epilepsy

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epilepsy

 [ep´ĭ-lep″se]
paroxysmal transient disturbances of nervous system function resulting from abnormal electrical activity of the brain. Epilepsy is not one specific disease, but rather a group of symptoms that are manifestations of any of a number of conditions involving overstimulation of nerve cells of the brain. The estimated incidence is 0.5 per cent of the population, making this a relatively common disease. Over 70 per cent of patients have their first attack (or seizure) either during childhood or after age 50. The type of seizure varies with age of onset.
Types. There are several methods for classifying types of epilepsy. On the basis of origin, it may be either idiopathic (cryptogenic, essential, genetic) or symptomatic (acquired, organic). Symptomatic epilepsy has a physical cause, such as a brain tumor, injury to the brain at birth, a wound or blow to the head, or an endocrine disorder.ƒ

One classification of epileptic seizures, called the Clinical and Electroencephalographical Classification of Epileptics of the International League Against Epilepsy, identifies four main types: (1) partial seizures, including those that begin locally, which are subdivided into (A) partial seizures with elementary symptomatology, (B) partial seizures with complex symptomatology (those with impairment of consciousness only, psychomotor symptomatology, and psychosensory symptomatology), and (C) partial seizures that are secondarily generalized; (2) generalized seizures that are bilaterally symmetrical and without local onset; (3) unilateral seizures (those involving only one hemisphere); and (4) other unclassified epileptic seizures.
Types According to Symptoms. The manifestations of epilepsy depend on the area of the brain where the abnormal discharge occurs. Simple partial seizures, called also focal seizures, result from a localized cortical discharge. The symptoms may be either motor, sensory, autonomic, or any combination of the three. Complex partial seizures, as in psychomotor (temporal lobe) epilepsy, usually, but not always, originate in the temporal lobe of the brain, often with a preceding aura. As the name implies, there are many different cognitive, affective, and psychomotor symptoms. There is either loss or alteration of consciousness when the seizure begins, and afterwards the patient may feel drowsy or confused.ƒ

An attack of petit mal (absence) epilepsy lasts only a few seconds and has sudden onset with no aura or warning and no postictal symptoms. Seizures of this type usually affect children between the ages of 5 and 12 years and may disappear during puberty, but they can continue throughout life. There typically is a twitching about the eyes or mouth, the patient remains sitting or standing, and appears to have had no more than a lapse of attention or a moment of absent-mindedness.

An attack of grand mal (tonic-clonic) epilepsy usually begins with bilateral jerks of the extremities or focal seizure activity. There is loss of consciousness and both tonic and clonic type convulsions. The patient may be incontinent during the attack and there is danger of tongue biting. In the postictal phase the patient is confused and drowsy.

Atonic or akinetic seizures are characterized by loss of body tone that can produce nodding of the head, weakness of the knees, or total collapse and falling. The patient usually remains conscious during the attack.
Diagnosis. A complete assessment of the patient's status is necessary, including a medical history, physical and neurological examination, and laboratory studies of the blood and spinal fluid. The latter are especially useful in determining whether an infection is the cause of the seizures. A CT scan may demonstrate a causative lesion. The diagnosis is confirmed by an electroencephalogram, which is helpful in locating the site and possibly the cause of the seizures.
Treatment. Medical management with anticonvulsant drugs is the preferred therapy for about 95 per cent of patients with epilepsy. Surgical intervention for the remaining 5 per cent involves removal of the portion of brain tissue believed to be responsible for the seizures. Because of the dangers inherent in the surgery, this mode of therapy is reserved for those patients who do not respond to medical management and in whom the focus of seizure activity is accessible.

The major antiepileptic drugs are phenytoin (Dilantin), which is usually the drug of choice, phenobarbital, primidone (Mysoline), carbamazepine (Tegretol) for complex partial tonic-clonic seizures, and ethosuximide (Zarontin) and clonazepam (Klonopin) for absence seizures. Valproic acid (Depakene) is also used in the treatment of absence seizures. The choice of drug and calculation of optimal dosage is very difficult and highly individualized.

