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The word Epilepsy comes from Greek and means to be "suddenly violently seized and overwhelmed." Those affected experience sudden seizures that can occur in varying degrees and degrees of severity, such as seizure patterns, causes, therapy, and first aid in epilepsy.
Epilepsy is one of the neurological diseases. Epilepsy is first mentioned when epileptic seizures occur repeatedly. The epileptic seizure is a single seizure of the brain, which occurs suddenly and usually stops after seconds or minutes.
Epilepsy is the most common chronic disease of the central nervous system. The risk of developing epilepsy is particularly high during the first years of life and from the age of 60 years. At least 5 percent of the population experiences at least one epileptic seizure by the age of 20, but epilepsy is present in only about a quarter of these children and adolescents.
The epileptic seizures are subdivided into several forms that are seriously different from each other. From dèja vu experiences and strange sensations of smell (for example, the scent of an orange grove or stink of a toilet block) to nails with hands to real cramps - all these signs can be the result of an epileptic seizure. And the seizure types change in part as the disease progresses.
Petit seizures are seizures with a short pause in consciousness, which usually does not lead to a fall or fall. Especially in childhood, these "small" seizures often express themselves only by the children briefly interrupting their current activity and stare absent-mindedly. Afterwards, they are often unaware of this. Seizures of this kind are therefore often referred to as daydreaming. In puberty, violent, sudden arm movements are typical of this type of seizure. Adults with petite seizures often perform automated - like machine-controlled - movements, which they do in a kind of twilight state.
In babies three months of age or more, there is a sudden flinching of the body (lightning), nodding of the head (Nick), and leading the arms (Salaam) forward. These seizures usually occur shortly before falling asleep or shortly after waking up and are difficult to treat.
This form is the most common form of childhood epilepsy. In schoolchildren before puberty, the seizures occur especially at night with facial twitching and speech difficulties. Often the children - seemingly awake - come to their parents' bedroom, but are unable to speak. Also typical is a drooping corner of the mouth with drooling saliva. The children later report being awakened by a strange feeling in their mouth.
Grand is the epileptic seizure that most people associate with epilepsy. In the event of a major attack, those affected suddenly become unconscious, falling to the ground, stiffening and twitching with arms and legs. Breathing may be irregular, the skin may turn blue. This big attack sometimes takes several minutes. After that, those affected often fall asleep, from which they awake dazed again. Urine usually goes away involuntarily, chair less often. As threatening as the grand mal seizure looks, it is usually not life threatening.
Febrile seizure in children is a casual attack that occurs in a feverish illness. This attack lasts 2 to 10 minutes and is the most common childhood cerebral seizure. Typical is a sudden loss of consciousness, followed by a muscular stiffening, which turns into twitches after 10 to 30 seconds. There are also cases where the muscles are limp and the children completely lose their body tension. The risk of later epilepsy is only slightly higher in children who have had a single febrile convulsion than their non-febrile counterparts.
Seizure This often causes twitching, which starts in one half of the face or in one hand and then gradually spreads over one half of the body. Rotational movements of the eyes, seeing flashes of light or alienated perception of the environment (eg lack of smell perception, taste sensations or the impression of having already experienced the situation - so-called Dèja vu experiences) are typical of the focal seizure. Those affected usually remain conscious. But for the most part they behave strangely for a few minutes: they fiddle, smack or laugh.
In the status epilepticus, a seizure lasts for more than 10 minutes, or a seizure follows the other in series, without the person being able to recover between seizures. Such status epilepticus is life-threatening and must be interrupted by the doctor medication. Please inform an emergency doctor immediately in such a case.
The cause of epilepsy is a change in the brain, which manifests itself in recurring epileptic seizures. Epilepsy can heal in childhood or persist throughout life. Some forms of epilepsy are particularly common in mentally disabled people, but most people with epilepsy are mentally fully developed. Often the cause of epilepsy is unknown. Epilepsy may be epileptic on epileptic seizures or may be caused or induced by congenital or acquired brain damage.
Sudden electrical discharges of many neurons in the brain simultaneously trigger epileptic seizures. This temporary disturbance can be triggered by several causes, such as:
Epileptic seizures are not always obvious at first glance, especially in young children and nocturnal, minor seizures. You should go to the doctor or call an ambulance, at:
The diagnosis of epilepsy is usually made by the doctor based on the symptoms that are asked in the case history interview. The only method for the direct detection of epilepsy is the EEG (electroencephalogram, recording of brain waves). In order to determine the extent of epilepsy more precisely, neuropsychological tests may be used in addition to further investigations. Most of all, they provide information about language, memory, attention, and general intelligence.
Continuous use of anti-epileptic drugs or anticonvulsants (drugs to suppress epileptic seizures) is only necessary in epilepsy, ie after repeated epileptic seizures. It can sometimes take months or years to find the appropriate drug and the right dosage, because each person reacts differently. Sometimes the therapy attempts are unsuccessful.
Commonly used anticonvulsants contain the following active ingredients: carbamazepine, ethosuximide, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, retigabine, topiramate, valproic acid (valproate) or zonisamide. Benzodiazepines are also used in epilepsy, for example clobazam, clonazepam, diazepam and lorazepam. After several seizure-free years, the doctor can usually reduce the dosage of the active ingredients.
