Introduction Epilepsy is defined as a brain disorder characterized by an enduring predisposition togenerate seizures (International League Against Epilepsy (ILAE) and the InternationalBureau for Epilepsy (IBE), 2005). It is a neurological disorder consisting of recurrentseizures that resulted from excessive, uncontrolled electrical activity in the brain (Wang,2011). The ancient Babylonian believed that seizures can occur when a person wasvisited by a demon and thus, the different kinds of seizures arise due to the differentdemons that visited each person (Stol, 1993). The word epilepsy was derived from theGreek word for attack. The ancient Greeks thought epilepsy was contagious, and hencepeople with epilepsy used to live alone (Dam, 2003).Epilepsy still carries a great stigma, thus many people hide their condition, whichhinders public awareness about the subject (Cendes, 2011). In 400 B.C, the earlyphysician, Hippocrates, labeled epilepsy as the scared disease resulting from a braindisorder that is caused by cold, sun and the changing restlessness of winds (Zeman,2008). The modern medical era of epilepsy began in the mid-1800s, with the works ofthree English neurologists: Russell Reynolds, John Hughlings Jackson, and Sir WilliamRichard Gowers (Rose, 1999). Jackson defined a seizure as "an occasional, an excessive,and a disorderly discharge of nerve tissue on muscles." (Chillemi, 2012).His definition isstill used to describe seizures.Epilepsy is classified into different types, depending on part of brain that is affected andthe resulting seizure. However, all type of epilepsies have the same symptoms;characterized by convulsions and seizures. Although epilepsy can develop at any age,itwas assumed to be a condition of childhood health issue. In fact, about 30% of newcases detected every year began in childhood. However, high incidences were alsoreported in people above the age of 65 (Epilepsy Canada, 2011). Data from OntarioHealth Survey has shown that there is a 0.1 % increase in the prevalence of epilepsyafter the age of 25 (extracted on 2012). According to one study, epilepsy is a verycommon chronic disease affecting as many as 1 in 100 Canadians, or 1% of the totalpopulation (Tellez-Zenteno JF, Pondal-Sordo M, Matijevic S, & Wiebe S, 2004). Even though epilepsy is very common disease in North America, the information onthe subject is not easily accessible. Moreover, researches done on this disease arepresented in professional language, and thus people with no relevant medicalbackground have difficulties to understand it clearly. Therefore this report aims togather valuable information on epilepsy and provide simple explanations on the issueof the most complicated processes that occur in the brain of epileptic patients. Largepart of the report has focused on the biological processes that occur within an epileptic
brain, the causes and treatments of epilepsy. This report does not describe the differenttype of seizures and different types of anti-epileptic drugs but goes in depth to describethe biological process of seizures and new treatments.Seizure and its biochemistryNerve cells are made up of smaller units called neurons that have three main structuresinvolved in transmitting message across the body. These structures are named Axon,Cell body and Dendrites (Figure 1). Based on their functions, neurons are divided intothree. These are the sensory neurons that carry message from our sense organs to thebrain, motor neurons transmit electrical message from the brain to our sense and interneurons process information within the brain. As shown in the Figure 1, there is a smallgap between each neuron called synaptic gap. For message to travel across this gapchemicals called Neurotransmitters have to be released. There are approximately 50neurotransmitters identified today (Scott and Maume, 2006).Figure. 1. Effect of neurotransmission on human (adapted fromhttp://iseibpsychology2012.wikispaces.com/Explain,+using+examples,+the+effects+of+neurotransmission+on+human+behavior)Neurons transmit messages when stimulated by signal from our sense organs or whentriggered by chemical signals from neighboring neurons. At such times, neurons firesan impulse, called an action potential or exciting state, a brief electrical charge thattravel down its axon (Mayers, 2010). For normal electrochemical message pathway tooccur nerve cells must create a balance between the inhibiting and inducing
