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  EPILepsy - LETS TALK ABOUT IT !!!   

WHAT IS EPILEPSY 





Epilepsy is a neurological condition, which affects the nervous system. Epilepsy is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition like alcohol withdrawal, extremely low blood sugar, heart problems or some other medical condition. Sometimes, epilepsy can be diagnosed after one seizure, if a person has a pre existing condition that places them at high risk for having another. Greater awareness about Epilepsy is your insurance to a more fit and healthy life.


Epilepsy is currently defined as a tendency to have recurrent seizures (sometimes called fits). A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption in the normal message passing between brain cells. This disruption results in the brain’s messages becoming halted or mixed up.
The  human brain is responsible for all the functions of your body, so what you experience during a seizure will depend on where in your brain the epileptic activity begins and how widely and rapidly it spreads. For this reason, there are many different types of seizure and each person will experience epilepsy in a way that is unique to them. Just as there are many different kinds of seizures, there are many different kinds of epilepsy. Doctors have identified hundreds of different epilepsy syndromes -- disorders characterized by a specific set of symptoms that include Epilepsy. Some of these syndromes appear to be hereditary. For other syndromes, the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. People should discuss the implications of their type of Epilepsy with their doctors to understand the full range of symptoms, the possible treatments, and the prognosis. The word "epilepsy" comes from the Greek word epi meaning "upon, at, close upon", and the Greek word Leptos meaning "seizure". From those roots we have the Old French word epilepsie, and Latin word epilepsia and the Greek words epilepsia and epilepsies.



How do I know if I have Epilepsy?

Your doctor will take a detailed medical history (including a family history of seizures), gather information about your behaviour before, during, and after the episode, and do a physical examination. An electroencephalogram (EEG) or brain
 wave study - performed on a Sleep -deprived individual can reveal abnormal brain waves characteristic of  Epilepsy 
and imaging tests such as an MRI or CT scan can identify brain abnormalities that may be causing seizures.





PHOTOSENSITIVE EPILEPSY

Photosensitive epilepsy is a type of epilepsy, in which all, or almost all, seizures are triggered by flashing or flickering lights or strobe lights. Both natural and artificial light may trigger seizures. Some patterns, like stripes or checks, can also trigger seizures for some people with photosensitive epilepsy.
Various types of seizure can be triggered by flashing or flickering light. These include tonic-clonic, absence, myoclonic and focal seizures. The most common is a tonic-clonic seizure. The seizure(s) will usually happen at the time of, or shortly after, looking at the trigger. Around three in every 100 people with epilepsy have photosensitive epilepsy. It usually begins before the age of 20, most commonly between the ages of seven and 19. Photosensitive epilepsy affects more girls than boys. If you have an epileptic seizure when looking at flashing or flickering lights or certain patterns, this is a sign that you may have photosensitive epilepsy.

Your doctor may ask you to have an electroencephalogram (EEG) test. This test records the electrical signals from your brain on an EEG machine. During the test, you will be asked to look at some flashing lights. If doing this changes the electrical signals in your brain, it may indicate that you have photosensitive epilepsy.

The person doing the test will usually try to stop the test before you actually have a seizure. However, there is a small risk that you will have a seizure when the test is done.

WHAT IS AN EEG

An electroencephalogram (EEG) is a test to measure the electrical activity of the brain.  Brain cells talk to each other by producing tiny electrical signals, called impulses. An EEG helps measure this activity. The test is done by a EEG specialist in your doctor's office or at a hospital or laboratory. You will be asked to lie on your back on a bed or in a reclining chair. Flat metal disks called electrodes are placed all over your scalp. The disks are held in place with a sticky paste. The electrodes are connected by wires to a speaker and recording machine. The recording machine changes the electrical signals into patterns that can be seen on a computer. It looks like a bunch of wavy lines.

You will need to lie still during the test with your eyes closed because movement can change the results. But, you may be asked to do certain things during the test, such as breathe fast and deeply for several minutes or look at a bright flashing light.


Normal Results

Brain electrical activity has a certain number of waves per second (frequencies) that are normal for different levels of alertness. For example, brain waves are faster when you are awake, and slower when you are sleeping. There are also normal patterns to these waves.



What Abnormal Results Mean

Abnormal results on an EEG test may be due to:

  • Abnormal bleeding (hemorrhage)
  • An abnormal structure in the brain (such as a   brain tumor )
  • Attention problems
  • Tissue death due to a blockage in blood flow (cerebral infarction)
  • Drug or alcohol abuse
  • Head injury
  • Migraines (in some cases)
  • Seizure disorder (such as epilepsy or convulsions)
  • Sleep disorder (such as Narcolepsy)
  • Swelling of the brain (Encephalitis)     

Note: A normal EEG does not mean that a seizure did not occur.

