Excerpt
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Abstract
The principal aim of this report is to develop advanced understanding of the status of
epilepsy, especially regarding its etiology, pathophysiology and treatment approaches.
Therefore, I carried out an extensive research on epilepsy to gather the most relevant
information on the disorder. In this research, I understood the definition of epilepsy and its
history.
Epilepsy is defined as a brain disorder which occurs when neurons convey abnormal
signals owing to interruptions in the process of generating electrochemical impulses. In
practice, epilepsy is characterized by seizures in which neurons fire signals repeatedly.
Epilepsy does not have a universally acceptable cause, but there are some factors
which are believed to contribute to the onset of the condition. Epidemiological studies reveal
that epilepsy is associated to genetic factors, head trauma, infectious diseases, prenatal injury
and some brain conditions. On the other hand, the pathophysiology of epilepsy involves two
principal physiological mechanisms: ictogenesis and epileptogenesis. During ictogenesis,
neuronal networks develop hyperexcitability, and this accounts for the signs and symptoms
presented as seizures.
In practice, medical treatment for epilepsy involves a monotherapy in which a single
drug is chosen to be administered to the patient based on the type of seizure observed. There
are seven different pharmacological agents which are used for monotherapy. Some of the
most common drugs used in the monotherapy are clonazepam, lamotrigine, gabapentin,
phenytoin, sodium valproate, phenobarbital and oxcarbazepine. These drugs have diverse
beneficial effects on different patients, and their dosages and modes of administration are also
different. In addition, the indications and mechanisms of the drugs are different.
Currently, there are different types of seizures which are classified in accordance to
the degree of consciousness, and drug therapy aims at eliminating the neuronal activity
experienced during seizures.
This information enabled me to conclude that epilepsy is a significant brain disorder
that requires attention by physicians and families.
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Introduction
Epilepsy is defined as a brain disorder which occurs when neurons convey abnormal
signals owing to interruptions in the process of generating electrochemical impulses.
Ordinarily, neurons operate in a highly coordinated order to produce human feelings,
thoughts and actions (Aicardi, Engel & Pedley, 2008). This neuronal activity is impaired in
epileptic conditions in which strange behavior, sensations and emotions occur leading to
muscle spasms, convulsions or even loss of consciousness.
In practice, epilepsy is characterized by seizures in which neurons fire signals
repeatedly. It is reported that during a seizure, the neural system can produce more than 500
signals within a second, and this attributable to the abnormal activity of the nerve clusters in
the brain.
Historically, epilepsy is known as the oldest mental illness to be identified by man. It
dates back to 400 B.C when Hippocrates described it as a brain disorder. Currently, epilepsy
has become an enormous challenge to the global public healthcare because it is not curable.
This implies that, the management of epilepsy poses challenge to physicians although surgery
techniques and medicines help in controlling seizures in 80 percent of epileptic patients. It is
estimated that 2.5 million individuals in the US have been diagnosed with epilepsy
(Goldenberg, 2010). However, experiencing a single seizure does not necessarily suggest
epilepsy. This is why a comprehensive diagnosis is required in determining epilepsy and the
different forms of seizures, in order to adopt the most appropriate treatment option.
Therefore, this report will provide a comprehensive overview on epilepsy.
Etiology of Epilepsy
Epilepsy does not have a universally acceptable cause, but there are some factors
which are believed to contribute to the onset of the condition. Epidemiological studies reveal
that epilepsy is associated to genetic factors, head trauma, infectious diseases, prenatal injury
and some brain conditions (Goldenberg, 2010).
Epilepsy has been found to run with families, and this suggests that some genes are
responsible for the condition. Currently, about 500 genes have been identified to be involved
in epileptic seizures. These genes have been found to influence an individual's response to
environmental conditions. It is believed that some genes make some people more sensitive to
some environmental stimuli which trigger seizures (Aicardi, Engel & Pedley, 2008).
On the other hand, brain conditions such as stroke and brain tumors can cause
epilepsy because they cause brain damage. For instance, stroke and Alzheimer's have been
identified as the leading cause of epilepsy, especially in old adults (Goldenberg, 2010). Head
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trauma has also been found to be a significant cause of epilepsy. In most cases, people with
traumatic injuries resulting from car accidents and other injuries present with epilepsy. On the
other hand, brain damage during the embryonic development of the fetus cause epilepsy more
or less the same way as it occurs in cerebral palsy.