neurotransmitters because failing to accomplish that will result in seizure. A seizureoccurs when the brains nerve cells misfire and generate a sudden, uncontrolled surgeof electrical activity in the brain. It is also called hyper excitable state (Schachter, 2006).Hyper excitable state can result from the increase of exciting synapticneurotransmitters, decrease of inhibiting neurotransmitters or an alteration in voltage-gated ion channels (Bromfield, Cavazos and Sirven, 2006). The irregular bodymovement during seizure happens when our sense organs receive mixed messages andtry to execute all at once. Traditionally, the diagnosis of epilepsy requires theoccurrence of at least 2 unprovoked seizures 24 hours apart (Medscape, extracted on2012). Just before the occurrence of seizure the concentration of glucose and cholesterolin the body decreases (Natelson et al, 1979).As stated above seizures are classified according to the part of the brain seizure starts. Ifa seizure arises from certain part of the brain, the initial symptoms of the seizure willreflect the functions of those parts. The left part of the brain controls the right side of thebody and vice versa. Thus if the seizure arises from the left side of the brain you willfirst observe the movement of the right hand or thumb (Schachter, 2006).What causes epilepsy?According to national institute of neurological disorders and stroke (NINDS), epilepsycan be caused by anything that disturbs the normal pattern of neuron activity – fromillness to brain damage to abnormal brain development. These all can lead to seizures.Researchers believe that some people with epilepsy have an imbalance in nervesignaling chemicals called neurotransmitters.In some cases brain attempts to repair itself after sever injuries, which may generateabnormal nerve connections that leads to epilepsy (Foundation for better health(FBHC), 2012). Research shows that approximately 50% of patients who suffer a severehead injury will develop a seizure disorder (Bromfield, Cavazos and Sirven, 2006).Listed below are causes of epilepsy. Due to the vast variations for the causes of epilepsythey are categorised in five main groups.1. Brain chemistryThis is caused by imbalance in neurotransmitters. Neurotransmitters are chemicalsfound in our nerve cells, which help transport electrical messages across the synapticgap between adjacent nerve cells. There is a fine balance between factors that spreadelectrical message and the ones that limit it. When neurotransmitters that induce orinhibit impulse are found at high concentration this balance will break apart causing anabnormal electrical discharge. The abnormal electrical discharge causes a seizure.
2. Prenatal InjuriesPrenatal injuries are damages caused to fetus before birth. The developing brain is verysensitive to different kinds of injuries. If a pregnant woman eats unbalanced diet,smokes, has an infection, or abuses drugs and alcohol the developing brain will behighly susceptible to prenatal injuries such as cerebral palsy (Mayo clinic stuff, 2012).Cerebral palsy is a term given to a group of disorders that can involve brain andnervous system, functions like thinking and movement. 20% of epilepsy in children iscaused due to cerebral palsy (FBHC, 2012). Prenatal injuries increase the chance ofdeveloping epilepsy.3. Hereditary causesSome types of epilepsy run in the family which suggest that there is a genetic base forepilepsy. Genetic abnormalities can cause subtle change in the way a body process bio-chemicals. Some types of epilepsy have been traced to an abnormality on a single gene;that causes defects in ion transporting channels (Gu W, Brodtkorb E, Piepoli T,Finocchiaro G, and Steinlein OK, 2005).A careful analysis of the relationship between ion channels and neurotransmitterrelease reveals that defects in ion channel function could result in altered synaptictransmission (Kapur, 2008). These altered synaptic transmissions can cause imbalancedelectrical discharge. In most cases genetic abnormalities are only partial causes. Theyincrease the chance of a person having seizures but never induce seizures. It is otherenvironmental factors that start the seizure (Sánchez-Carpintero Abad R,SanmartíVilaplana FX, SerratosaFernández JM, 2007).4. Environmental causesThere are many environmental factors that cause epilepsy. Use of drugs and alcohol,lack of sleep, stress, exposure to lead, and carbon monoxide are the leading causes.These chemicals are poisonous. They affect hormonal production and nerve path in ourbody. Researchers warned that the risk of seizures may be much higher afterconsuming three or more alcoholic beverages (Schachter, 2006).What are the treatments for epilepsy? These symptoms can be controlled by the proper use of antiepileptic drugs (AED),surgery, vagus nerve stimulation (VNS), and deep brain stimulation (DBS) (Kotagal2011). A recent study has also suggested auricular acupuncture as a possible solution tosuppress epileptic seizures (He, 2012).