CT scans (computerised tomography)

A CT scan is a type of X-ray that shows the physical structure of the brain. It does not show if you have epilepsy. However it may show if there is anything in your brain, such as a scar, or damaged area, that could cause epilepsy. Not everyone will need to have a CT scan.

Magnetic resonance imaging (MRI) scan

An MRI scan can often detect possible causes of epilepsy, such as defects in the structure of your brain or the presence of a brain tumour. When a magnetic resonance imaging (MRI) scanner is used to investigate epilepsy, it takes detailed pictures of your head. It can help to find if there is an abnormality that might be causing epilepsy, for example, scar tissue due to a brain injury. The MRI will send images of your brain to a computer, which will show different types of brain tissue in different colours. The person who does the test is a radiographer. The radiographer may need to inject you in your hand or arm, with a harmless dye, to make the tissue show up more clearly. This could make you feel hot and flushed, but it will not hurt.

The MRI is a common scan used for individuals with Epilepsy, particularly if any of the following applies to a person suffering with Epilepsy:

You developed Epilepsy before the age of two years or in adulthood; or
You could have damage in your brain which may be causing the seizures; or
You continue to have seizures despite taking medication.

The MRI will look for an anything unusual in a specific area of the brain, which may be the cause of the seizures.


How can I prevent epilepsy?

In someone with epilepsy, certain triggers can lead to a seizure. Identify and watch for particular behaviours, environments, or physical and emotional signs that precede attacks. It's not uncommon, for example, to feel annoyed or elated several hours prior to a grand mal seizure, and immediately before the attack. By far the most common approach to treating epilepsy is to prescribe Anti Epileptic drugs. The first effective antiepileptic drugs were bromides, introduced by an English physician named Sir Charles Locock in 1857. He noticed that bromides had a sedative effect and seemed to reduce seizures in some patients. More than 20 different antiepileptic drugs are now on the market, all with different benefits and side effects. The choice of which drug to prescribe, and at what dosage, depends on many different factors, including the type of seizures a person has, the person’s lifestyle and age, how frequently the seizures occur, and, for a woman, the likelihood that she will become pregnant. People with epilepsy should follow their doctor’s advice and share any concerns they may have regarding their medication.

In addition, the person may become aware of a warning "aura", perhaps a taste or smell: This warning may allow you to lie down in time to avoid falling. In cases where the aura is a smell, some people are able to fight off seizures by sniffing a strong odour, such as garlic or roses. When the preliminary signs include depression, irritability, or headache, an extra dose of medication (with a doctor's approval) may help prevent an attack. In the case of a Jacksonian seizure, firmly squeezing the muscles around those that are twitching can sometimes stop the attack.  Take as many precautions if your seizures are not fully controlled. Avoid or limit alcohol, comply with DVLA requirements for a seizure-free period prior to driving a vehicle (this is normally a year, but it is your responsibility to check with the relevant authority). It is important to teach family members about how to minimise injury if you have a seizure. Tell them to protect you against falling, and to roll you onto your side into the recovery position if you lose consciousness.

WHAT ARE TRIGGERS

Triggers are situations that can bring on an Epileptic  Seizure in some people with epilepsy. Some people do not have any specific triggers for their seizures, but common triggers include tiredness and lack of sleep,anxiety, panic, fear, stress, alcohol, and not taking medication. For some people, if they know what triggers their seizures, they may be able to avoid these triggers and so lessen the chances of having a seizure- or even avoid the situation. Triggers for seizures are not the same as  for  the condition of Epilepsy it self. A trigger for someone to have their first seizure may be a stressful situation, but the underlying cause for that person to start having seizures may be quite different. Causes can include structural damage to the brain, from birth, from a stroke, or an infection such as meningitis, or through a head injury. Causes can also be genetic, for example a naturally low resistance to having seizures (a low seizure threshold), or another condition that makes a person more likely to develop seizures, such as Tuberous Sclerosis.

How can stress cause seizures?

Stress can affect brain function in the following ways:

Stress can trigger an increase in the breathing rate, known as hyperventilation. Doctors use hyperventilation to provoke seizures in certain patients, especially those with absence seizures.

Stress may cause you to miss your medication, leading to an increase in seizures.

Stress can cause hormonal changes such as an increase in the steroid hormone cortisol, which also may influence seizure activity.

