Epilepsy (Definition). 3 Research Paper Samples
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Types of epilepsy seizures 3
Signs and symptoms. 4
Causes of Epilepsy 6
Etiology and pathogenesis 7
Attachment 1: Figures 11
Works Cited 12
The ancient Greeks and Romans considered epilepsy as divine intervention – ‘Hercu- disease,’ ‘divine disease.’ Also in one of the medieval manuals of calling the spirits it is said that after the properly preparing for the ritual magician may die, experiencing an epileptic seizure and stroke. The patients with epilepsy are still widely stigmatized. It can affect people economically, socially and culturally. For example, before 1970, the UK had the laws that prohibited people with epilepsy to marry. Even now, many countries do not allow people, even with well-controlled epilepsy, to drive and choose a different profession without the sufficient reasons. In developed countries, people with well-controlled epilepsy can usually work as teachers, health workers and as actors (Browne, Holmes, p. 11).
Epilepsy is a chronic non-infectious disorder of the brain, which affect people of all ages. Worldwide, about 50 million people suffer from epilepsy. Almost 80% of people with epilepsy live in developing countries. Epilepsy responds to treatment in about 70% of cases, however, three-quarters of the people suffering from this disease in developing countries do not receive treatment they need. In many countries, people with epilepsy and their families can suffer stigma and discrimination. The estimated proportion of people with epilepsy in the active form (i.e. with continuing seizures or the need for treatment) at the moment is from 4 to 10 per 1,000 people. However, a number of studies conducted in developing countries suggest that this proportion varies from 6 to 10 per 1,000 people (Birbeck et al., p. 18).
Worldwide, epilepsy affects about 50 million people. In developed countries, the annual number of new cases of the disease at the population level is between 40 and 70 per 100 000 people. In developing countries this indicator is higher because of the increased risk of experiencing conditions that can lead to the permanent brain damage. Around the world, about 80% of cases of epilepsy occur in developing regions. The risk of premature death of people with epilepsy is in two to three times higher than of the general population (Birbeck et al., p. 236).
Epilepsy is a chronic brain disorder that manifests itself in people all over the world. The disease is characterized by the recurrent seizures. These seizures manifest themselves as the transient involuntary spasms in any part of the body (partial seizures) or throughout the body (generalized convulsions) and sometimes accompanied by the loss of consciousness and loss of control over the functions of a bladder or bowel. These episodes are the result of excessive electrical discharges in a group of brain cells. Such discharges can occur in different brain regions. Seizures may take the form of a minor memory lapses or muscle spasms and severe, prolonged convulsions. Seizures can also vary in frequency, as happening at least once a year, and up to several times a day (Browne, Holmes, p. 34).
Such diseases as epilepsy have a chronic nature, while it is characterized by a spontaneous manifestation of rarely occurring, short-term episodes of seizures. It should be noted that epilepsy, the symptoms of which are very pronounced, is one of the most common neurological diseases such as every hundredth person on the planet is experiencing recurrent seizures (Browne, Holmes, p. 27).
Types of epilepsy seizures
Manifestations of epilepsy appear, as it has been noted, in the form of attacks, and they have their own classification (Browne, Holmes, p. 26):
on the basis of the causes (primary epilepsy and secondary epilepsy);
based on the location of the initial outbreak, characterized by excessive electrical activity (deep parts of the brain, the left or right hemisphere of it);
based on the options that shape the development of events in the attack (with loss of consciousness or not).
A simplified classification of epileptic seizures, it is distinguished the generalized and partial seizures. Generalized seizures are characterized by seizures with the complete loss of consciousness, as well as control over the workflow. The reason for this situation is the excessive activation characteristic of the deep parts of the brain that triggers attraction and subsequently the whole brain. It is not necessarily the result of this condition, which is expressed in the fall, because the muscle tone is violated only in rare cases (Browne, Holmes, p. 28).