Most, but not all, patients with epilepsy seizures respond well to available medications.When epileptic seizures can’t be controlled by AEDs different measures are used. Theseinclude insertion of medical devices and in most difficult scenarios surgery will beperformed. Some type of seizures can be controlled by special diet called ketogenic diet.The ketogenic diet is a very high fat diet with a minimum amount of sugar. This diet iscarefully planned with nutritionist and must be started in hospital. Patients on theketogenic diet have to take a lot of vitamins because the diet is imbalanced. The dietmimics aspect of starvation by forcing the body to burn fat instead of carbohydrates.When carbohydrates are present in food they will be converted to glucose and aretransported to the brain. However if there is very little carbohydrate present in the food,liver will convert the fat into fatty acids and ketone bodies. The ketone bodies willreplace carbohydrates as energy source. The buildup of these ketone bodies willdecrease the frequency of epileptic seizures (Wilder and Winter, 2012). Half of thechildren who stop the diet within a year have reduced epileptic seizures and 20 percentof these had become seizure-free without surgery (March et al, 2006).Vagus nerve stimulation (VNS) is another method used to treat epilepsy. A pacemakertype device is inserted to generate continuous electrical impulse to stimulate the vagusnerve cell. The vagus nerve cell is one of the 12 cranial nerves found in our body. Nervecells that emerge from the brain are called cranial nerves cells. The device containslithium battery and microprocessor enclosed in titanium case. It transmits electricalimpulse according to the program set before the insertion. The program is set accordingto the person’s heartbeat and blood pressure (Kotagal, 2011). Around 40 % of patientsexperience 50 % reduction in seizure and only the rare patients become seizurefree(Ramsey, 1999). Deeper infections occur in about 3 to 5 percent of the patients. Mildcases can be treated by antibiotics (EL et al, 2009).Current estimate shows that 20 % to 30 % of patients with epilepsy can’t control theirseizures with AEDs (Robb, 1975). If a seizure is refractory to all forms of medication,then the patient is subjected to surgery. The other group of patients that are candidatefor surgery are those who have certain characteristics that suggest surgical interventioncan be curative (Cosgrove and J. Cole, 2005). Surgery only works when a small area ofdamaged brain like a tumor, or a scar, or a tangle of abnormal blood vessels is causingthe seizures. Presurgical evaluations are done on each patient before surgery. Theseevaluations include detailed clinical history and physical examination, advanced neuro-imaging, video-EEG monitoring, neuropsychological testing and assessment ofpsychosocial functioning. The goal of epilepsy surgery is to identify area of cortex thatis affected and remove it without causing any significant damage to the brain (Cosgroveand J. Cole, 2005).
In this report I will not discuss the different types of anti-epileptic drugs but one shouldknow that anti-epileptic drugs are the most common method of treating epilepticseizures and almost 60% of patients can control their seizures with AEDs (Health-link,2003). It is now well established that AED are not fully effective to control seizure inabout one quarter to one third of patients (Kwan and Brodi2, 2000). Therefore, currentlycombinations of the above treatments are being used.ConclusionAs seen from the report epilepsy is one of the very common chronic disorders affecting50 million people worldwide. An estimated 2.1 to 2.7 million of these live in NorthAmerica. In USA 1.65% of the population reported having epilepsy in 2005 (Jeffrey,2008). The research also noted that there was no significant differences (p<0.05) by sexor race/ethnicity for susceptibility to epilepsy. From my research I have concluded thatthe public lacks proper understanding of the causes and symptoms of epilepsy. Thestudy looking at the prevalence of epilepsy in 19 US states shows that 1 out of 3 adultsreported for not seeing a neurologist despite having a recent seizure (Thurman, 2008).This report explains the history of epilepsy and important discoveries made aboutepilepsy. I have as well given a detail explanation for the chemistry of seizures. I hopeyou find the report comprehensive and you were able to understand your son’scondition very well. The various treatment options discussed will give you a clearpicture of the available options for your son’s treatment but keep in mind that there aremany different solutions for this condition. You have to speak with your neurologist todetermine which one is better suited for your son Dawit.
