Epilepsy

Epilepsy means seizures, fits convulsion. Epilepsy is a paroxysmal and transitory disturbance of the function of the brain which develops suddenly, ceases spontaneously, and exhibits a conspicuous is a tendency to recur "Russel Brain". Epilepsy is characterized by abnormal electrical waves "discharges" in conducting nervous tissue between cerebral cortex and midbrain with chronically resuming disturbances of consciousness.

OCCURRENCE

• Incidence is 4-8 per 1000
• Age: Most common in infancy childhood and adolescence
• Sex: men and women appear to be equally affected

CAUSES

Unknown or idiopathic, ‘constitutional' cause asymptomatic epilepsy, increased susceptibility to seizure tend to run in some families.
Known causes of "Symptomatic Epilepsy"

1. Systematic diseases such as infection and fevers as well as intoxication "uraemia and eclampsia"
2. Local damage to the brain for example meningitis, neurosyphilis, encephalitis "rare", cerebral arteriosclerosis, cerebral thrombosis.
3. A cerebral tumour, very important cause of fits in a healthy adult.
4. Birth injury to the brain
5. Metabolic disturbance, for example, hypoglycaemia
6. Reflex epilepsy, for example, flashing lights watching television, bright lights
7. Hysteria.
8. Pre Morbid Personality
9. Episodes of aggressiveness impulsiveness and moodiness.

Type/Classification of Fit

There are many kinds of seizures and sometimes several types occur in the same individual.

Grand Mal or Major Epilepsy or General Convulsion:

Its onset occurs at any age, and it may be a sudden occurrence. This has a peculiar characteristic or sequence regardless of the cause they can be divided into six stages, which are as follows:

Aura or warning phase in 3-5 of all cases.

The patient experiences a peculiar smell, taste noise or other sensation.

Cry

The convulsion may begin with epileptic cry a harsh scream

Tonic Phase

the patient loses consciousness suddenly and completely fall to the ground, often sustains a cut, bruise or fracture, develops muscular rigidity, spasm. The jaws are closed, pupils are dilated, respiration ceases, transiently and cyanosis may be present and may last for 30-45 seconds.

Clonic Phase

The victim remains unconsciousness and in the stages of alternating contraction and relaxation of the muscles "twitching" with jerking of the head-trunk and limbs, biting of the tongue, micturition facial inconvenience may occur jerking gradually becomes slower and less forcible last for 1 – 5 minutes.

Coma

In this relaxation phase coma, tendon and cutaneous reflexes are absent, Heavy breathing through blowing lips, and body become flaccid, often passes into sleep or drowsiness for several hours.

Recovery Phase

Consciousness return automatism "action performed without later remembrance "may occur following a fit. In the post-seizure the patient may vomit, he confused, exhausted and complain of a headache

Petitmal Lapse Attack or Absence

Occurs most commonly in children but also occur in the adult, either alone or interspersed between grand mal attacks. Petit mal is a transient loss of consciousness, without a conspicuous convulsion, which develops without warning, the patient loses consciousness suddenly and for a few seconds. The victim may drop object held on the hand stare blankly, show slight twitching of face or finger or go pale.

Temporal Lobe Psychomotor Seizure

Lessons in one both temporal lobes. This Makes the patient confused and often anxious and negativistic, symptom is variable and the attack last from a few seconds to a minute or two exhibit amnesia, automatism altered consciousness and peculiar experience or smell, taste, sight or hearing.
Animatism is a distinctive feature of the temporal lobe seizure, the victim may smack his lip, make aimless or inappropriate movements, wander aimlessly and ramble in his speech, illusion and hallucination of smell, bound and taste may be present.

Focal and Jacksonia Seizures

This is characterized by localized motor sensory or combined phenomena location of convulsion movement depend on cerebral site of origin and manifestation may remain localised or may progress from one area of the body to another
‘referred to as a "Jacksonia Episode" and to a general seizure with loss of consciousness motor fit characterised by muscular contraction which begin in one parts of the body, thumb, big toe or corner of the mouth and may spread to another parts.

Akinetic Seizure

This is considered to be part of the peptitmal syndrome. There is a sudden loss of muscle tone and falling to the ground without losing consciousness.

Status Epilepicus

One fit succeeds another without the victim regaining consciousness between them. It is a dangerous condition, repetitive apnea, associated with lack of oxygen and accumulation of carbon dioxide is damaging to the brain especially in children, hyperpyrexia develops and patients may die, children who recover may be left blind spastic or demented.
Children will petit mal their personality is immature and over-dependent serious minded passive, stubborn, usually nice mannered and rarely aggressive.
Children will grand mal ‘especially with brain injury' tend to be aggressive stocking built and of normal intelligence, usually, have a positive family history and often an adverse environment.

Observation and Details of Fit

The affected person should be closely observed and details of behaviour recorded as follows:

1. What was the victim doing just before the attack, occupation, any particular attitude or prolonged lack of food?
2. The general condition before the attack ‘asleep', awake, irritable, dull.
3. Onset, was it sudden or gradual, falling?
4. Cry or noise
5. Colour of the face, was it pale, flushed, blue or natural?
6. Eye open or close were conceal reflex present
7. Movement, if there is any stiffness of the limbs, their position jerking or twitching. Purposive movement such as clutching at objects, or as observers, fighting or kicking, avoidance of examination
8. Turning of head, eyes and if so to which side?
9. Duration of movement
10. Biting the tongue
11. Sign after the attack, headache, sleep, vomiting, peculiar behaviour, weeping or other emotional disturbance.

Management

This self-perpetuating and extremely dangerous condition requires vigorous measure if life is to be saved and permanent brain damage averted.

1. Rest the affected person in a quiet, preferable darkened room.
2. Maintenance of good airway that is, head turned sideways to prevent mucus and saliva from running into the reaches. Ensure the victim is getting enough oxygen
3. Evacuation of the lower bowel by an enema followed by an enema containing chloral hydrate may rarely order.
4. Nourishment tube feeding may be necessary
5. Good monitoring of vital signs

Complication

1. Pulmonary complication such as pneumonia
2. Mental retardation
3. Heart failure which could result in death

Precaution

1. Ensure that they take their drug regularly
2. Victims should not be allowed out of observation if they frequent fits, because attack may occur during sleep also.
3. Find suitable employment that does not involve the use of heavy machinery or heights.
4. Guard against open fires
5. Forbid car driving, unless the epilepsy is well controlled.
6. Victims should not be allowed to bath alone or swim alone if they are subject too frequent attacks.

References

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Epilepsy
Everything You Need to Know About Epilepsy
Epilepsy