AEDs, for example, can raise the risk of neurodevelopmental problems.

These dangers, however, are uncommon. As a result, doctors advise that people with epilepsy continue to take AEDs while pregnant.

People with epilepsy should also take folic acid during pregnancy, according to medical experts. For those with the condition, this supplement can lessen the risk of some congenital impairments by up to 86 percent.

Before making any modifications to their AEDs, people with epilepsy should visit their doctor.

Prenatal care

During pregnancy, people with epilepsy require specialized care. These people should be looked after in the following areas.

Counseling and education

During prenatal checkups, individuals with epilepsy should consult a specialised care team. An OBGYN, midwife, neurologist, and mental health counselor could be part of this team.

People with epilepsy can benefit from quality education to help them have a safe and successful pregnancy. Counselors can also assist in keeping track of stress patterns in order to lessen seizure risk.

Checkups on a regular basis

Over 95% of epilepsy-affected pregnant people have a healthy delivery. There is, nevertheless, a tiny risk of certain problems.

Individuals with epilepsy should undergo regular check-ups during pregnancy to avoid this risk. Medical professionals can keep an eye on the fetus to ensure that it develops normally.

Consistent checkups with a solid medical team, like with any pregnancy, are essential.

How to get ready

Education is the most effective strategy for people with epilepsy to prepare for pregnancy. Learning about risk factors, according to the Epilepsy Foundation, is the first step toward managing them.

Individuals should speak with their doctors about how to use AEDs. Take the smallest dosage of AED required to control symptoms, according to healthcare professionals. AED levels in the blood can also be monitored by doctors throughout and after pregnancy.

People with epilepsy should consume a well-balanced diet and keep their stress levels low throughout pregnancy. These tips can assist you in having a healthy pregnancy.

Parental and baby considerations

Being a parent or caregiver with epilepsy can be daunting, and many people worry that their condition will negatively affect their children.

According to studies, parents of children with epilepsy have many of the same concerns. They may be concerned about:

  • not been able to care for their child due to a seizure.
  • as a parent, not being able to achieve their own standards
  • being in need of greater assistance and support than other parents

It is not simple to become a parent or caregiver. Before and throughout pregnancy, all people, regardless of their health, have comparable worries.

Individuals suffering with epilepsy may find solace in devising strategies to address their issues. They may, for example, establish or start a support group for people who have similar concerns, or they could keep a list of phone contacts on hand for case they need a helping hand.

Anxiety and apprehension are common emotions you experience as a parent. While people with epilepsy may have additional concerns, both the parent or caregiver and the newborn can thrive with the correct information and support network.

Delivery and labor

The great majority of epileptic people have a normal labor and delivery experience. For many of these people, the most terrifying aspect of childbirth is experiencing a seizure.

According to studies, 98 percent of people with epilepsy do not have a seizure during delivery. The chance of major problems during labor, on the other hand, is normally low.

Individuals who have epilepsy should, of course, take extra measures when planning their labor and delivery. These can include the following:

  • selecting a medical center that is suited to treat epileptic patients
  • collaborating with a skilled team of medical experts
  • reducing the number of stressors in the delivery room

Making a birth plan can also help to reduce the stress and worry that comes with giving birth. Furthermore, adequate knowledge and support are essential for a healthy labor and delivery experience.

Breastfeeding and postpartum care

Parents with epilepsy may be concerned that nursing will affect their children. AED people can be concerned that their medication would hurt their children.

However, studies have shown that most AEDs are safe to use while nursing. As a result, doctors advise that people who are on AEDs continue to nurse.

Breastfeeding can also aid in the parent-child bonding process. Breastfeeding enhances infant nutrition and the immune system, hence medical specialists advise people with epilepsy to do so if at all possible.

Individuals with epilepsy, in particular, require important postnatal care. It could include the following:

  • analyzing stress levels
  • finding nighttime support to ensure good sleep
  • regular blood tests to check medication levels
  • screening for postpartum depression

Many new parents and caregivers may be concerned about the risks associated with epilepsy. Working with a postnatal care team to alleviate these worries and improve parent and child health is critical.

Conclusion

Certain dangers may exist for epileptic people before, during, and after pregnancy. They can, however, have a healthy labor and delivery with the correct planning and support.

People who have epilepsy should talk to their doctors during their pregnancy. Counseling and education are crucial in their quest to become parents.

People with the condition can have a positive and healthy pregnancy with the right medical treatment and support.

