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Epilepsy is one of the most common transient brain dysfunctions. It is characterized by epileptic seizures: Nerve cells (neurons) in the brain suddenly fire synchronized and uncontrolled pulses for a short time.

Such a seizure can be pronounced to different degrees. Accordingly, the effects are variable. For example, some patients experience only a slight twitching or tingling of individual muscles. Others are briefly "as if stepping away" (absent). In the worst case, it leads to an uncontrolled seizure of the whole body and to a short unconsciousness.

In industrialized countries such as Germany, between five and nine out of every 1,000 people are affected by epilepsy. Every year, about 40 to 70 out of every 100,000 people become ill. The highest risk of disease is in childhood and beyond the 50th to 60th year of life. However, epilepsy can basically occur at any age.

The onset of epilepsy is diverse and complex. Often, the exact disease development remains in the dark. Thus, in some cases, despite modern investigation methods, no specific cause for epileptic seizures can be identified, even though there is clear evidence of a cause in the brain. Then one speaks of unexplained (cryptogenic) epilepsy.

Sometimes one can not even explain why a patient experiences epileptic seizures. There are no indications of the cause, such as pathological changes in the brain or metabolic disorders. This is what doctors call idiopathic epilepsy.

The long-term treatment of epilepsy patients usually takes over a resident neurologist or pediatric neurologist. Sometimes it may be wise to contact an outpatient clinic or clinic specializing in epilepsy treatment (Epilepsy, Epilepsy Outpatient Clinic, Epilepsy Center). For example, if the diagnosis is unclear, epileptic seizures occur despite treatment, or there are specific problems associated with epilepsy.

For most epilepsy patients, drug treatment helps to lead an attack-free life. Used are so-called antiepileptic drugs. They inhibit the excessive activity of nerve cells in the brain. This can reduce the risk of seizures. Therefore one speaks also of anticonvulsants (= anticonvulsants). But the drugs can not do anything about the cause of epilepsy. This means that anti-epileptic drugs only have a symptomatic effect but can not cure epilepsy.

In some patients, epilepsy is not sufficiently treatable with medication. If the seizures always start from a limited brain area (partial seizures), this part of the brain may be surgically removed (resection, resective surgery). This can in many cases prevent future epileptic seizures.

Resective surgery is only possible under certain conditions. Thus, cutting out the relevant brain region must be relatively safe. In addition, it must not entail any unacceptable disadvantages for the patient, such as serious impairment of certain brain functions.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a
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Epilepsy is the fourth most common neurological disorder and affects people of all ages. Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. 2020-03-10 Epilepsy Treatment
Profiles of Doctors for Epilepsy Treatment
Epilepsy Treatment

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.

Symptoms

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.

Small fit (Petit)

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.

BNS cramps (West Syndrome)

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.

Rolando-epilepsy

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.

Big fit (Grand)

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

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.

Localized (focal)

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.

Status epilepticus

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.

Causes

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.

Triggers of epileptic seizures

Sudden electrical discharges of many neurons in the brain simultaneously trigger epileptic seizures. This temporary disturbance can be triggered by several causes, such as:

  • Alcohol withdrawal
  • Fever
  • Brain or meningitis (encephalitis, meningitis)
  • Cerebral hemorrhage
  • Brain injury due to accident
  • Massive blood sugar waste
  • Lack of oxygen during childbirth
  • Stroke
  • Metabolic disorder of the brain
  • Tumor or malformation in brain development
  • Poisoning

Diagnosis

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:

  • frequently recurring attention breaks
  • frequent departure for short moments
  • febrile seizures lasting more than 15 minutes, or when another febrile seizure occurs in the same febrile illness
  • distinct, uncontrollable convulsions
  • a grand mal seizure
  • unconsciousness or inexplicable fall
  • epilepsy with a seizure of more than 10 minutes or when multiple seizures occur without a break in a row
  • especially recurrent epileptic seizures - even if they seem harmless - should not be taken lightly

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.

Treatment

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.

Surgical treatment of epilepsy

Depending on the severity and frequency of epileptic seizures, surgical treatment for epilepsy may be the right choice. There are several possibilities:

  • Surgical removal of the focal point in the brain
  • Transection of the nerve tracts over which a seizure spreads
  • Vagus nerve stimulation: The vagus nerve (10th cranial nerve) connects the brain with numerous internal organs. By electrical stimulation of the nerve to the excitability of the brain to be influenced

Further treatment methods

  • Psychotherapeutic procedures help to deal with epilepsy in everyday life or to cope in the workplace.
  • Biofeedback can help sufferers better control their seizures. In biofeedback, epileptics learn to sense signs of waste and respond to it in a targeted manner.
  • Ketogenic diet: By significantly increasing the fat and protein content and reducing the carbohydrate content in the diet, there are various metabolic changes in the brain that reduce the seizures in a way yet to be known exactly. The ketogenic diet must be started in the hospital and requires regular medical checks. Some patients have amazing results, while others have no profit.

Self-help with epilepsy

  • Detect and avoid seizure triggers (these include strobe flashes in nightclubs or on the hype / carnival).
  • Learn a method of self-control (biofeedback), which can also be used as an accompaniment to other forms of treatment.
  • A healthy lifestyle without lack of sleep or alcohol consumption reduces the number of seizures in many epileptics.
  • As an epileptic, you should also carry an emergency card. It is best to combine the emergency card with a so-called SOS capsule, which is worn on a chain around the neck. SOS capsules on the neck are easier for first responders than ID cards hidden in pockets or wallets.

First aid for epileptic seizures

If you are witnessing an epileptic seizure:

  • Keep calm.
  • Register the duration of the seizure.
  • Keep objects out of reach that could cause injury.
  • Loosen constricting clothing for those affected.
  • Do not push anything between your teeth (even if it bites your tongue, beware of suffocation).
  • Do not hinder the person affected by the convulsions. Do not hold your arms and legs, as this prolongs seizure duration.
  • Do not perform mouth-to-mouth resuscitation, despite irregular breathing.
  • Protect the person affected from hypothermia.
  • Contact a doctor or ambulance if twitching lasts more than 5 to 10 minutes, the face turns blue, the twitching only temporarily ceases, or the confusion persists for more than 30 minutes.
  • If the victim falls asleep, put the person in a stable side position.
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