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Epileptic disorders It is a neurological disorder characterized by convulsions. It is one of the most common neurological diseases, with a prevalence of about 1%. Epileptic seizures are clinical events caused by abnormal electrical discharges in the cerebral cortex, localized or diffuse, which can be asymptomatic or significantly impaired.
What Causes Epilepsy?
Epileptic seizures are basically divided into partial (also called focal) seizures and generalized seizures. Partial seizures originate from epileptogenic foci in areas of the cerebral cortex, i.e. areas that have abnormal stimulation, and their clinical manifestations depend on the affected area. While generalized seizures involve the entire cerebral cortex and usually cause complete loss of consciousness. The causes of epilepsy differ depending on whether it is a partial or generalized form.
In symptomatic focal epilepsy, the most common cause is the presence of structural lesions, such as ischemic, hemorrhagic areas, tumors, or even scars from previous trauma or surgery. In other cases, although there is clinical evidence of the origin of the seizures from a specific brain area, radiological examinations such as CT or MRI (magnetic resonance imaging) cannot reveal the presence of a structural lesion.
On generalized epileptic disorder, there is an idiopathic form, in which it is believed that the patient, due to an individual, or sometimes hereditary predisposition, has a reduced epileptogenic threshold in which his cerebral cortex can experience seizures even in the absence of certain external causes or stimuli. There are several conditions such as abstinence or abuse of psychotropic drugs, acute or chronic alcoholism, metabolic or electrolyte disturbances, which play a role as trigger factors in patients who already suffer from epilepsy.
Epilepsy generally has two peaks of incidence during life: the first in childhood, the second in the elderly population, after 65 years. This peak reflects the most common causes, which are common idiopathic or congenital forms, usually onset in childhood, and cerebrovascular and neurodegenerative diseases, which increase with age.
Epilepsy Symptoms
In partial seizures, the symptoms depend on the area of the brain affected. Therefore, depending on the involvement of motor, sensitive areas or language, jerks, abnormal movements, tingling, sensory disturbances, speech difficulties may appear. Visual phenomena, behavioral changes, strange feelings or deja-vu may also occur.
The most common type of seizure in epilepsy disorder are petit mal and tonic-clonic (grand mal) seizures. If there are no seizures, the patient suddenly becomes unconscious, often with the eyes open, usually does not fall, and there is no motor impairment. In tonic-clonic seizures, loss of consciousness is associated with diffuse muscle contractions, which causes the patient to fall to the ground. Mandibular contractures are common, transient cyanosis of the face with respiratory obstruction, and subsequent recovery periods of variable duration. There are also other, less common types of seizures such as tonic, atonic, or myoclonic seizures.
The most important diagnostic tests of epileptic disorders are electroencephalogram (EEG) and brain MRI (or, if this is not possible, CT). An EEG is a recording of the electrical activity of the brain that allows highlighting of several anomalies, called epileptiforms, that raise the suspicion, or sometimes pathognomics, of an epileptic condition. Brain MRI, on the other hand, is very important to look for or exclude structural brain pathology. EEG and MRI of the brain can still be completely negative even in certain cases of epilepsy, so the first diagnostic step is always represented by an accurate anamnestic and neurological examination.
Epilepsy Disorder Treatment
Single epileptic seizures should not be treated pharmacologically, except in very special cases. Epilepsy is the tendency of recurrent epileptic seizures, always requiring treatment that must be continued at least until the seizures are completely controlled. The first action that must be taken is to eliminate possible triggering factors, such as abuse of psychotropic drugs, alcohol and drugs.
If without precipitating factors, the patient is still experiencing seizures, pharmacological treatment should be given aimed at eliminating, or controlling epilepsy. In certain cases, and where there is a poor response to drug treatment, surgical treatment should be considered, which requires careful examination.
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