It is also distinguished the globalized epilepsy (focal, partial), which can be frontal, temporal, parietal, occipital epilepsy. There are also generalized epilepsy (idiopathic and symptomatic); epilepsy syndromes and clearly unclassifiable as focal and generalized (convulsions newborn, myoclonus epilepsy, etc.); specific syndromes (febrile convulsions, acute metabolic and toxic disorders) (Browne, Holmes, pp. 25-26).
It should be noted that the partial epilepsy, as localized and focal epilepsy, the symptoms of which are a distinct group of diseases, in their development are based on the metabolic or morphological damage of a particular area of the brain. Their cause may serve a variety of factors (brain trauma, infections, and inflammatory lesions, vascular dysplasia, type of acute cerebrovascular accident, etc.) (Browne, Holmes, p. 135).
Signs and symptoms
Characteristic signs of epilepsy attacks are variable and depend on where in the brain it begins the violation and how far it spreads. There may be temporary symptoms such as loss of consciousness, or orientation, and movement disorders, sensation (including vision, hearing and taste), mood or mental functions (Browne, Holmes, pp. 46-48).
People who have seizures face other problems of more physical properties (such as, for example, fractures and bruising). They are also characterized by the higher rates of other diseases or psychosocial problems and conditions such as anxiety and depression. Manifestations of seizures vary from generalized seizures to subtle changes in people around the internal state of the patient (Browne, Holmes, pp. 133-136).
It is isolated the focal seizures associated with the occurrence of an electrical discharge in a certain limited area of the cerebral cortex and generalized seizures, in which both hemispheres of the brain are involved in the discharge. In focal seizures or convulsions it may occur peculiar sensations (e.g., numbness) in certain parts of the body (face, arms, legs, etc.). Also, the focal seizures may occur in short bouts of visual, auditory, olfactory or gustatory hallucinations. The consciousness during these attacks can be stored, and in such a case the patient describes in detail his feelings. The duration of partial seizures are usually not more than 30 seconds. Generalized seizures are divided into convulsive and non-convulsive (absences) (Browne, Holmes, p. 46).
For others the most frightening are generalized seizures. At the beginning of the attack (the tonic phase) it occurs muscle tonus, short stop breathing, often a piercing scream, perhaps biting language. After 10-20 seconds it occurs a clonic phase when the muscle contractions are alternated with their relaxation. At the end of clonic phase incontinence is often observed. Seizures usually disappear spontaneously after a few minutes (2-5 minutes) (Browne, Holmes, pp. 133-136). Then it comes post-seizure period, characterized by drowsiness, confusion, headache and sleep onset. Non-convulsive generalized seizures are called absences. They occur almost exclusively in childhood and early adolescence. The child suddenly stops and stares at one point, glance away. It can be observed the shielding of the eyes, trembling eyelids, easy tilting of the head. Seizures last only a few seconds (5-20 seconds) and often go unnoticed (Browne, Holmes, p. 45).
There are about 40 different forms of epilepsy and various types of attacks. In this case, for each form it is developed its own scheme of treatment. That is why it is so important for the physician not only to diagnosis the epilepsy, but also to determine its shape (Browne, Holmes, pp. 133-136).
The main diagnostic methods are the electroencephalography and computed or magnetic resonance imaging (Figure 2). Normal (routine) method EEG involves no more than 15 minutes of recording time, and is used for the mass studies. According to most researchers, in diagnostics of epilepsy the most informative diagnostic method is the EEG monitoring, which is a recording of the electroencephalogram for a long time (from 1 to 12 hours, with the inclusion of the sleep period) (Browne, Holmes, pp. 133-136).
Causes of Epilepsy
Secondary epilepsy can be caused by: brain tumor; cyst of brain; disruption of blood supply (stroke, hemorrhage); malformations; traumatic brain injury; infectious damage; perinatal damage (birth trauma); the use of drugs, alcohol or certain medicines; metabolic disorders (increased blood sugar levels, liver disease, kidney); poisoning (e.g. by a lead) (Browne, Holmes, p. 87).
