Epilepsy: Causes, Symptoms, Diagnosis, and Treatment

Epilepsy is a disorder of the central nervous system (neurological) that makes brain activity become abnormal, causes seizures, and sometimes causes loss of consciousness. Central nervous system disorders can affect men and women of all races and ages.

In Indonesia, there are an estimated 1.3-1.6 million sufferers of epilepsy. Even so, this number does not reflect the actual number of cases because many families do not want to take their children to the puskesmas or hospital for treatment. This is because of the stigma given to epilepsy.

Causes of Epilepsy

In most cases, the cause of epilepsy can not be identified. But for other cases, the following factors turned out to play a role in the occurrence of epilepsy, including:

  • Genetic Influence

Certain genes can make a person more sensitive to environmental conditions that trigger seizures.

  • Head trauma

Head trauma can result from a car accident or other traumatic injury, causing epilepsy.

  • Brain Conditions

Conditions that cause damage to the brain such as tumors or brain strokes can cause epilepsy. Stroke is a major cause of central nervous system disorders in adults over 35 years old.

  • Infectious diseases

Infectious diseases such as meningitis, AIDS, and viral encephalitis can cause epilepsy.

  • Prenatal Injury

The fetus is sensitive to brain damage caused by several factors such as infection in the mother, poor nutrition or lack of oxygen. This brain damage can cause epilepsy or cerebral palsy.

  • Developmental Disorders

Epilepsy is a condition that can sometimes be associated with developmental disorders such as autism and neurofibromatosis.

Risk Factors that Increase Epilepsy

Following are certain factors that can increase the risk of epilepsy are:

  • Age. Central nervous system disorders are most common in children and the elderly, but this condition can occur at any age.
  • Family history. If you have a family history of epilepsy, you may be at high risk of experiencing the same condition.
  • Activities that are at risk of causing head injury. You can reduce the risk by wearing a seat belt when driving a car and wearing a helmet when biking, skiing, riding a motorcycle or doing other risky activities.
  • Stroke and other vascular diseases. Stroke and vascular disease can cause brain damage that can trigger epilepsy. You can take a number of steps to reduce the risk of this disease, including limiting alcohol intake, avoiding cigarettes, eating healthy foods, and exercising regularly.
  • Dementia. Dementia can increase the risk of epilepsy in older adults.
  • Brain infection. Infections such as meningitis that cause inflammation in the brain or spinal cord can increase the risk of epilepsy.

Symptoms of Epilepsy

Because epilepsy is caused by abnormal activity in the brain, it can affect whatever processes are coordinated by the brain. Signs and symptoms of epilepsy include:

  • Temporary confusion.
  • Mumble.
  • Uncontrollable jerking of the arms and legs.
  • Loss of consciousness.
  • Psychological disorders such as fear or anxiety.

Even so, the symptoms of epilepsy depend on the type of seizure that occurs. In many cases, a person with central nervous system disorders will tend to have the same type of seizure, so the symptoms will be similar from episode to episode.

Focal Seizures

Seizures that occur due to abnormal activity in one particular area of ​​the brain, so this is called focal (partial) seizures. These seizures fall into two categories:

  • Focal seizures without loss of consciousness (Simple Partial Seizure)

Before experiencing seizures, sufferers can experience emotional changes or change the way they look, smell, etc. This condition results in parts of the body (such as arms or legs) jerking unintentionally accompanied by spontaneous sensory symptoms such as tingling, dizziness, and dizzy eyes.

  • Focal seizures with impaired consciousness (Complex Partial Seizure)

This type of seizure is accompanied by disturbance or loss of consciousness, often found in the condition of the patient where the eye is in a state of looking up, not responding normally to the surrounding environment, or making repetitive movements such as rubbing hands, chewing, swallowing, up to circular movements.

Also, be aware, symptoms of focal seizures can be caused by other neurological disorders such as migraine, narcolepsy, or mental illness. A thorough examination and testing is needed to distinguish central nervous system disorders from other disorders.

General Seizures

Seizures that involve all areas of the brain are called generalized seizures. There are six types of common seizures, including:

  • Seizure absent

Absence seizures formerly known as petit mal seizures, often occur in children and are characterized by eye gazing up or subtle body movements such as blinking eyes or lip movements. This condition can also cause a brief loss of consciousness.

  • Tonic convulsions

Tonic spasms cause muscles to become stiff. These spasms usually affect the muscles in the back, arms and legs, which can cause falls to the floor.

  • Atonic seizures

Atonic seizures cause loss of muscle control (loss of muscle tone) which can cause you to suddenly collapse or fall to the floor.

  • Clonic seizures

Clonic seizures are associated with jerky or rhythmic muscle movements. This spasm usually attacks the neck, face and arms.

  • Myoclonic spasms

Myoclonic spasms usually appear as a brief jolt of a sudden or twitching on the arms and legs.

  • Tonic-clonic seizures

Tonic-clonic seizures formerly known as petit mal seizures, these seizures are the most dramatic type of epilepsy and can cause sudden loss of consciousness, the body becomes rigid and vibrating, and sometimes loses bladder control or biting the tongue.

When is the Right Time to See a Doctor?

Seek immediate medical attention if any of the following symptoms occur:

  • The seizure lasts more than five minutes.
  • Breathing or awareness does not return after the seizure stops.
  • The second seizure soon occurred.
  • Accompanied by high fever.
  • Is pregnant
  • Suffering from diabetes.
  • Have injured myself during the seizure.

