The Epilepsy is a chronic seizure disorder in which the brain has a predisposition to generate crises over time. According to the International League Against Epilepsy, this disease not only causes seizures, but also impacts the neurological, psychological and social development of patients who suffer from it.
Seizures are neurological disorders that occur when sudden and abnormal electrical activity is generated by neurons in the brain.
Seizures can occur only once in a lifetime or manifest in several episodes and are due to various causes such as infections of the central nervous system, brain tumors, head injuries and diseases such as epilepsy.
Epilepsy in the world
According to the World Health Organization, epilepsy affects at least 50 million people in the world, making it a relevant disease in global health. However, it is estimated that only two thirds of the population with epilepsy receive adequate treatment for their disease.
The epilepsy is manifested in both men and women, with peak onset in childhood and later in adulthood after 70 years, but can occur at any age.
What are the causes of epilepsy?
The causes of epilepsy are varied. But the most common form that affects at least 60% of patients with this condition is called idiopathic epilepsy (that is, it does not have a specific cause). The other 40% of patients have secondary epilepsy, due to:
· Cerebral hypoxia or ischemia (when the brain does not receive enough oxygen), this can occur during birth or from a stroke.
· Cerebral arterio-venous malformations.
· Central nervous system infections such as meningitis, encephalitis, neurocysticercosis.
· Brain tumors.
· Head injuries (traffic accidents, work accidents, gunshot wounds, among others).
It is important to note that not every seizure is an epilepsy, so in a patient who has a seizure for the first time, other non-epileptogenic causes that could trigger a seizure disorder should be ruled out.
Symptoms of epilepsy
The symptoms of epilepsy will depend on the brain area in which the epileptic discharges are activated.
The epilepsy characterized by partial seizures or generalized in the form of crisis or attacks with tonic movements (increased muscle tone), clonic tonic-clonic (repeated movements) or of the body, which may be associated with loss of the state of consciousness, loss of sphincter control, ocular retroversion (the patient turns his gaze to one side) and an episode of slow recovery, in which the patient may lose some of the senses such as hearing, vision or smell momentarily. It should be noted that these episodes are repeated over time and are not triggered by an apparent cause.
How is epilepsy diagnosed?
The diagnosis of epilepsy is made based on the patient's medical history, evaluating the number of seizures and ruling out other pathologies that may have triggered a seizure (infectious, tumor or metabolic causes). The doctor will consider performing additional tests such as neuroimaging studies and the EEG.
The symptoms of epilepsy must be evaluated by the doctor, who must carry out a detailed medical history of the patient, ruling out with his questioning a non-epileptic cause of the seizures (history of diabetes mellitus, brain tumors, relatives with arteriovenous malformations, tissue diseases connective, among others.)
It is necessary that after a seizure, the doctor indicates a cerebral tomography with contrast or a cerebral magnetic resonance, in order to rule out a structural lesion of the cerebral cortex.
It is a study that evaluates the functioning of the cerebral cortex and detects abnormal electrical discharges in the brain lobes. Some patients with epilepsy may have a normal EEG, so the diagnosis should be based on all the tests together.
Cerebrospinal fluid study:
It is obtained by performing a lumbar puncture, which is performed only if it is necessary to rule out the presence of a neuroinfection (such as meningitis or encephalitis) or a subarachnoid hemorrhage. It is recommended to perform this study after performing a brain tomography that rules out a space-occupying lesion or moderate or severe cerebral edema.
The doctor will consider carrying out blood tests if an infectious state is suspected (to evaluate white blood cells), hypoglycemia or to rule out a pseudo-seizure (movements that resemble a seizure that are of psychiatric origin), for which he will request prolactin and CK levels that will rise after 10 to 20 minutes of a true seizure.
Another laboratory study that the doctor may request, in patients who already have treatment for epilepsy, are the levels of anticonvulsants (such as carbamazepine, lamotrigine and oxcabazepine); since some patients convulse with levels below therapeutic to control their pathology.
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