Epilepsy

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Alternative names: Seizure disorder 

Definition: Epilepsy is a brain disorder involving repeated seizures of any type.

Seizure disorders affect about 0.5% of the population. Approximately 1.5-5.0% of the population may have a seizure in their lifetime. Epilepsy can affect people of any age.

Risk factors include a family history of epilepsy, head injury, or other condition that causes damage to the brain.

Symptoms

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions.

The diagnosis of epilepsy and seizure disorders requires a history of recurrent seizures of any type. A physical examination (including a detailed neuromuscular examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

An electroencephalograph (EEG), a reading of the electrical activity in the brain, may confirm the presence of various types of seizures. It may, in some cases, indicate the location of the lesion causing the seizure. EEGs can often be normal in between seizures, so it may be necessary to do prolonged EEG monitoring.

Tests may include various blood tests to rule out other temporary and reversible causes of seizures, including: CBC, Blood chemistry, Blood glucose, Liver function tests, Kidney function tests, Tests for infectious diseases, CSF (cerebrospinal fluid) analysis. Tests for the cause and location of the problem may include: Head CT or MRI scan and Lumbar puncture (spinal tap)

Treatment

Anti-convulsants (medications) taken by mouth may reduce the number of future seizures. How well medicine works depends on each individual’s response to the drug. The type of medicine used depends on seizure type, and dosage may need to be adjusted from time to time. Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.

Epilepsy that does not respond to the use of several medications is called refractory epilepsy. Certain people with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. Others may be helped with a vagal nerve stimulator, which is implanted in the chest. This stimulator can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most one is the ketogenic diet.

Patients should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.