Sources:

  • https://www.epilepsy.com/living-epilepsy/women/epilepsy-and-pregnancy/after-baby-born
  • https://www.racgp.org.au/afp/2014/march/epilepsy-in-pregnancy/
  • https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg68_epilepsy.pdf
  • https://n.neurology.org/content/86/16_Supplement/I5.001
  • https://www.medicalnewstoday.com/articles/epilepsy-and-pregnancy
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4455853/pdf/ndt-11-1291.pdf
  • https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-015-0214-7
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784252/pdf/10.1177_1756285615623934.pdf
  • https://jamanetwork.com/journals/jamaneurology/fullarticle/2679319
  • https://www.epilepsy.com/living-epilepsy/epilepsy-and/women/epilepsy-and-pregnancy/risks-during-pregnancy
  • https://www.epilepsy.com/learn/triggers-seizures/stress-and-epilepsy
  • https://www.sciencedirect.com/science/article/pii/S1059131115000485
  • https://www.ilae.org/files/ilaeGuideline/ManagementOfEpilepsyInPregnancy-Tomson-epi.16395.pdf
  • https://www.seizure-journal.com/article/S1059-1311(15)00041-2/fulltext

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Cardiovascular / Cardiology

A new study finds hypertension increases epilepsy risk by 2.5 times

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high blood pressure check
High blood pressure may increase the risk of epilepsy, new research shows.
  • Researchers looked into hypertension and epilepsy.
  • Antihypertensive drugs reduce the risk of epilepsy by roughly 2.5 times.
  • Researchers need to do more research to understand how elevated blood pressure affects epilepsy.

After stroke and dementia, epilepsy is the third most frequent neurological condition that affects the elderly.

Late-onset epilepsy has become increasingly common in the previous two decades, according to research. As the population ages, the number of people suffering from epilepsy is projected to climb, and epilepsy will likely become a major public health condition.

Despite this, the fundamental causes of epilepsy are unknown in 32–48% of patients. According to some evidence, vascular risk factors may raise the likelihood of late-onset epilepsy. Other research suggests that vascular risk factors play a role in epilepsy in people in their 30s.

Understanding the significance of vascular risk factors in late-onset epilepsy could aid policymakers in developing public health initiatives and prevention efforts to reduce and manage the condition’s prevalence.

Researchers from Boston University School of Medicine in the United States recently undertook a study to look at the link between vascular risk factors and epilepsy onset.

They discovered that hypertension was linked to a nearly 2-fold increased incidence of late-onset epilepsy. This risk was even higher for people who did not take blood pressure medication to control it.

The research was published in the journal Epilepsia.

Analyzing data

The Framingham Heart Study (FHS), a community-based study that began in 1948, was utilised by the researchers. Its Offspring Cohort follows the health results of 5,124 of the initial participants’ offspring over the course of four years, based on health examinations.

The researchers collected data from 2,986 people who had their fifth assessment between 1991 and 1995, were at least 45 years old at the time, and had vascular risk factor data in their health records.

Systolic and diastolic blood pressure were among the vascular risk indicators gathered. High blood pressure was defined by the researchers as a systolic blood pressure of 140 mm Hg or higher, and a diastolic blood pressure of 90 mm Hg or higher, as well as the usage of antihypertensive drugs.

In addition, the researchers looked for:

  • diabetes
  • cholesterol levels
  • smoking status
  • cardiovascular disease
  • stroke
  • body mass index (BMI)

The researchers employed routine record checks for neurological diseases, self-reported seizures, International Classification of Diseases Ninth Revision (ICD-9) codes linked to epilepsy or seizures, and antiepileptic drug use to screen subjects for epilepsy or seizures.

To determine cases of epilepsy, the researchers used brain imaging and electroencephalography (EEG), as well as cardiac and other pertinent data.

The study found 55 cases of epilepsy in the group, with 26 cases being confirmed, 15 being probable, and 14 being suspected. At the time of potential diagnosis, the participants were on average 73.8 years old.

Hypertension was linked to a nearly 2-fold increased incidence of epilepsy, according to the study. The other risk factors, on the other hand, had no link to epilepsy.

After removing antihypertensive drugs out of the equation, the researchers discovered that high blood pressure was linked to a 2.44-fold increased risk of having epilepsy.

They also discovered that every 10 mm Hg increase in systolic blood pressure was linked to a 17 percent increased incidence of epilepsy.

Mechanisms at work

The association between epilepsy and hypertension could be explained by a number of explanations. The renin-angiotensin system (RAS), which regulates blood pressure, could be one way.