All of the anticonvulsant drugs can produce unpleasant side effects. They include gingival hyperplasia, rash, and, in the case of Dilantin, fever and leukopenia. Physical dependence can become a problem in patients taking phenobarbital or primidone, which is largely converted to phenobarbital in the blood stream. Toxic side effects are also common and include drowsiness, ataxia, nausea, sedation, and dizziness. The untoward effects of anticonvulsant drug therapy require close monitoring of the patient's response to therapy and regulation of dosage as indicated.
Patient Care. Emergency care of the patient having a seizure includes clearing the immediate area to protect the patient and others, administering 100 per cent oxygen by face mask, and intravenous administration of antiepileptic medication. No one should force an object into the patient's mouth to hold it open (such as a comb, bite block, or wallet), as such objects might obstruct the airway. Do not attempt to restrain the patient, as that may cause harm to both the rescuer and the patient.ƒ

Until a diagnosis of epilepsy is confirmed, observations made before, during, and after each of the seizures can provide important information to the diagnostician. Such data also can help prepare an effective plan of care for managing the seizures once a definitive diagnosis is made.

Just before a seizure (the preictal stage) the patient may experience an abnormal somatic, visceral, or psychic sensation called an aura. The presence or absence of the aura and its nature (if it is present) should be noted and recorded. If a patient does experience a particular kind of aura just before each seizure, this information can be useful when planning care for prevention of injury. It also is helpful to note what the patient was doing just before the seizure began. If a particular emotional event or environmental or physiologic condition is found to trigger the seizures, the patient might be able to use this information to avoid or minimize the recurrence of seizures.

During the interictal stage (while the seizure is occurring) significant data include the time the seizure begins and its duration; where in the body the seizure begins and what parts of the body are involved; whether the head or eyes turn to one side and, if so, to which side; whether there is incontinence of urine or stool, bleeding, or foaming or frothing at the mouth; effects of the seizure on the vital signs; and changes in skin color or profuse perspiration.

During the postictal period the patient is assessed for lethargy, confusion, impaired speech, and reports of headache or muscle soreness.

The successful long-term management of epilepsy requires coordinated effort on the part of the patient, family, and health care professionals. Patient and family education and support are essential components of any plan of care. Epileptic patients must take their prescribed medications on their own and actively participate in the management of their illness. They and those upon whom they are dependent (as in the case of children) must know the nature of the illness, the purpose and expected effects of treatment, the side effects of the drug they are taking and its potential for interaction with other drugs that could inhibit or enhance its anticonvulsant action, and the signs and symptoms of drug intolerance that should be reported to the physician or nurse.

Education should also include information about possible seizure triggers and ways in which they might be avoided. Alcohol is especially dangerous for epileptic persons because most antiepileptic drugs are sedatives and cardiopulmonary depressants. The combination of drug and alcohol could cause loss of consciousness or even death. Moreover, alcohol acts as a seizure trigger in some persons.

It is important that patients with epilepsy wear some form of medical identification. In spite of efforts to educate the general public about the nature of epilepsy and its effects on those who have it, there remains some social stigma attached to epilepsy. Therefore, many patients do not want their friends, classmates, or employers to know they have the disease. Efforts must be made to improve the self-esteem of these people. Local chapters of the Epilepsy Association of America offer programs and opportunities for social interaction and group support to help persons with epilepsy and their families deal with the psychosocial effects of the disease. Information and guidance to a local chapter can be obtained by contacting the Epilepsy Association of America, 111 W. 55th St., New York, NY 10019.

The Epilepsy Foundation of America, 4351 Garden City Dr., Suite 406, Landover, MD 20785, supplies information on all aspects of epilepsy and can refer patients and their families to specialists and clinics in their locality.