Spontaneous (idiopathic) epilepsy develops in the absence of the organic brain damage. It is believed that in this case the role is played by the genetically caused structural features of the cell membranes of the processes of excitation and inhibition, reaction to stimuli.
The most common type, characteristic for 6 out of 10 people suffering from this disorder, is idiopathic epilepsy, which has no set of reasons. In many cases, there are genetic causes.Epilepsy, the cause of which is known, is the secondary epilepsy or symptomatic epilepsy. The causes of secondary (or symptomatic) epilepsy may be as follows (Figure 1):
brain damage in the prenatal or perinatal period (hypoxia or birth trauma, low birth weight);
congenital abnormalities or genetic conditions in the presence of malformations of the brain, which are caused by the same factors;
a strong blow to the head;
stroke, causing hypoxia;
infection of the brain, such as meningitis, encephalitis, neurocysticercosis;
some genetic syndromes;
brain tumor (Henry, pp. 15-19).
Etiology and pathogenesis
There is the idiopathic (primary, essential) epilepsy, as an independent disease (epilepsy with personality changes), and symptomatic (secondary) as a syndrome with a disease (phenylketonuria, neoplastic process in the brain, vascular malformations, vasculitis, intracerebral hematoma, ischemic cerebral hemispheres, brain injury, CNS, neurointoxication) (McPhee, Hammer, p. 544).
It has been established that the disease is based on the increased convulsive readiness due to features of the flow of the metabolic processes of the brain. However, it is impossible to explain the development of the disease only by an increased willingness. There may be other conditions that contribute to the development of epilepsy. Among them there are the traumas, infection, intoxication, et al. Heredity also has the impact. It is noted the identical siblings in relatives for several generations. In families where there is a patient with epilepsy, the disease’s small features are often found in healthy relatives (bedwetting, migraine, dipsomaniya, etc.) (McPhee, Hammer, p. 234). It is believed that the heredity includes not a disease, but the certain enzymatic and metabolic changes that lead to the development of the so-called convulsive readiness. One measure of this is a gradient of the intracellular and extracellular potassium ion content. The endocrine disorders and metabolic disorders (particularly protein) play also a significant role (Henry, p. 6).
In the brain of the dead patients with epilepsy it is revealed the degenerative changes of the ganglion cells, cell shades, neuronophagia, hyperplasia of glial abnormalities in synaptic apparatus, neurofibrillary swelling, formation of ‘windows’ in nerve sprouts, ‘swelling’ of the dendrites. These changes are more manifested in the motor cortex of the cerebral hemispheres, sensitive area, gyrus of the hippocampus, the amygdala and the nuclei of the reticular formation. It is identified also the residual changes in the brain associated with the past infection, trauma, malformations (Browne, Holmes, p. 67).
Ten systems of organism, which are affected by epilepsy are the followings:
1. Respiratory System. Epilepsy can cause the aspiration pneumonia. During the attack the respiratory tract of the patient can get a variety of foreign objects: small objects, pieces of food, vomiting, etc. As a result, it develops the inflammation in the airway. Cramps are one of the most common causes of aspiration pneumonia. Epilepsy also can cause neurogenic pulmonary edema. The left atrial pressure increases to a level at which it develops the pulmonary edema. As a result, patien suffers from the oxygen starvation (Browne, Holmes, p. 188).
2. Musculoskeletal System. During the epilepsy attack the patient's muscles involuntarily tighten and relax. The patient may fall anywhere and be injured, as well as they can broke arms, legs, hit by a car or train. With a sharp drop a patient can obtain a compression fracture of the spine, which is fraught with the development of kyphoscoliosis, degenerative disc disease, sciatica. This may include a variety of injuries of tongue and cheeks, which the patient may bite in convulsions. Sometimes the muscles are compressed so much that there are dislocations, fractures and other injuries of the musculoskeletal system (Browne, Holmes, p. 156).
