How to recognize the causes of epileptic seizures, symptoms and treatments

This disease can affect a person when there are changes or damage in the brain. As is known, there are neurons or nerve cells in the brain which are part of the nervous system. Each of these nerve cells will communicate with each other using electrical impulses. In the case of epilepsy, seizures occur when electrical impulses are generated in excess.

1. Definition 

Epilepsy: A brain disorder characterized by a tendency to produce continuous epileptic seizures, with neurobiological, cognitive, psychological, and social consequences. This definition requires the occurrence of at least 1 epileptic seizure. 
Epileptic seizure: A momentary onset of signs/symptoms due to abnormal and excessive neuronal activity in the brain.

2. Etiology

The etiology of epilepsy can be divided into three categories, as follows:
Idiopathic: no structural lesions in the brain or neurologic deficits. It is thought to have a genetic predisposition and is generally age-related. 
Cryptogenic: considered symptomatic but the cause is unknown. These include West syndrome, Lennox-Gastaut syndrome and myoclonic epilepsy. Clinical features are consistent with diffuse encephalopathy. 
Symptomatic: epileptic seizures caused by structural abnormalities/lesions of the brain, e.g. head injury, CNS infection, congenital abnormalities, space destructive lesions, cerebral circulatory disorders, toxic (alcohol, drugs), metabolic, neurodegenerative disorders.

3. Diagnosis

Pre-, greeting, and post-awakening symptoms and signs:

• Before awakening / prodomal symptoms o Physical and psychological conditions that indicate an impending awakening, such as behavioral changes, feelings of hunger, sweating, hypothermia, drowsiness, sensitivity, and others.
• During awakening/ictal: o Is there an aura, symptoms felt at the beginning of the awakening? o What is the pattern/form of awakening, ranging from eye deviation, head movement, body movement, vocalization, aumatization, movement in one or both arms and legs, tonic/clonic awakening, incontinence, tongue biting, pallor, sweating, and others. (It would be better if the family can be asked to mimic the movement of the awakening or record a video during the awakening) o Is there more than one pattern of awakening? o Is there a change in pattern from the previous awakening o Activities of the person during the awakening, such as sleeping, awake, playing video games, micturition, and others.
• ∙Post-awakening/post-ictal: Confusion, immediate awareness, headache, sleep, restless noise, Todd's paresis.

4. Precipitating factors: fatigue, lack of sleep, hormonal, psychological stress, alcohol.
5. Supportive examination:

• Electro-encephalographic examination (EEG) EEG recording is the most useful examination when a seizure is suspected to: o Help support the diagnosis o Help determine the type of seizure or syndromes of epilepsy o Help determine the prognosis o Help determine whether OAE should be given.
• Brain imaging examination Useful for detecting epileptogenic lesions in the brain. High-resolution MRI (at least 1.5 Tesla) can non-invasively diagnose various pathologic lesions such as mesial temporal sclerosis, glioma, ganglioma, cavernous malformation, DNET (dysembryoplastic neuroepithelial tumor), tuberous sclerosis.4 Functional brain imaging such as Positron Emission Tomography (PET), Single Photon Emission Computed Tomography (SPECT) and Magnetic Resonance Spectroscopy (MRS) are useful in providing additional information on the impact of metabolic changes and regional blood flow changes in the brain associated with seizures.4 The indication for neuroimaging examination (CT scan of the head or MRI of the head) in cases of seizures is when the first unprovoked seizure appears in adulthood. The purpose of neuroimaging examination in this condition is to look for structural lesions that cause seizures. CT scan of the head is preferred for emergency cases, because the examination technique is faster. On the other hand, head MRI is preferred for elective cases. In terms of sensitivity in determining lesions in elective cases. In terms of sensitivity in determining structural lesions, MRI is more sensitive than CT scan of the head.
• Laboratory examination o Hematological examination This examination includes hemoglobin, leukocyte and type count, hematocrit, platelets, peripheral blood smear, electrolytes (sodium, potassium, calcium, magnesium), blood sugar level, liver function (SGOT/SGPT), ureum, creatinine and albumin. - Initial treatment as one of the references in ruling out differential diagnosis and OAE selection - Two months after OAE administration to detect OAE side effects - Routinely repeated every year to monitor OAE side effects, or if clinical symptoms arise due to OAE side effects.

6. Therapy

THE GOALS OF THERAPY The main goal of epilepsy therapy is to enable the person with epilepsy to live a normal life and achieve an optimal quality of life for his or her disability. The expectation is "generation-free, without side effects". To achieve this goal, several efforts are needed, including side / with minimal side effects, reducing morbidity and mortality. 
 

 

Sumber : Pedoman Tatalaksana Epilepsi. PERDOSSI. 2015.