One of the major challenges to persons working in the health field and concerned with the care of patients with epilepsy is the dispelling of myths and superstitions about the disease and the propagation of accurate information. Most persons with epilepsy can lead normal lives with few restrictions, but many are subjected to unfair employment practices and social stigma because of prejudices resulting from the general public's ignorance of the effects of epilepsy.
absence epilepsy petit mal epilepsy.
audiogenic epilepsy reflex epilepsy brought on by sound.
grand mal epilepsy a form attended by loss of consciousness and convulsive movements, as distinguished from petit mal epilepsy. See epilepsy.
jacksonian epilepsy a form of epilepsy characterized by unilateral clonic movements that start in one group of muscles and spread systematically to adjacent groups, reflecting the march of the epileptic activity through the motor cortex.
myoclonus epilepsy any form of epilepsy accompanied by myoclonus; one type is Lafora's disease.
petit mal epilepsy a relatively mild type of epilepsy in which the person loses consciousness only momentarily, in contrast to grand mal epilepsy; called also absence epilepsy. See epilepsy.
photogenic epilepsy reflex epilepsy brought on by flickering light.
psychomotor epilepsy temporal lobe epilepsy.
reflex epilepsy epileptic seizures occurring in response to sensory stimuli (tactile, visual, auditory, or musical).
temporal lobe epilepsy a type manifested by impaired consciousness of variable degree, with the patient carrying out bizarre but coordinated movements; called also psychomotor epilepsy. See epilepsy.

ep·i·lep·sy

(ep'i-lep'sē),
A chronic disorder characterized by paroxysmal brain dysfunction due to excessive neuronal discharge, and usually associated with some alteration of consciousness. The clinical manifestations of the attack may vary from complex abnormalities of behavior including generalized or focal convulsions to momentary spells of impaired consciousness. These clinical states have been subjected to a variety of classifications, none has been universally accepted to date and, accordingly, the terminologies used to describe the different types of attacks remain purely descriptive and nonstandardized; they are variously based on: the clinical manifestations of the seizure (motor, sensory, reflex, psychic or vegetative); the pathologic substrate (hereditary, inflammatory, degenerative, neoplastic, traumatic, or cryptogenic); the location of the epileptogenic lesion (rolandic, temporal, diencephalic regions); and the time of day at which the attacks occur (nocturnal, diurnal, menstrual).
[G. epilēpsia, seizure]

epilepsy

/ep·i·lep·sy/ (ep´ĭ-lep″se) any of a group of syndromes characterized by paroxysmal transient disturbances of brain function that may be manifested as episodic impairment or loss of consciousness, abnormal motor phenomena, psychic or sensory disturbances, or perturbation of the autonomic nervous system; symptoms are due to disturbance of the electrical activity of the brain.
absence epilepsy  that characterized by absence seizures, usually having its onset in childhood or adolescence.
focal epilepsy  that consisting of focal seizures.
generalized epilepsy  epilepsy in which the seizures are generalized; they may have a focal onset or be generalized from the beginning.
grand mal epilepsy  a symptomatic form of epilepsy, often preceded by an aura, characterized by sudden loss of consciousness with tonic-clonic seizures.
jacksonian epilepsy  epilepsy marked by focal motor seizures with unilateral clonic movements that start in one muscle group and spread systematically to adjacent groups, reflecting the march of epileptic activity through the motor cortex.
juvenile myoclonic epilepsy  a syndrome of sudden myoclonic jerks, occurring particularly in the morning or under periods of stress or fatigue, primarily in children and adolescents.
Lafora's myoclonic epilepsy  a form characterized by attacks of intermittent or continuous clonus of muscle groups, resulting in difficulties in voluntary movement, mental deterioration, and Lafora bodies in various cells.
myoclonic epilepsy  any form of epilepsy accompanied by myoclonus.
petit mal epilepsy  absence e.
photic epilepsy , photogenic epilepsy reflex epilepsy in which seizures are induced by a flickering light.
posttraumatic epilepsy  that occurring after head injury.
psychomotor epilepsy  temporal lobe e.
reflex epilepsy  epileptic seizures occurring in response to sensory stimuli.
rotatory epilepsy  temporal lobe epilepsy in which the automatisms consist of rotating body movements.
sensory epilepsy 
1. seizures manifested by paresthesias or hallucinations of sight, smell, or taste.
somatosensory epilepsy  sensory epilepsy with paresthesias such as burning, tingling, or numbness.
temporal lobe epilepsy  a form characterized by complex partial seizures.
visual epilepsy  sensory epilepsy in which there are visual hallucinations.