Negative emotions related to stress, such as worry or fright, may cause seizures. This may happen because the limbic system, the portion of the brain that regulates emotion, is one of the most common places for seizures to begin.

How can I deal with stress in my life?

Try to avoid situations that you know will be stressful.

Learn relaxation techniques or take yoga or tai chi classes.

During times when you can't avoid stress, make an extra effort to get enough sleep and to take your seizure medicine on time.



THE IMPORTANCE OF SLEEP AND EPILEPSY

There are a number of topics about sleep that are of particular concern to people with epilepsy. First, sleep disruption from any cause can be a reason for an increase in seizure frequency or severity. Second, sleep disruption can also have a negative effect on short-term memory, concentration, and mood. Seizures during the night can disrupt sleep, possibly resulting in further problems with memory and concentration the following day. Finally, various anticonvulsant drugs can affect sleep in both positive and negative ways.

Studies have shown that, overall, about 20% of seizures occur during sleep. Most sleep seizures begin during stage 2, with few beginning during slow wave sleep. These are times during which the electrical activity of the brain is more synchronized (rhythmic), which is why scientists believe that seizures are more likely to begin during these states. By contrast, few or no seizures begin during REM sleep, though it is not known why the state of REM sleep (occupying roughly one quarter of sleep time) appears to be protective against seizures.

Sleep deprivation, whether due to sleep disorders, nocturnal seizures, or simply not sleeping enough, has long been thought to increase the risk of seizures. In specific syndromes such as juvenile myoclonic epilepsy, this relationship can be quite dramatic to the point where seizures rarely or never happen when sufficient sleep is obtained. Sleep deprivation also increases the risk of partial seizures in many patients particularly when occurring frequently. This can be due to sleep disorders from outside influences like poor sleep hygiene, or because patients are busy and simply do not get enough sleep. Any of these influences can result in increased seizures, further disrupting the already limited sleep time, and leading to a vicious cycle of sleep disruption and intractable seizures. In this scenario, seizures are not likely to be controlled unless the sleep disruption is also resolved.

People with epilepsy are particularly vulnerable to the effects of sleep disruption, and unfortunately seizures and the medications used to control them can contribute to this problem. If you have problems with drowsiness or trouble with your memory or concentration, even when you seem to be spending enough hours asleep, you may need a change of seizure medicine or a sleep study. To achieve your best overall level of function, you must pay attention to the relationship between your seizures and your sleep.

REM  SLEEP

Rapid eye movement sleep, or REM, is one of the five stages of sleep that most people experience nightly. It is characterized by quick, random movements of the eyes and paralysis of the muscles. The amount of time spent in REM sleep varies significantly with age; it normally makes up around 20-25% of an adult humans total time spent asleep (on average about 90-120 minutes), and approximately 80% of a newborn's. People usually experience REM sleep 4 or 5 times a night (it comes in cycles), the first cycle - which occurs at the beginning of one's sleep - only lasts for a short time, with each following cycle being a little longer.During REM, certain neurons in the brain stem, called REM sleep-on cells, become especially active - these cells are most likely what trigger this phase in the sleep cycle. Once triggered and in a state of REM, the body stops releasing neurotransmitters - called monoamines - that are responsible for stimulating the motor neurons; this means that the muscles stop moving, essentially entering a state of temporary paralysis.












Try A Malt Drink at Bedtime

Malt are germinated cereal grains, usually barley, that have been dried out in a process known as "malting," which allows enzymes to break down the grain's complex sugars into simple sugars, such as maltose. The maltose is then consumed by yeast during the process of fermentation. Malt extract is a concentrated liquid or powdered form of malt used to make many beverages, such as beer, whisky, malted shakes and flavored drinks such as Horlicks and Ovaltine. It is also considered a dietary supplement and can provide some essential nutrients for your mind and body. Drinking malt extract beverages at night or closer to bed time might help you get to sleep more easily because of the mineral content, which relaxes your muscles. The maltose in malt extract is easy for your body to digest and provides a quick source of energy. B vitamins are needed for metabolism and energy production. Minerals are needed for normal muscle tone and strong bones. Some  people prefer hot beverages like Horlicks. Horlicks is a malt drink made from powdered granules and warm milk. It is marketed as an aid to promote sound sleep. The drink is manufactured by a UK company that is also named Horlicks.

Or you may want to try a Hot Chocolate instead.   Although, coco and  hot chocolate,  are thought to help you sleep. It is recommended that you avoid pure chocolate drinks as these may be stimulants and keep you awake. Carefully read the label to see that there is no caffeine within the product.