3. GI System. Epilepsy can cause the temporary dysfunction of the gastrointestinal tract (constipation). Also, cluster of putrefactive bacteria and slag in the organism results in various ailments until the infectious diseases, and to the central nervous system (e.g. epilepsy).
4. Immune System. The presence of genetically determined disorders of immunological reactivity with epilepsy is shown in several studies. Thus, in patients with epilepsy, compared to the population, it is observed the predominance of HLA-A2 antigen (respectively 96% and 45%). The low content of IgA is in the direct correlation with the high frequency of HLA-A2 (Browne, Holmes, p. 137).
5. Cardiovascular System. It takes a little time between epileptic attacks and the patient did not regain consciousness. A number of different disorders in the internal organs rapidly increases. Irregularities in the nervous system in epilepsy lead to an increase in blood pressure. This complication is a dangerous failure for the cardiovascular, respiratory and other systems of the body.
6. Endocrine System. The impact of epilepsy on the body is a complex multi-level process, which has an effect on the endocrine system and mineral metabolism. The impact of epilepsy on the endocrine system has attracted a considerable attention from the researchers. A role in the development of endocrine disorders in patients with epilepsy is played by t laterality localization of epileptic focus (Henry, p. 18).
7. Urinary System. Epilepsy causes the disorders of the urinary system (most often hypospadias, which occurs in early stages of fetal development due to the disease and drugs).
8. Reproductive System. Epilepsy causes convulsions, which are dangerous for pregnant woman and for her and for the child. Due to the reception of some anticonvulsant drugs it may develop birth defects of the fetus (Browne, Holmes, p. 242).
9. Nervous System is surely damaged as the epileptic seizure is the result of simultaneous excitation of neurons (nerve cells) of a particular area of the cerebral cortex - the epileptogenic focus.
10. Integumentary System is also can be damaged by epilepsy, due to the fact that the disease makes an impact on the organs and nervous system of the patients, causing the damage of the integumentary parts of them.
At the moment, there are opportunities to improve the health of epileptics. With good and proper treatment, in the patient it is observed a decrease or complete absence of seizures, that is, a person can lead to a normal life (Wyllie, p. 601).
One of the most common variants of the treatment is a treatment with the multiple drugs that affect only a certain part of the human brain, which is the cause of epilepsy in a particular case. Of course, this type of treatment has the side effects, so it is important to comply with all requirements of physicians to minimize them (Wyllie, p. 508).
Another category of patients are pregnant and breastfeeding women. They are not prescribed in any way to abruptly stop taking the medication for epilepsy (Kokaia, p. 130). In such cases, it is needed the additional tests with the possible change of the drug, but only at the doctor's appointment. If epilepsy is progressing and the prescribed medications do not help, there is a radical method of treatment – the removal of damaged parts of the brain, but such an operation is permitted only after a complex analysis, as well as with the use of the high-tech equipment (Birbeck et al., p. 536).
Attachment 1: Figures
Figure 1. Causes of epilepsy
Figure 2. MRI in epilepsy
Birbeck, Gretchen L. et al. 'Seizure Reduction And Quality Of Life Improvements In People With Epilepsy'. Epilepsia 43.5 (2002): 535-538. Web. 12 Mar. 2015.
Browne, Thomas R., and Gregory L. Holmes. Handbook of epilepsy. Philadelphia: Lippincott Williams & Wilkins, 2008. Print.
Henry, R. Thomas. 'Seizures And Epilepsy: Pathophysiology And Principles Of Diagnosis'. Epilepsy 1.1 (2015): 1-21. Web. 12 Mar. 2015.
Kokaia, Merab. 'Novel Perspectives In Treatment Of Epilepsy'. Epilepsy Research 85.2-3 (2009): 129-130. Web.
McPhee, Stephen J., and Gary D. Hammer. Pathophysiology of disease : an introduction to clinical medicine. New York: McGraw-Hill Medical, 2010. Print.
Wyllie, Elaine. Wyllie's treatment of epilepsy : principles and practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2011. Print.
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