Infectious diseases and developmental disorders are also considered as significant
causes of epilepsy. Some infectious diseases, especially those which cause brain damage such
as meningitis, viral encephalitis and AIDS cause epilepsy. On the other hand, developmental
disorders such as neurofibromatosis and autism are believed to play significant roles in the
onset of epilepsy.
Pathophysiology of Epilepsy
The pathophysiology of epilepsy explains why some signs and symptoms are
observed in epileptic patients. However, it is worth distinguishing the pathophysiology of
epilepsy from seizures which are usually caused by the synchronous, excessive or abnormal
neuronal activity in the patient's brain. Ordinarily, epileptic seizures are manifested by
sensory auras, convulsive movements and altered awareness. Therefore, the pathophysiology
of epilepsy explains the mechanisms involved in the initiation of epileptic seizures and the
development of the patient's seizure-prone brain (Eisai, 2012).
The pathogenesis of epilepsy involves two principal physiologic mechanisms:
ictogenesis and epileptogenesis. Ictogenesis is associated with hyperexcitation in the neural
system. This excitation is believed to originate from different molecular sources including
individual neurons, neuronal networks and the neuronal environment (Eisai, 2012). It is
believed that functional, structural and physiologic changes in the postsynaptic membrane of
neurons cause excessive excitation, and this causes seizures.
The spread of seizures and the effect of synaptic and nonsynaptic mechanisms play a
significant role in epileptogenesis. During epileptogenesis, thalamocortical networks,
synaptic, nonsynaptic and astrocytes play significant roles in the development of
hypersynchronicity leading to ictal-interictal transition (Blumenfeld, 2003).
Types of Epileptic Seizures
Epileptic seizures are some of the most prevalent pediatric neurologic disorders
among children, especially in children aged below three years. However, seizures occur in the
first 16 years of the child's development and growth but, their frequency decreases with older
age. Friedman and Sharieff (2006) state "seizures are the most common pediatric neurologic
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disorders, with 4% to 10% of children suffering at least one seizure in the first 16 years of
life" (p. 257).
There are different forms of epileptic seizures which are grouped into two broad
groups: partial and generalized seizures. In reality, these two types of seizures differ in the
level of consciousness.
Partial Seizures
Partial seizures are usually localized to a specific area of the brain. The most
prevalent types of partial seizures are simple partial seizures and complex partial seizures. In
simple partial seizures, patients do not experience loss of consciousness or awareness
(Goldenberg, 2010). On the other hand, complex partial seizures involve loss of
consciousness.
Generalized Seizures
Generalized seizures are different from partial seizures in that, they begin all over the
brain, and this is why they are described as generalized. Some of the most common
generalized seizures include tonic-clonic seizures, myoclonic seizures, atonic seizures,
absence seizures, and tonic seizures (Goldenberg, 2010).
Generalized tonic-clonic seizures, also referred to as grand mal seizures are among
the group of generalized seizures, which causes considerable alteration of the child's level of
consciousness. Grand mal seizures are known to be the most prevalent of all generalized
seizures (Friedman & Sharieff, 2006).
Ordinarily, generalized tonic-clonic seizures are not localized to one side of the brain
as it is the case with other forms of seizures. These seizures occur among children, usually in
five distinct phases although the most conspicuous phases are the clonic and the postictal
phases. The first phase involves the contraction of the child's body and the limbs, followed
by the extension period in which the body straightens. The third phase is characterized with
tremor, in which the child experiences rhythmic shaking and, the third phase, which is
referred to as the clonic period, involves contraction and relaxation of the body muscles,
characterized with continuous twitching of the limb and eye muscles. The postictal period is
usually characterized with body aches, fatigue, severe headache and vision impairment. In
general, generalized tonic-clonic seizures are believed to have a sudden onset but, they do not
cause sensory or motor aura.
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- Patrick Kimuyu (Author), 2018, Epilepsy Management. An Overview, Munich, GRIN Verlag, https://www.grin.com/document/388405
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