Epilepsy – Causes, Symptoms, Diagnosis & Treatment

 

Introduction:

*Epilepsy* is a *neurological disorder* marked by *recurrent, unprovoked seizures* caused by abnormal electrical activity in the brain. It affects people of all ages and can result from genetics, brain injury, infections, or unknown causes. With proper diagnosis and treatment, most people with epilepsy can lead normal lives.

Pathophysiology:

Seizures occur when there is a *sudden, excessive, and synchronous discharge of neurons* in the brain. This abnormal activity can be *focal* (originating in one part) or *generalized* (involving both hemispheres).

- *Excitatory neurotransmission (glutamate)* ↑  

- *Inhibitory neurotransmission (GABA)* ↓  

- Imbalance → Hyperexcitability of neurons → Seizures

Types of Seizures:

1. *Focal (Partial) Seizures*

   - *Simple Partial:* Consciousness preserved  

   - *Complex Partial:* Altered consciousness  

2. *Generalized Seizures*

   - *Tonic-Clonic (Grand Mal)*

- *Absence (Petit Mal)*  

   - *Myoclonic, Tonic, Atonic*

Symptoms and Signs:

- *Convulsions* (uncontrolled shaking)  

- *Loss of consciousness or awareness*  

- *Staring spells* (in absence seizures)  

- *Jerking movements of arms/legs*  

- *Confusion after the episode*  

- *Aura* (warning symptoms like smells or feelings)

Diagnosis:

- *Clinical History* – Type, duration, frequency of seizures  

- *EEG (Electroencephalogram)* – Detects abnormal brain activity  

- *MRI or CT Scan* – To identify structural abnormalities  

- *Blood tests* – Rule out infections, metabolic issues  

- *Video EEG monitoring* – In complex or unclear cases

Treatment:

*Goals:*  

- Control seizures  

- Minimize side effects  

- Improve quality of life  

Anti-Epileptic Drugs (AEDs):

*1. Sodium Valproate (Epival, Depakine)*  

- *Use:* Generalized & focal seizures  

- *Dose:* 10–15 mg/kg/day → Max 60 mg/kg/day  

- *Side Effects:* Weight gain, liver toxicity, tremor, hair loss  

- *Avoid in pregnancy* (teratogenic)

*2. Carbamazepine (Tegretol)*  

- *Use:* Focal seizures  

- *Dose:* 200–1200 mg/day in divided doses  

- *Side Effects:* Drowsiness, rash, hyponatremia, blood dyscrasias

*3. Phenytoin (Dilantin)*  

- *Use:* Generalized tonic-clonic seizures  

- *Dose:* 4–7 mg/kg/day  

- *Side Effects:* Gum hyperplasia, ataxia, hirsutism, rash

*4. Levetiracetam (Keppra)*  

- *Use:* Broad-spectrum AED  

- *Dose:* 500–3000 mg/day  

- *Side Effects:* Mood changes, fatigue, dizziness

*5. Lamotrigine (Lamictal)*  

- *Use:* Focal and generalized seizures  

- *Dose:* Start 25 mg/day → increase gradually  

- *Side Effects:* Rash (can be severe), insomnia

*6. Topiramate (Topamax)*  

- *Use:* Generalized seizures, migraine prevention  

- *Dose:* 25–400 mg/day  

- *Side Effects:* Weight loss, cognitive slowing, kidney stones

Other Treatments:

- *Surgery* – For drug-resistant epilepsy (e.g. temporal lobectomy)  

- *Vagus Nerve Stimulation (VNS)* – Implanted device to reduce seizures  

- *Ketogenic Diet* – High-fat, low-carb diet (especially in children)  

- *Psychological Support* – Especially in epilepsy with mood disorders

Conclusion:

Epilepsy is a manageable condition with a wide variety of treatment options. *Early diagnosis*, *appropriate medication*, and *lifestyle modifications* can help most patients live seizure-free lives. Continuous follow-up and medication compliance are key to long-term success.