If you experience a seizure for the first time, seek immediate medical help.

Diagnosis of Epilepsy

Usually the doctor will ask for a medical history, for example whether the patient is suffering from a condition that can cause epilepsy. In addition, the patient’s lifestyle, for example whether the patient is addicted to alcohol, narcotics users, and drugs that are being consumed by the patient is also very important.

In addition, doctors also need to know the characteristics of seizures experienced. This needs to be done because a number of other conditions sometimes have symptoms similar to epilepsy such as migraines and panic attacks.

In addition to paying attention to the symptoms of epilepsy that appear, additional tests are usually carried out for the diagnosis of epilepsy are:

  • Blood test

The doctor may take a blood sample to check for signs of infection, genetic conditions or other conditions that may be related to seizures.

  • Electroencephalogram (EEG)

The EEG can confirm the diagnosis and provide more information about seizures. This action uses a special sensor that is an electrode mounted on the head and connected via a cable to the computer.

EEG will record the electrical activity of the brain that is represented in the form of wave lines. Changes in pattern during a seizure can indicate which part of the brain is affected so that it can help in treatment.

  • MRI Scan

This type of examination, which is carried out with the help of radio waves and magnetic fields, produces detailed images of organs in the body. This aims to determine the presence of brain tumors or defects in brain structure as a cause of epilepsy.

  • Positron Emission Tomography (PET)

PET scanning uses a small amount of low-dose radioactive material that is injected into a vein to help visualize the active area of ​​the brain and detect abnormalities.

  • Single-Photon Emission Computerized Tomography (SPECT)

This type of test is used especially if MRI and EEG do not determine the location where the seizure originated. The SPECT test uses a small amount of low-dose radioactive material that is injected into a vein to make a detailed 3-D map of blood flow activity in the brain during seizures.

  • Neuropsychological Test

In this test, the doctor evaluates thinking ability, memory, and speaking ability. Test results help doctors determine which areas of the brain are affected.

Complications of epilepsy

Seizures at certain times can cause dangerous conditions for yourself or others. Here are some of the complications that can occur from epilepsy are:

  • Fall down

If you fall during a seizure, you can hurt your head or break bones. Meanwhile, it is more likely to sink while swimming also to watch out for.

  • Accident

Seizures that cause loss of consciousness or control can be dangerous if you drive a vehicle or operate other equipment.

  • Pregnancy Complications

Seizures during pregnancy pose a danger to the mother and fetus, and certain anti-epileptic drugs increase the risk of birth defects. If you suffer from epilepsy and are considering becoming pregnant, talk to your doctor about planning a pregnancy.

Most women with central nervous system disorders can get pregnant and have healthy babies. You must be monitored closely throughout pregnancy, and medications may need to be adjusted. It’s important to consult a doctor when planning a pregnancy.

  • Emotional Health Problems

People with epilepsy are more likely to have psychological problems, especially depression, anxiety and thoughts and suicidal behavior. This problem may be due to difficulty handling the condition and side effects of the drug.

Treatment of epilepsy

An epilepsy treatment plan will be based on the severity of symptoms, health conditions and how well you respond to therapy.

Here are some treatment options that can be done to treat epilepsy are:

  • Diet

Diet can play a role in reducing seizures. According to a study published in the journal Neurology, a diet high in fat and low in carbohydrates can benefit children and adults with epilepsy.

Despite a 50% decrease in seizure regularity, many people find it difficult to maintain this diet. Certain diets may be useful in some cases, but more research is needed to confirm this.

  • Vagus Nerve Stimulator

This tool is placed under the skin of the chest through a surgical process and electrically stimulates nerves that flow through the neck. This tool can also help prevent seizures.

  • Brain Surgery

Areas of the brain that cause seizure activity can be removed or changed.

  • Medication for Epilepsy

Your doctor can prescribe a single drug or combination of drugs, depending on the type of seizure you have. Common epilepsy drugs include:

  • Levetiracetam.
  • Lamotrigine.
  • Topiramate.
  • Valproic acid.
  • Carbamazepine.
  • Ethosuximide.

These drugs are generally available in tablet, liquid or injection form and taken once or twice a day. You will start with the lowest dose possible, which can be adjusted until you start working. These medicines must be taken consistently and according to the prescription.

Some of the side effects of epilepsy drugs are fatigue, dizziness, skin rashes, poor coordination, to memory problems. Although rare, this drug can cause depression and inflammation of the liver or other organs.

Epilepsy is different for everyone, but most people get better with anti-seizure medications. Some children with central nervous system disorders stop having seizures and can stop taking medication.

Prevention of Epilepsy

According to the World Health Organization, 25% of cases of central nervous system disorders can be prevented. The following are steps that can be taken to reduce the risk of epilepsy:

  • Wear a helmet when riding a motorcycle to help prevent head injuries.
  • Seek perinatal care to prevent epilepsy from birth injuries.
  • Manage risk factors for stroke and heart disease, two diseases that can cause brain damage resulting in epilepsy
  • Practicing good hygiene and prevention methods to avoid cysticercosis, an infection that is the most common cause.

A study published in the journal Seizure also suggests that regular physical activity can help prevent the development of epilepsy and reduce how often seizures occur.

Although preventing epilepsy is not easy, taking the steps above can help reduce the risk of this disease.


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