Epilepsy

What Is Epilepsy?

Epilepsy describes disorders in which epileptic seizures occur repeatedly. It is the most common chronic disease of the central nervous system.

An epileptic seizure is a temporary dysfunction of the brain's nerve cells. Depending on which nerve cells are affected, different symptoms occur. The spectrum can range from a convulsion of the whole body to twitching or the movement of individual body parts.

However, the seizure may also manifest in a temporary absence. Epileptic seizures can occur in anyone and at any age. However, a single seizure is not necessarily epilepsy. Only in case of multiple seizures in specific periods or epilepsy-typical signals in the EEG indicates epilepsy.

Different Types of Epilepsy

In medicine, a fundamental distinction is made between focal and generalized seizures.

Only certain brain areas are involved in focal seizures, and, accordingly, only individual body regions are involved. So, for example, maybe only the eyelid twitches during a focal seizure. In addition, focal seizures are divided into those with impaired consciousness and those without impaired consciousness.

A disturbance of consciousness usually manifests as a brief seizure that is inconspicuous to an extent to outsiders that they typically do not notice it. Usually, affected individuals have no memory of the seizure.

In generalized seizures, the whole brain is affected by the seizure. Either from the beginning or from a focal seizure. Generalized seizures manifest as so-called absences, which last a short time, and the affected person is unresponsive. Furthermore, myoclonic seizures, which appear as sudden and sharp twitches of whole muscle groups, are also counted among generalized seizures. In addition, seizures that lead to stiffening and then convulsing the entire body, called grand mal, are among generalized seizures.

Epilepsy Cause

Several different factors can cause epilepsy. However, in about half of the cases, the cause remains unexplained. Possible known causes are:

• Other neurological diseases with epilepsy as a symptom
• Metabolic diseases
• Prenatal maldevelopment
• Neurological damage during pregnancy and birth
• Poisonings
• Brain injuries
• Genetic factors

Epilepsy Symptoms

In simple focal seizures, there is usually muscle spasm with consciousness remaining. Only in more complex seizures can consciousness be limited or briefly suspended.

• Generalized seizures are divided into several forms:
• Absences - brief disturbance of consciousness whereby patients merely freeze in their activity and act as if nothing had happened after a few seconds.
• Myoclonic seizures feature sudden, brief, bilateral muscle twitching.
• Clonic seizures feature muscle twitching. Arms and legs may twitch violently. There is also an increased saliva flow so that the affected person may foam at the mouth.
• Tonic seizures - characteristic: muscle spasms. Affected persons often stiffen their arms and legs and fall. The risk of injury is very high. Bite wounds to the tongue or cheeks may occur.
• Atonic seizures are characteristic of the sudden collapse of muscle tension and brief loss of consciousness.
• Status epilepticus - emergency. Status epilepticus describes how epileptic seizures occur at such short intervals that the affected person cannot recover in between. This condition must be interrupted immediately by the emergency physician with medication. Otherwise, severe brain damage can occur.

Epilepsy Treatment

Epilepsies are usually treated conservatively, i.e., with medication, as a first step. Medicines from the group of antiepileptic drugs are used. Several drugs must be given simultaneously in severe cases, and different combinations attempted. Antiepileptic drugs are intended to prevent an epileptic seizure. Therefore, drug treatment of epilepsy is always a long-term therapy and usually lasts several years. The following factors also have a preventive effect and protect against another seizure:

Regular use of medication

• Regular lifestyle with a constant sleep-wake rhythm
• Healthy balanced diet
• Regular medical check-ups
• Stress avoidance
• Avoidance of factors that provoke seizures

Drug therapy is not sufficient for a small number of patients with so-called therapy-resistant epilepsies. Instead, they can be helped with modern medicine by neurosurgical intervention (epilepsy surgery), provided the focus is on the brain's precisely circumscribed region.

Epilepsy Consequences

Under drug treatment, many patients remain seizure-free and can lead an everyday life. However, after a seizure, there may be a "probationary period" in which the affected person refrains from activities that could endanger themselves or other people, such as driving a car or building scaffolding. Then, if the affected person remains seizure-free after a certain period, such activities can be resumed.

The brain can compensate for grand mal seizures for a long time. Later, the following deficits may occur:

• Attention deficits and concentration disorders
• Learning disorders
• Attention deficits
• Increased risk of injury

Which Doctors and Clinics Are Specialized in Epilepsy?

Neurologists are specialists in epileptic seizures and epilepsies. They are responsible for diagnosis and drug therapy. If surgery is necessary, a neurosurgery specialist is consulted. In many cases, the emergency physician is the first to reach the affected person during or after a generalized seizure.

We can help you find an expert for your condition. All listed physicians and clinics have been reviewed by us for their outstanding specialization in epilepsy and are awaiting your inquiry or treatment request.

Sources:

• Nass et al.: The role of postictal laboratory blood analyses in the diagnosis and prognosis of seizures. In: Seizure. Band 47, 2017, doi: 10.1016/j.seizure.2017.02.013.
• Neligan: The Mortality of Status Epilepticus. In: Epileptologie. Band 34, Nummer 3, 2017.
• Rosenow et al.: S1-Leitlinie Status epilepticus im Erwachsenenalter. Deutsche Gesellschaft für Neurologie (DGN). Stand September 2012. Abgerufen am 30.10.2017.
• Knake et al.: Incidence of Status Epilepticus in Adults in Germany: A Prospective, Population-Based Study. In: Epilepsia. Band 42, Nummer 6, 2001, doi: 10.1046/j.1528-1157.2001.01101.x, S. 714–718.
• Masuhr, Neumann: Duale Reihe Neurologie. 6. Auflage. Thieme 2007, ISBN 978-3-131-35946-9.
• Moskopp, Wassmann: Neurochirurgie. Schattauer 2014, ISBN 978-3-794-52442-6.
• Elger et al.: S1-Leitlinie Erster epileptischer Anfall und Epilepsien im Erwachsenenalter. Deutsche Gesellschaft für Neurologie (DGN). Stand April 2017. Abgerufen am 30.10.2017.
• Gräcmann, Albrecht: Begutachtungsleitlinie zur Kraftfahreignung. Bundesanstalt für Straßenwesen (BAST). Stand August 2017. Abgerufen am 30.10.2017.