Epilepsy and its types

                                                             (EPI= upon; LEPTOS= seizures)

• Epilepsy is a medical condition that mainly affects the nervous system.
• Also known as a seizure disorder.
• Disorders in brain cells occur because of genetic influence, head trauma, or any infectious disease.
• Unusual electrical activity occurs which leads to repetitive seizures.

• Abnormal behavior is seen in the case of epilepsy.
• Involuntary muscle movement occurs with unusual perception.
• The consciousness level also gets disturbed.

TYPES OF EPILEPSY

GENERALISED SEIZURES:

• The whole brain is involved.
• Immediate loss of consciousness.
• 2 subtypes:

1. Tonic-clonic epilepsy- 
• Also known as Grand mal seizures.
• Consciousness is lost and muscle convulsions.
• Carbamazepine, phenytoin, oxcarbazepine, valproic acid, lamotrigine is the first-line drugs used in this condition.
2. Absence seizures- 
• Also known as Petit mal seizures.
• Children>adults
• Starring at some site for a few seconds.
• Include brief, sudden lapses of consciousness.
• Valproic acid & ethosuximide are the first-line of drugs used in this type of seizure.

PARTIAL SEIZURES:

• Cortical discharge occurs locally & remains localized in one region.
• Symptoms vary according to the region affected:
• Abnormal sensory experience and behavior.
• Involuntary muscle contraction.
• Carbamazepine, phenytoin, lamotrigine, valproic acid, oxcarbazepine are the first line of drugs used in this type of seizure.

STATUS EPILEPTICUS:

• In this, seizures occur repeatedly and there is no recovery in between the repeated seizures.

MYOCLONIC SEIZURES:

• Sudden brief muscular contraction occurs in one part of the body or in the whole body in a repeated manner.
• Falling tendency increases & stiffness of the body is seen.
• This seizure can occur alone or with other seizures.
• Valproic acid and clonazepam are the first-line of drugs used in this type of seizure.

FEBRILE SEIZURES:

• Seen in children's due to an increase in the temperature of the body.

ETIOLOGY

Some conditions can help us to understand the cause of epilepsy, otherwise, the cause of epilepsy is idiopathic.

1. Head trauma
2. Meningitis
3. AIDS
4. Prenatal injury
5. Genetically influenced individual
6. Brain tumors
7. Stroke

 SIGNS AND SYMPTOMS

1. Loss of consciousness
2. Uncontrolled jery movements of arms & forearms
3. Problem in speaking
4. Temporary confusion
5. Mental problem symptoms

RISK FACTORS

1. Metabolic disturbances.
2. Sleep deprivation
3. Intercurrent infections
4. Alcohol withdrawals.
5. Physical fatigue.
6. Mental fatigue.

PATHOGENESIS OF EPILEPSY

• Brain functions get altered, this results in generating abnormal electrical activity which results in seizures/epilepsy.
• Epilepsy is caused due to some genetic influence, trauma/brain injury, and infectious diseases.
• Neurons get stimulated and pass signals/waves of excitation to other neurons.
• It results in the development of a paroxysmal depolarization shift which shows the characteristics of giant excitatory postsynaptic potential, thus the neuronal network begins bursting.
• GABA inhibition & Dopamine level gets decreased. 
• GABA & Dopamine are neurotransmitters.

DIAGNOSIS

1. Medical history- an important aspect that has to be considered while examining the patient. It helps in understanding the main root cause of the patient(genetic).
2. Neurological examination- Electroencephalogram(EEG)
3. CT-scan
4. MRI-scan
5. Genetic testing- CMA(chromosomal microarray) to check whether the patient is having any gene of epilepsy from his/her family or a mutation occurs.

COMPLICATIONS

1. Injury to the skull- when an individual falls down because of a seizure, the skull can get damaged as it hits directly the surface which is close to an individual(ground, table, etc.).
2. A shoulder dislocation-(seizures can lead to dislocation of the shoulder because of jerky movements of arm and forearm).
3. Fracture of the vertebra- vertebra get fractures when jery movements of the body occur or fall down from some height.
4. During an epileptic attack, the patient can injure his tongue, lip, or chick.
5. When an individual vomits, the contents of the vomited stomach may go into the lungs.
6. Limbic structures(hypothalamus, hippocampus, and amygdala) can also get damage that is involved in regulating emotions.

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