epilepsy

(ĕp′ə-lĕp′sē)
n. pl. epilep·sies
Any of various neurological disorders marked by sudden recurring attacks of motor, sensory, or cognitive dysfunction, with or without convulsive seizures or loss of consciousness. Also called seizure disorder.

epilepsy

[ep′ilep′sē]
Etymology: Gk, epilepsia, seizure
a group of neurological disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, loss of consciousness, or all of these. Common to all types of epilepsy is an uncontrolled electrical discharge from the nerve cells of the cerebral cortex. Although most epilepsy is of unknown cause, it is sometimes associated with cerebral trauma, intracranial infection, brain tumor, vascular disturbances, intoxication, or chemical imbalance. See also absence seizure, focal seizure, psychomotor seizure, tonic-clonic seizure.
observations The frequency of attacks may range from many times a day to intervals of several years. In predisposed individuals, seizures may occur during sleep or after physical stimulation, such as by a flickering light or sudden loud sound. Emotional disturbances also may be significant triggers. Some seizures are preceded by an aura, but others have no warning symptoms. Most epileptic attacks are brief. They may be localized or general, with or without clonic movements, and are often followed by drowsiness or confusion. Diagnosis is made by observation of the pattern of seizures and abnormalities on an electroencephalogram. Diagnosis is also aided by a system of classification of the criteria that characterize the different types of epileptic seizures. One major category in the classification scheme encompasses the partial seizures, which often begin focally, then spread to other brain areas. A second major category includes the generalized seizures, which usually begin deep in the brain and impair consciousness.
interventions The kind of epilepsy determines the selection of preventive medication. Correctable lesions and metabolic causes are eliminated when possible. During a seizure the patient should be protected from injury without being severely restrained.
nursing considerations In addition to protecting the patient from injury, a nurse observing an epileptic seizure should carefully note and accurately describe the sequence of seizure activity. The patient and family must be fully informed and counseled about the disorder; the importance of regularly taking prescribed medication, never discontinuing treatment without professional advice, and using a medical identification tag; the toxic effects of medication; and the maintenance of the most normal life-style possible. Nurses also have a responsibility to help improve the public's attitude toward epilepsy and to correct misunderstanding that limits educational and occupational opportunities for individuals affected by this condition. See also anticonvulsant, aura, central nervous system stimulant, clonus, ictus, tonic. epileptic, adj., n.
enlarge picture
Childhood absence epilepsy: typical EEG pattern

epilepsy

Neurology Any syndrome characterized by paroxysmal, usually transient, defects in cerebral function which are manifest as episodic impairment of neurologic activity, loss of consciousness, abnormal motor activity, sensory defects and alterations in the autonomic nervous system Imaging MRI, PET, SPECT. See Absence, Automatic epilepsy, Focal epilepsy, Gelastic epilepsy, Juvenile myoclonic epilepsy, Progressive myoclonus epilepsy, Seizure disorder.

ep·i·lep·sy

(ep'i-lep'sē)
A chronic disorder characterized by paroxysmal brain dysfunction due to excessive neuronal discharge, and usually associated with some alteration of consciousness. The clinical manifestations of the attack may vary from complex abnormalities of behavior including generalized or focal convulsions to momentary spells of impaired consciousness. These clinical states have been subjected to a variety of classifications, none universally accepted to date and, accordingly, the terminologies used to describe the different types of attacks remain purely descriptive and nonstandardized; they are variously based on the clinical manifestations of the seizure (motor, sensory, reflex, psychic, or vegetative); the pathologic substrate (hereditary, inflammatory, degenerative, neoplastic, traumatic, or cryptogenic); the location of the epileptogenic lesion (rolandic, temporal, diencephalic regions); and the time period during which the attacks occur (nocturnal, diurnal, menstrual).
Synonym(s): seizure disorder.
[G. epilēpsia, seizure]