According to studies, rats with repeated seizures had 2.6–8.2 times the components of RAS as mice without seizures. Antihypertensive medications that reduced RAS component levels slowed the onset of seizures and reduced seizure frequency.

More research is needed, however, to determine how much this mechanism explains the link between epilepsy and hypertension, as other research suggests the system may only have a minor impact.

Small vessel disease (SVD), a condition in which the walls of small arteries and capillaries are damaged and consequently do not supply enough oxygen-rich blood to numerous organs, is another likely underlying mechanism, according to the researchers. Scientists discovered that the duration of high blood pressure is a powerful predictor of SVD later in life in a recent study.

SVD has been linked to temporal lobe epilepsy, according to the study. Cortical microinfarcts, minor lesions in cortical tissue, and the disruption of U fibers, which can contribute to excessive excitability and seizures, are all possible explanations. U fibers connect the cerebral cortex’s surrounding sections.

According to the researchers, hypertension is an independent predictor of late-onset epilepsy, with a 2-fold risk of seizures after 45 years.

They do acknowledge, however, that their research has limitations. It is possible that it does not reflect all ethnicities and races because it largely comprised white participants. The researchers also point out that because it is an observational study, it cannot show causation.

Dr. Jason Hauptman, a neurosurgeon at Seattle Children’s Hospital, told Medical News Today, “These results are particularly interesting because whether or not high blood pressure (hypertension) in and of itself is an independent risk factor for stroke has been a topic of controversy,”.  “The thought is that independent of the presence of stroke, hypertension may lead to disease of small arteries throughout the brain that can cause injuries on the microscopic level.”

“These injuries could potentially lead to epilepsy with or without the presence of a visible or symptomatic stroke. This research is important because hypertension is not only common, but it is modifiable – that is, we may have ways of assessing and treating it. This would need to be pursued in larger, more diverse patient populations to fully assess exactly how much this is a risk factor and to test the potential interventions,” he stated.

Sanjay Prasad, M.D., a cardiologist at Mayo Clinic Healthcare in London who was not involved in the study, told MNT that the findings were not surprising and that they matched earlier findings.

“This work is observational, so does not confirm that there is a definite direct link. However, it builds on our knowledge base and highlights the importance of lifestyle, regular exercise, and a low salt intake to control blood pressure as an important way of reducing morbidity,” he noted.

“[These results highlight] the need for aggressive control of blood pressure — and encourage everyone —particularly those above the age of 50, to regularly monitor their blood pressure. We also need to assess the impact of blood pressure control in those with epilepsy and after a stroke.”

– Dr. Prasad

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Biology / Biochemistry

How can individuals tell if they’re having a seizure?

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Seizures are caused by an abnormal surge of electrical activity in the brain. Seizures can be random, but some people have triggers that might cause them. Being aware of possible triggers can assist to reduce the likelihood of experiencing them.

Seizures are sudden, brief changes in movement, behavior, sensation, or states of consciousness caused by aberrant electrical discharges in the brain. Seizure symptoms range depending on which parts of the brain are affected and how severe they are.

Seizures are classified by the International League Against Epilepsy (ILAE) depending on the kind of onset or where they begin in the brain.

Seizures can be caused by a variety of factors, including genetics, brain damage, or underlying illnesses. Seizure triggers do not cause seizures, but they can cause them in people who are prone to them.

Stress, fatigue, and the lack of medications are all typical factors. Knowing what might cause seizures and how to avoid them will help you avoid them.

In this post, we will look at some of the most frequent seizure triggers, the distinction between causes and triggers, and how to detect probable triggers.

Common triggers

Epileptic Patient

Some people with epilepsy, especially those who have experienced recurring seizures, may observe that they happen in predictable patterns or in certain people. These variables, often known as seizure triggers, may increase the likelihood of seizures. Some people with epilepsy, on the other hand, may not have any triggers. Seizures can be triggered by a variety of triggers, including:

Missed medications

Anti-epileptic medications must be taken on a regular basis to maintain a constant amount of medication in the body. A person’s risk of seizures increases if they miss a dosage, and seizures become more severe or occur more frequently as a result.

If you don’t take them as directed, you might develop status epilepticus, a long-term seizure that doctors consider a medical emergency.

Sleep deprivation and tiredness

According to a 2020 research, seizures and sleep have a bidirectional link, with seizures causing sleep deprivation and sleep deprivation triggering seizures. During typical sleep-wake cycles, changes in the brain’s electrical and hormonal activity occur, which may contribute to seizures and affect their intensity and length.

Stress

Seizures are frequently triggered by stress. However, the actual nature of their relationship remains unknown. Everyone reacts to stress differently, and stress can take many forms. A person may get stressed as a result of big life events or a pile of everyday annoyances.