ReferencesAdam Zeman. (2008). A portrait of the brain. London, England: St Edmundsbury press.Bromfield EB, Cavazos JE, Sirven JI. (2006). Basic Mechanisms Underlying Seizures andEpilepsy.NCBI. Retrieved on April, 01, 2012 fromhttp://www.ncbi.nlm.nih.gov/books/NBK2510/Bromfield EB, Cavazos JE, Sirven JI. (2006): An Introduction to Epilepsy. American Epilepsy Society;Causes of epilepsy.(n.d.).retrieved April 01, 2012, fromhttp://www.mayoclinic.com/health/epilepsy/DS00342/DSECTION=causesCendes, F. (2005).progressive hippocampal and extra hippocampal atrophy in drugresistance epilepsy curropinneurol 18,172-7.D.Purpura, J. Penry, R.D. Walter (eds.).(1975.) Raven the problem, prevalence, andcontributing factors. In Advances Focal epilepsy in Neurology,pp. 11-22. New YorkPress.Early Ketogenic Diet Helps in Some Epilepsy Types. (n.d.).Retrived April 01, 2012,fromhttp://www.medscape.com/resource/seizuresStacy chillemi. (2012) Epilepsy :- themost important secrets you must learn in order to live, learn, and be happy with epilepsy. New York, Ny Rinehart.Epilepsy gaining control with medication and surgery. (2003). Retrieved April 01, 2012, Fromhttp://www.theuniversityhospital.com/healthlink/archives/articles/epilepsy.htmlpublished in january 2003Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy:
definitions proposed by the International League Against Epilepsy (ILAE) and theInternational Bureau for Epilepsy (IBE).Epilepsia, 46, 470-490.Gu W, Brodtkorb E, Piepoli T, Finocchiaro G, & Steinlein OK (2005) LGI1: a geneinvolved in epileptogenesis and glioma progression? Neurogenetics 6(2):59-66.He W, et al. (2012) Auricular Acupuncture May Suppress Epileptic Seizures via Activating the Parasympathetic Nervous System: A Hypothesis Based on InnovativeMethods. Evidence-based complementary and alternative medicineKotagal P (2011) Neurostimulation: vagus nerve stimulation and beyond. Seminars inpediatric neurology 18(3), 186-194Kwan P & Brodie MJ (2000) Early identification of refractory epilepsy. The New England journal of medicine 342(5), 314-319.Martin Stol (1999). Epilepsy in Babylonia. The Netherlands: STYX.Mogens Dam (2003). Epilepsy hand book. Retrieved on April. 08, 2012, fromhttp://www.epilepsy.dk/Handbook/Introduction-uk.asp MOGENS DAM 2003Ramsey RE, Uthman B, Ben-Menachem E, et al Efficacy of vagal nerve stimulation inpartialseizueres: double blind comparison of two stimulus paradigms. Epilepsia(suppl) 32:90-91,1991S, Natelson, D.J. Miletich, C.F. Seals, D.J. Visintine, and R.F. Albrecht: Clinicalbiochemistry of epilepsy. I. Nature of the disease and a review of the chemicalfindings in epilepsy. Clinical Chemistry, 25, 889-897Siobhan Scott and Kevin Maume. (2008). Biology:- New senior. Dublin, Ireland: Folens.
Steven C. Schachter, (2006, December 15). vagus nerve stimulation. Epilepsy therapyproject. Retrived on April. 01, 2012, fromhttp://www.epilepsy.com/epilepsy/VnsTellez-Zenteno JF, Pondal-Sordo M, Matijevic S, & Wiebe S (2004) National and regional prevalence of self-reported epilepsy in Canada. Epilepsia 45(12), 1623-1629.Theodore WH & Fisher R (2007) Brain stimulation for epilepsy. Acta neurochirurgica. Supplement 97(Pt 2), 261-272.W. Gu . E. Brodtkorb . T. Piepoli . G. Finocchiaro .O. K. Steinlein. (2005) :LGI1: a geneinvolved inepileptogenesis and glioma progression?. Neurogenetics,6, 59–66.Zeman A (2008) Consciousness: concepts, neurobiology, terminology of impairments, theoretical models and philosophical background. Handbook of clinical neurology /edited by P.J. Vinken and G.W. Bruyn 90, 3-31.