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Epilepsy with Tonic-clonic Seizures

epilepsy general


A seizure is a short episode of symptoms caused by a burst of abnormal electrical activity in the brain. Typically, a seizure lasts from a few seconds to a few minutes. Different parts of the brain control different parts and functions of the body. Therefore, the symptoms that occur during a seizure depend on where the abnormal burst of electrical activity occurs.
There are different types of seizures but they are broadly divided into two main types - generalised and partial:

Generalised seizures. These occur if you have a burst of abnormal electrical activity which spreads throughout the brain. It affects consciousness, and may cause a convulsion.
Partial seizures. Partial seizures are also called focal seizures. In these types of seizures the burst of electrical activity starts in, and stays in, one part of the brain. Therefore, you tend to have localised symptoms.

What is a tonic-clonic seizure?

Your body becomes rigid due to strong muscular contractions (the tonic part). You lose consciousness and fall. Your chest muscles contract and force air out of your mouth, often with a grunt. Your jaw muscles contract and you may bite your tongue. Saliva may escape from your mouth. Your bladder may contract and you may pass urine. This stiff or tonic phase soon passes into the clonic (shaking or convulsive) phase. This is when the muscles repeatedly contract and relax. Your whole body appears to shake. This may last from a few seconds to a few minutes.

When the seizure has stopped, you gradually regain consciousness, but you may be confused and dazed for a while. The time taken to recover varies.

What is epilepsy?

If you have epilepsy, it means that you have had repeated seizures. If you have a single seizure, it does not necessarily mean that you have epilepsy. The definition of epilepsy is more than one seizure. The frequency of seizures in people with epilepsy varies. In some cases, there may be years between seizures. Epileptic seizures arise from within the brain. A seizure can also be caused by external factors which may affect the brain. For example, a high fever may cause a febrile convulsion. Other causes of seizures include: lack of oxygen, a low blood sugar level, certain drugs, poisons, and a lot of alcohol. Seizures caused by these external factors are not classed as epilepsy.

What causes epilepsy?

Unknown cause (idiopathic epilepsy)

Symptomatic epilepsy

In some cases, an underlying brain condition or brain damage causes epilepsy. Some conditions are present at birth. Some conditions develop later in life. There are many such conditions. For example: a patch of scar tissue in a part of the brain, a head injury, stroke, cerebral palsy, some genetic syndromes, growths or tumors of the brain, previous infections of the brain such as meningitis, encephalitis.

What triggers a seizure?

There is often no apparent reason why a seizure occurs at one time and not another.

  1. Stress or anxiety.
  2. Heavy drinking.
  3. Street drugs.
  4. Some medicines such as antidepressants, antipsychotic medication.
  5. Lack of sleep, or tiredness.
  6. Irregular meals which cause a low blood sugar level.
  7. Flickering lights such as from strobe lighting.
  8. Menstruation.
  9. Illnesses which cause fever, such as flu or other infections.

How is epilepsy diagnosed?

You should see a doctor if you have had a possible seizure or similar event. The most important part of confirming the diagnosis is the description of what happened. Therefore, it is important that a doctor should have a clear description of what happened during the event. Preferably this is from the person affected, and also from an eyewitness.

A brain scan - usually a magnetic resonance imaging (MRI) or computed tomography (CT) scan - can show the structure of different parts of the brain.

EEG. This test records the electrical activity of the brain.

Blood tests and other tests may be advised to check on your general well-being. They may also look for other possible causes of the event.

What are the treatments for epilepsy?

Medication

Epilepsy cannot be cured with medication. However, various medicines can prevent seizures. They work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures.

The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, the medicine. A common option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely. Medication is commonly started after a second seizure that occurs within 12 months of the first.
Tell your doctor if you intend to become pregnant. Pre-conception counselling is important for women with epilepsy.

Are there any other treatments?

Surgery to remove a small part of the brain, which is the underlying cause of the epilepsy. This is only a suitable option if your seizures start in one small area of your brain. It may be considered when medication fails to prevent seizures. Only a small number of people with epilepsy are suitable for surgery and, even for those that are, there are no guarantees of success.

Vagal nerve stimulation is a treatment for epilepsy where a small generator is implanted under the skin below the left collar bone. The vagus nerve is stimulated to reduce the frequency and intensity of seizures. This can be suitable for some people with seizures that are difficult to control with medication.

The ketogenic diet is a diet very high in fat, low in protein, and almost carbohydrate-free. This can be effective in the treatment of difficult-to-control seizures in some children.
Counselling. Some people with epilepsy become anxious or depressed about their condition.

During a seizure:

Note the time.
Do - prevent crowds gathering round.
Do - place a cushion or some clothing under the head to prevent injury.
Do not - try to restrain the person. If there is a warning (aura) before a seizure, it may be possible to guide the person to a safe place or cushion the expected fall to the ground.
Do not - move the person unless they are in a dangerous place (for example, in a road or next to a fire). If possible, move dangerous objects away from the person.
Do not - place anything in the person's mouth, or try to move their tongue.

Once the seizure has stopped:

Do - roll the person on to their side into the recovery position.
Do - check that breathing has resumed normally.
Do - stay and talk to the person. Give reassurance until they are fully recovered. It may take a while for the person to wake up fully. Do not leave a person alone whilst they remain dazed or confused.
Do not - offer something to eat or drink until you are sure they are fully recovered.

What is the outlook for people with epilepsy?

The success in preventing seizures by medication varies depending on the type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control. The overall outlook is better than many people good.


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