Stress may have a physical impact on the body, resulting in a loss of sleep, a shift in dietary habits, and the use of alcohol or other substances, all of which can lead to seizures.

Alcohol

Small quantities of alcohol are unlikely to cause seizures. Even for people who do not have epilepsy, consuming an excessive amount of alcohol in a short period of time might trigger a seizure.

When the effects of alcohol on the body start to wear off, alcohol-related seizures become more likely. They can happen anywhere between 6 and 72 hours after drinking. Alcohol can also impair sleep and interfere with medicines, raising the chance of a seizure.

Flashing lights

Flashing lights or contrasting patterns might trigger a seizure in people with photosensitive epilepsy. Photosensitive seizures affect only around 3% of epilepsy people. This variety appears to be more frequent in females and younger people, according to evidence.

Nutrition and deficiencies

If a diabetic suffers from severe hypoglycemia, which can develop as a result of missing meals, their extremely low blood sugar levels might trigger a seizure.

Vitamin and mineral deficits can also cause seizures in certain people. Vitamin B6 deficiency can trigger seizures in newborns, however it is less prevalent in adults. Mineral imbalances, such as calcium, sodium, potassium, and magnesium, can cause seizures by altering brain cell electrical activity.

Infection and illness

Seizures might be triggered by illness in certain people. This might be caused by the illness’s physical impact on the body, a lack of sleep, bad dietary habits, certain drugs, or dehydration.

Seizures are frequently caused by a viral infection of the central nervous system. Seizures can be triggered by common ailments like sinus infections or a cold in rare cases.

Menstruation

Catamenial epilepsy is a kind of epilepsy in which seizures become worse or more common during specific people of the menstrual cycle. This is extremely uncommon, and research shows that it is caused by variations in progesterone and estrogen levels.

Weather

According to a 2017 research, low pressure and excessive humidity might trigger seizures. Although there isn’t conclusive evidence that weather has an influence on seizure risk.

Seizures are more common in the winter, according to a 2018 research. However, according to a survey conducted by the Epilepsy Society, extreme heat can provoke breakthrough episodes in well-controlled seizures and make uncontrolled seizures more severe and intense. This suggests that extremes in temperature might produce physiological changes that lead to seizures.

Certain medications

Seizures may be triggered by several over-the-counter drugs. Antidepressants, stimulants, tramadol, and isoniazid are among the drugs that have been linked to seizures in certain people, according to a 2016 research.

Triggers vs. causes

The cause of epilepsy is unknown in two out of every three people . It can, however, be caused by genetic problems or brain ailments including stroke, traumatic brain damage, infections, or other neurological diseases.

Although a seizure can be triggered by a trigger, seizure triggers are not the same as seizure causes. A stressful circumstance, for example, might provoke a seizure, but the underlying cause of the seizure could be brain structural damage.

Because seizures are unpredictable, it may be difficult to figure out why they happen, and some people mistakenly believe that triggers like exhaustion are to blame. However, it’s more likely that the person was already predisposed, and the trigger just triggered a seizure in someone who was already vulnerable.

Reflex seizures

Seizures are typically unpredictable and can happen at any time. While some people may identify triggers, many people’s triggers are more general, such as stress or exhaustion. Other people, on the other hand, may have reflex seizures, which are seizures that occur on a regular basis as a result of particular and recognizable stimuli or cognitive processes.

Potential stimuli, such as seeing flashing lights or touching hot water, or interior stimuli, such as feeling particular emotions or going through specific mental processes, can all cause reflex seizures. This is quite uncommon.

How to Recognize Triggers

Identification of a person’s particular seizure triggers can be challenging and time-consuming. A seizure diary can be kept to record actions or events that lead up to a seizure. Over time, a pattern may emerge, exposing likely seizure triggers.

A person should try to manage their condition and prevent or decrease exposure to potential triggers while seeking to identify likely triggers. People can attempt the following suggestions:

  • taking medication as their doctor prescribes
  • getting enough and regular sleep
  • lowering stress

Conclusion

Stimuli that can induce a seizure in some people are known as seizure triggers. Individual triggers vary, but common ones include illness, tiredness, alcohol, and a lack of medication.

Triggers are not the same as causes. Seizures are frequently caused by underlying conditions, whereas triggers simply cause seizures in people who are already predisposed to them.

People may find it difficult to identify their own specific triggers, but maintaining a journal of possible triggers and avoiding certain stimuli may help prevent seizures.

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