epilepsy

A physical indication of an abnormal electrical discharge in the brain. Epilepsy takes various forms. These include generalized epilepsy, or ‘grand mal’ which is a major fit affecting all the muscles of the body with a massive contraction (tonic stage) followed by a succession of jerky contractions (clonic stage); partial seizures, which may affect only a few muscles (simple partial seizures) or may also involve almost any of the functions of the brain and cause elaborate hallucinations (complex partial seizures); and absence attack, or ‘petit mal’ in which the affected person, usually a child, is momentarily inaccessible but does not fall or appear to lose consciousness.

epilepsy

a nervous condition due to abnormalities in the brain cortex that results in seizures ranging from a sense of numbness in certain body areas (petit mal) to extreme muscular convulsions and fits (grand mal). Epileptics exhibit large, abnormal brain waves, which can be detected on an EEG.

Epilepsy

A neurological disorder characterized by recurrent seizures with or without a loss of consciousness.

epilepsy

a condition resulting from disordered electrical activity in the brain and manifesting as epileptic seizures or 'fits'. A generalized seizure or grand mal is the commonest form of epilepsy, with loss of consciousness and generalized convulsions. In absences or petit mal there is only a brief alteration in consciousness. When the electrical disturbance is limited to a particular focus in the brain there is a partial seizure, e.g. twitching of a limb, known as Jacksonian epilepsy . Other types include psychomotor seizures, with changes in mood, perception and memory as well as physical symptoms, such as nausea. All types can usually be controlled by appropriate drugs. There is some concern as to whether those with epilepsy should take part in sport and leisure activities but with a few exceptions and precautions, the majority should be encouraged to do so. However, particular care should be taken in uncontrolled epilepsy, especially with water-based sports (seizure while in the water) and those at heights, including horse riding (seizure leading to a fall). Scuba diving is not recommended. Boxing is not considered safe but other contact sports are possible, especially with appropriate head protection. Cyclists should always wear a helmet.

epilepsy

chronic neurological disorder characterized by variable episodes of paroxysmal brain dysfunction (i.e. a fit), altered levels of consciousness and excessive neuronal discharge and/or convulsions followed by a period of sleepiness; fits are controlled by antiepileptic drugs, e.g. carbamazepine (Tegretol), gabapentin (Neurontin), phenytoin (Epanutin), pregabalin (Lyrica), sodium valproate (Epilim); local anaesthetic drugs within the systemic circulation agonize antiepileptic medications
  • focal epilepsy; cortical epilepsy seizure often preceded by a specific sensory phenomenon (aura), and characterized by isolated disturbance of cerebral function, e.g. uncontrollable twitching of one limb, and followed by some degree of subsequent temporary mental dysfunction

  • generalized epilepsy; grand mal epilepsy a classic epileptic seizure often preceded by a brief, specific sensory phenomenon (aura), and characterized by a sudden loss of consciousness, cyanosis and tonic muscular spasm (lasting approximately 30 seconds), followed by repetitive clonic body jerking, (lasting for a few minutes), with frothing at the mouth and urinary incontinence after which the patient remains unconscious or semiconscious and flaccid for several minutes; the patient may remain drowsy or confused for some time after the seizure has passed

  • petit mal epilepsy characterized by short period of 'absence', during which the patient does not become unconscious or suffer muscular spasms but is temporarily non-reactive to and unaware of his or her surroundings or actions

  • temporal-lobe epilepsy; psychomotor epilepsy attacks characterized by impaired consciousness and amnesia, clonic limb movements, hallucinations or other psychic disturbances