Depending on the severity and frequency of epileptic seizures, surgical treatment for epilepsy may be the right choice. There are several possibilities:
If you are witnessing an epileptic seizure:
18.10.2021
Epilepsy usually breaks in early in life: around three out of four patients suffer from recurring epileptic seizures in their childhood. Especially at a young age, the disease can impair development and severely limit professional and social opportunities. An operation can make around two-thirds of young people permanently seizure-free, compared with 58 percent of adults. In addition, most patients who are not seizure-free postoperatively have significantly fewer seizures than before the operation. Nevertheless, this important therapy option is still used too seldom or too late, criticizes the German Society for Clinical Neurophysiology and Functional Imaging e.V. (DGKN). Hesitation means that a lot of valuable time is lost in their development, especially for young people.
There are currently around 640,000 people in Germany receiving medical treatment for epilepsy. With the help of modern anticonvulsants, around 70 percent of them can live free from seizures. "But that also means that drug therapy alone is not enough for almost every third person affected," says Professor Dr. med. Felix Rosenow, Head of the Epilepsy Center Frankfurt Rhein-Main at the Goethe University Frankfurt / Main and 1st Vice President of the DGKN. Surgical removal of the epilepsy focus is an important treatment option here. Patients in whom the anticonvulsants prevent seizures but cause severe side effects such as tiredness, dizziness, double vision and headaches, may also benefit from an operation.
For which persons a surgical procedure is possible, which chances of success exist and which functional failures are to be expected on the other side - questions like these can now be clarified quite precisely in advance of the operation. "With the help of brain wave recordings (EEG), magnetoencephalography (MEG) and modern imaging methods such as special high-field magnetic resonance imaging (3T MRT) adapted to epilepsy, the triggering brain region can be very precisely delimited," says Rosenow. These examinations are an important prerequisite for being able to plan a surgical procedure at all. The neurologist is all the more critical of the fact that parts of the specialized preoperative diagnostics such as the MEG and EEG source localization have so far not been settled with the health insurance companies and are only used in the context of research. "As a result, there is hardly any clinical application that prevents these methods from spreading." This deficiency may contribute to the fact that only around 500 epilepsy operations are performed per year in Germany - although experts assume that the procedure could bring relief to tens of thousands of patients.
The decision for or against a surgical intervention always rests with the person concerned, emphasizes Rosenow. Sometimes a difficult decision has to be made here - as in the case of a little girl whose epilepsy was noticeable by hand twitches, but also significantly impaired brain development. "By removing the focus of the seizure, the girl's brain was able to develop normally again. The price for this, however, was permanent paralysis of the affected hand," reports Rosenow. Such neurological deficits are unavoidable in some cases - after all, brain tissue is removed - but today they can be kept to a minimum. In many cases, the focus of the seizure can now be removed microsurgically or even minimally invasively through small drill holes without having to open the skull over a large area.
However, not only patients, but also many doctors still consider surgery to be the last resort. "On average, patients are treated with medication for 16 years before they are referred to a center with epilepsy surgery expertise," says Rosenow. In the meantime, the seizures cause some people to lose their job, their driver's license, or their partners. The Frankfurt neurologist therefore advocates examining the surgical option much earlier than before - at the latest when the second anti-epileptic drug does not bring about freedom from seizures.
22.09.2021
Epilepsy has many faces. With a genetically determined form, those affected suffer from severe epileptic seizures in the first year of life. The disease goes hand in hand with severe developmental disorders: They find it difficult to walk, they have trouble concentrating and later have problems speaking, arithmetic and spelling. Until now, this form of epilepsy could only be treated poorly with the usual drugs. For the first time, researchers from Tübingen are using a drug that is actually approved for use against multiple sclerosis.
The drug directly counteracts the underlying genetic defect and successfully alleviates the symptoms of the sick, reports the team led by Dr. Ulrike Hedrich-Klimosch, Dr. Stephan Lauxmann and Prof. Dr. Holger Lerche from the Hertie Institute for Clinical Brain Research, the University Hospital and the University of Tübingen. This means that the affected children and adults have access to drug treatment for the first time. The results are published in the journal "Science Translational Medicine".
This form of early childhood epilepsy is caused by a rare genetic defect. Mutations in the KCNA2 gene lead to damaged potassium channels in the brain. "Potassium channels are small pores that are located in the cell membrane of nerve cells and are important for the transmission of electrical signals," explains first author and biologist Hedrich-Klimosch. "In some sub-forms of the disease, the mutations lead to increased activity of the channel. In these cases we speak of a 'gain of function' mutation."
The research team is now using for the first time a drug for treatment that attacks precisely this point. "In this case, a cause-related therapy must inhibit the increased channel activity," explains co-first author and neurologist Lauxmann. "One such channel blocker is the active ingredient 4-aminopyridine. It specifically inhibits the overactivity of potassium channels and is contained in a drug approved for the treatment of gait disorders in multiple sclerosis patients." In cooperation with eight other centers around the world, the team treated eleven patients in individual healing attempts with the drug. With encouraging results: the symptoms improved in nine of them. "The number of daily epileptic seizures decreased or disappeared completely. The patients were generally much more alert and mentally fitter in everyday life. Their speech also improved after starting medication."
The active ingredient does not work in all sub-forms of the disease. In some, the gene mutation leads to reduced activity of the potassium channels. The researchers have created a database so that treating physicians can quickly decide whether the active ingredient can help a patient with a newly diagnosed KCNA2 gene defect or not. It lists the various mutations from the KCNA gene family and the associated effects on the potassium channel. In this way, therapy can be started quickly and the often severe course of the disease can be alleviated.
"Epilepsies that are caused by KCNA2 gene mutations are very rare diseases. Only about 50 cases are known worldwide," reports the head of the study and neurologist Lerche. The development of a suitable drug is usually too expensive for these "orphans of medicine" and not profitable enough for pharmaceutical companies. "We are all the more pleased when we can help these patients individually with so-called drug repurposing: the use of drugs that are actually approved for other diseases."
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