Epilepsy Risk Factors, and treatments 



Epilepsy Risk Factors

  1. Premature birth or low birth weight
  2. Trauma during birth (such as lack of oxygen)
  3. Seizures in the first month of life
  4. Abnormal brain structures at birth
  5. Bleeding into the brain
  6. Abnormal blood vessels in the brain
  7. Serious brain injury or lack of oxygen to the brain
  8. Brain tumors
  9. Infections of the brain such as meningitis or encephalitis
  10. Stroke resulting from blockage of arteries
  11. Cerebral palsy
  12. Mental disabilities
  13. Seizures occurring within days after head injury
  14. The family history of epilepsy or fever-related seizures
  15. Alzheimer's disease (late in the illness)
  16. Lengthy fever-related (febrile) seizures
  17. Alcohol or drug abuse

Complications

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

  1. Falling. If you fall during a seizure, you can injure your head or break a bone.
  2. Drowning. If you have epilepsy, you're 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
  3. Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment.
  4. Many states have driver's license restrictions related to a driver's ability to control seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being allowed to drive.
  5. Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you're considering becoming pregnant, talk to your doctor as you plan your pregnancy.
  6. Most women with epilepsy can become pregnant and have healthy babies. You'll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It's very important that you work with your doctor to plan your pregnancy.
  7. Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety, and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.

Other life-threatening complications of epilepsy are uncommon
  1. Status epilepticus. This condition occurs if you're in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
  2. Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions.

People with frequent tonic-clonic seizures or people whose seizures aren't controlled by medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.


Diagnosis


 A doctor makes his or her epilepsy diagnosis based on symptoms, physical signs and the results of such tests as an electroencephalogram (EEG), computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI).
It is essential that the type of epilepsy and the type of seizures both are diagnosed properly. There are several major classifications of seizures and most are associated with specific forms of the disorder.




Treatment


 Epilepsy may be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment choice for almost all patients with multiple seizures. Some patients who only have a single seizure and whose tests do not indicate a high likelihood of seizure recurrence may not need medications. The medications treat the symptoms of epilepsy (the seizures), rather than curing the underlying condition. They are highly effective and completely control seizures in the majority (approximately 70%) of patients. The drugs prevent seizures from starting by reducing the tendency of brain cells to send excessive and confused electrical signals.
With many different antiepileptic drugs currently available, choosing the right medication for an individual patient has become complicated. Choice of medication depends on a variety of factors, some of which include the type of seizure and type of epilepsy, the likely side effects of the medication, other medical conditions the patient may have, potential interactions with the patient’s other medications, age, gender and cost of the medication.

 Before any drug is prescribed, patients should discuss potential benefits, side effects and risks with their doctors.
Diet therapy may be utilized in some patients with specific forms of epilepsy. The most common diets utilized are the ketogenic diet and the modified Atkins diet. The ketogenic diet is a special high-fat, adequate protein and low carbohydrate diet that is initiated over three to four days in the hospital. The modified Atkins diet is similar to the ketogenic diet but is slightly less restrictive. It can be initiated as an outpatient. Both diets have been shown to reduce seizures in approximately half the patients that are identified to be appropriate candidates. These are mainly children with refractory epilepsy who are not surgical candidates.
While approximately 70 percent of patients have well-controlled seizures with these modalities, the remaining 30 percent do not and are considered medically-resistant. Patients with medically-resistant epilepsy are often treated at specialized epilepsy centers in a multi-disciplinary fashion.

The team of trained specialists that collaborate to provide these patients with comprehensive diagnosis and treatment of epilepsy may include:

  1. Adult epileptologists
  2. Pediatric epileptologists
  3. Epilepsy nurse practitioners
  4. Epilepsy neurosurgeons
  5. EEG technicians
  6. Clinical neuropsychologists
  7. Psychiatrists
  8. Neuroradiologists
  9. Nuclear medicine radiologists
  10. Dietitians
  11. Neuroscience nurses

In patients whose seizures are medically resistant, surgery provides the best chance of complete control of seizures. However, not all patients with refractory epilepsy are suitable candidates for surgery. In addition to being refractory, they need to have partial, rather than generalized epilepsy (i.e. their epilepsy arises from a single part of the brain, rather than from both sides or from all over the brain).
Furthermore, the epileptic region should be in a part of the brain that, if removed, is unlikely to result in major neurological complications. Whether or not patients are likely to benefit from surgery is determined by detailed testing (pre-surgical evaluation).
The pre-surgical evaluation consists of a one- or two-phase process to determine if surgery is the best option and can provide good seizure control with minimal risk. Phase I involves all non-invasive (non-surgical) tests. Phase II testing involves invasive tests (requires surgery) that are used in select patients.

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