  • tonic epilepsy seizure characterized by tonic convulsions and rigidity

epilepsy (eˈ·p·lepˑ·sē),

n medical condition characterized by repeated episodes of erratic brain electrical discharge. They may be convulsive or nonconvulsive. Epilepsy may be caused by degenerative brain diseases; injuries incurred at birth; infections affecting the brain and central nervous system, head traumas, strokes, drugs, or unknown causes. Also called
falling sickness.

ep·i·lep·sy

(ep'i-lep'sē)
A chronic disorder characterized by paroxysmal brain dysfunction due to excessive neuronal discharge, and usually associated with some alteration of consciousness. The clinical manifestations of the attack may vary from complex abnormalities of behavior including generalized or focal convulsions to momentary spells of impaired consciousness.
[G. epilēpsia, seizure]

epilepsy (ep´ilep´sē),

n a group of neurologic disorders characterized by recurrent episodes of convulsive seizures, sensory disturbances, abnormal behavior, and loss of consciousness. Most epilepsy is of an unknown etiology but may be associated with cerebral trauma, brain tumors, vascular disturbances, or chemical imbalance. Drugs used in the treatment of symptoms (e.g., hydantoin sodium, diphenylhydantoin sodium) may promote gingival hyperplasia.

epilepsy

paroxysmal transient disturbances of nervous system function resulting from abnormal electrical activity of the brain. It is not a specific disease, but rather a group of signs that are manifestations of any of a number of conditions that overstimulate the brain. Such signs include episodic impairment or loss of consciousness, abnormal motor phenomena or convulsions, psychic or sensory disturbances or perturbation of the autonomic nervous system. The term is often used interchangeably with seizures or convulsions.
There are several methods for classifying the various types of epilepsy. On the basis of origin, epilepsy is idiopathic (cryptogenic, essential, genetic) or symptomatic (acquired, organic). Symptomatic epilepsy has a physical cause, for example, brain tumor, injury to the brain at birth, a wound or blow to the head, or an endocrine disorder.

autonomic epilepsy
see visceral epilepsy (below).
cortical epilepsy
seizures originating from a discrete focus in the cerebrum. Called also partial seizures.
idiopathic epilepsy
no cause can be diagnosed during life and no lesions are demonstrable at autopsy. The diagnosis is made by ruling out all extracranial and other intracranial causes. In dogs, this disorder occurs most frequently in certain breeds, particularly German shepherd dogs, miniature poodles, Keeshonds, Tervuren shepherds and Beagles, in which it is regarded as an inherited trait. Generalized seizures begin occurring at a young age, typically from 1 to 3 years; the affected dog is otherwise normal. Called also true epilepsy.
In affected cattle seizures occur from 2 to 3 months of age. A form of idiopathic epilepsy has been recorded in horses.
Jacksonian epilepsy
myoclonic epilepsy
visceral epilepsy
a visceral response to a focus of irritation in the cerebral cortex, usually vomiting and diarrhea. Called also autonomic epilepsy.

Patient discussion about epilepsy

Q. what are the chances for a one time epileptic seizure? I had an epileptic seizure a few years ago and after all the tests it appeared to be a one time seizure. I know having one indicates my tendency for this kind of seizures so should I be afraid now to do things that might bring it up again- like alcohol, drugs, being exposed to flashing lights or having lack of sleep? what are the chances of it to come back after 5 years? any help will be very appreciated....thanks!

A. After 5 years with no recurrence of seizures after a one time episode, tha chances of having another one are low, almost exact to the general population. I would not advise you to start heavily drinking alcohol and doing drugs, because these things can certainly have an effect, however you need not be afraid.

Q. if some one gets a one time epileptic seizure- he have to take medication all his life? how do they decide if it's a one timer or it's going to continue from this day forth?

A. I had a one time epileptic seizure 5 years ago (due to lack of sleep- probably) and didn't have to take any medication though I did have some tests made like EEG and CT every half a year for some time. Like everything else in life- you can't decide it's not a one time till you get the second- which I hope you wont of course...
:)

Q. will my son get over his epilepsy he has had seizers since he was 6 months old he is know 3 and a half

More discussions about epilepsy