Travel AND JET LAG

You should make sure you have sufficient medication with you for your travels. Long journeys and jet-lag may make you tired and more prone to a seizure. This should not stop you from travelling. However, it may be best that someone on the trip be aware of your situation. Some antimalarial tablets interfere with anti-epilepsy medication. Your Epilepsy nurse, pharmacist or travel clinic should be able to advise you about this.

LONG HAUL TRAVEL AND EPILEPSY 

Long haul flights can add to stress and can provoke seizures by:

  • disturbing sleep/lack of sleep
  • days being longer (flights travelling eastwards)
  • days being shorter (flights travelling westwards)
  • (travelling north to south or vice versa doesn’t seem to pose the same problems)
  • crossing time zones can pose problems of when to take medication (seek advice from your doctor before commencing the journey)
  • having unusual/erratic mealtimes
  • dry, stuffy atmosphere in the cabin—drink plenty of still water and avoid alcohol
  • jet lag on arrival.

Flights can reduce travel time but they can also be stressful. Stress may be further exacerbated by :

  • struggling with luggage
  • long queues for check-in, security, passport control
  • delayed flights
  • making connecting flights
  • long queues for check-in, security, passport control

Food and Drink

For your comfort and safety during your journey, make sure you have enough to eat and drink.

Stay hydrated

Air travel in particular can cause dehydration, which may be a seizure trigger for some
people. When you are dehydrated, your attention and concentration can decrease by 13% and short term memory by 7%. No matter how you are travelling, drink 6-8 glasses of water a day to stay on top form during your journey.
Don’t ever go hungry.

Hunger can cause blood sugar levels to fall which may in turn trigger seizures. Make sure you eat regularly; if travelling by car take plenty of breaks and plan ahead for rail and air journeys.

Avoid alcohol

It is safest to avoid alcohol when travelling particularly on long journeys and when flying. Alcohol can lead to dehydration and interferes with the absorption of antiepileptic medication, which in turn can cause seizures not whilst drinking but afterwards. Alcohol may pose the additional risk of status epilepticus occurring.






Medication

If you are going on a long trip find out well in advance if your AEDs will be available in the country or countries you intend to visit. Older AEDs are normally available in Western Europe, USA, Canada, Australia, New Zealand and Japan. Newer AEDs  may only be licensed for sale in a small number of other countries. Be aware that your  AED may be known under a different name outside the UK. Your GP, pharmacist or Epilepsy Connections will be able to advise you about the availability of your particular medication and how to get it while you are travelling.


Epilepsy medicines available in the United Kingdom

The main way of treating epilepsy is with epilepsy medicines. You may hear these referred to as anti-epileptic drugs.The following information is taken mainly from the British National Formulary (BNF) Number 64 (September 2012). Published by the British Medical Association and the Royal Pharmaceutical Society of Great Britain, it is updated twice a year. For the most up-to-date information, visit the British National Formulary  website. The medicines listed are those usually prescribed for everyday seizure control. Other medicines, such as diazepam or midazolam, are available for emergency use. We have not included emergency medicines on this list. Most side effects of antiepileptic drugs involve such as fatigue, dizziness, or weight gain. However, severe and life-threatening side effects such as allergic reactions can sometimes occur. Epilepsy medication also may predispose people to developing depression or psychoses. People with epilepsy should consult a doctor immediately if they develop any kind of rash while on medication, or if they find themselves depressed or otherwise unable to think in a rational manner. Other danger signs that should be discussed with a doctor immediately are extreme fatigue, staggering or other movement problems, and slurring of words. People with epilepsy should be aware that their epilepsy medication can interact with many other drugs in potentially harmful ways. For this reason, people with epilepsy should always tell doctors who treat them which medications they are taking. Women also should know that some antiepileptic drugs can interfere with the effectiveness of oral contraceptives, and they should discuss this possibility with their doctors.

Word list

adjunct/adjunctive

used with other epilepsy medicines

atypical

not typical or not usual

monotherapy

used on its own

focal-onset seizures

seizures that start in one part of the brain

refractory seizures

seizures that are difficult to control with epilepsy medicines

secondary generalisation

Focal seizures that spread to the rest of the brain, causing generalised seizures

Under the heading Indications in epilepsy, the main use of each medicine is given. Sometimes a doctor may prescribe medicines for other seizure types than those listed. You can find information about side-effects of individual epilepsy medicines on the  Medicine Guides website. Epilepsy medicines are available in a number of different formulations such as tablets, capsules, chewtabs, sugar-free liquid, syrup, dispersible tablets, crushable tablets and sprinkle capsules.


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