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Research paper on epilepsy

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Research paper on epilepsy

  1. 1. Introduction Epilepsy is defined as a brain disorder characterized by an enduring predisposition to generate seizures (International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE), 2005). It is a neurological disorder consisting of recurrent seizures that resulted from excessive, uncontrolled electrical activity in the brain (Wang, 2011). The ancient Babylonian believed that seizures can occur when a person was visited by a demon and thus, the different kinds of seizures arise due to the different demons that visited each person (Stol, 1993). The word epilepsy was derived from the Greek word for attack. The ancient Greeks thought epilepsy was contagious, and hence people with epilepsy used to live alone (Dam, 2003). Epilepsy still carries a great stigma, thus many people hide their condition, which hinders public awareness about the subject (Cendes, 2011). In 400 B.C, the early physician, Hippocrates, labeled epilepsy as the scared disease resulting from a brain disorder 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 of three English neurologists: Russell Reynolds, John Hughlings Jackson, and Sir William Richard 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 is still used to describe seizures. Epilepsy is classified into different types, depending on part of brain that is affected and the resulting seizure. However, all type of epilepsies have the same symptoms; characterized by convulsions and seizures. Although epilepsy can develop at any age,it was assumed to be a condition of childhood health issue. In fact, about 30% of new cases detected every year began in childhood. However, high incidences were also reported in people above the age of 65 (Epilepsy Canada, 2011). Data from Ontario Health Survey has shown that there is a 0.1 % increase in the prevalence of epilepsy after the age of 25 (extracted on 2012). According to one study, epilepsy is a very common chronic disease affecting as many as 1 in 100 Canadians, or 1% of the total population (Tellez-Zenteno JF, Pondal-Sordo M, Matijevic S, & Wiebe S, 2004). Even though epilepsy is very common disease in North America, the information on the subject is not easily accessible. Moreover, researches done on this disease are presented in professional language, and thus people with no relevant medical background have difficulties to understand it clearly. Therefore this report aims to gather valuable information on epilepsy and provide simple explanations on the issue of the most complicated processes that occur in the brain of epileptic patients. Large part of the report has focused on the biological processes that occur within an epileptic
  2. 2. brain, the causes and treatments of epilepsy. This report does not describe the different type of seizures and different types of anti-epileptic drugs but goes in depth to describe the biological process of seizures and new treatments. Seizure and its biochemistry Nerve cells are made up of smaller units called neurons that have three main structures involved in transmitting message across the body. These structures are named Axon, Cell body and Dendrites (Figure 1). Based on their functions, neurons are divided into three. These are the sensory neurons that carry message from our sense organs to the brain, motor neurons transmit electrical message from the brain to our sense and inter neurons process information within the brain. As shown in the Figure 1, there is a small gap between each neuron called synaptic gap. For message to travel across this gap chemicals called Neurotransmitters have to be released. There are approximately 50 neurotransmitters identified today (Scott and Maume, 2006). Figure. 1. Effect of neurotransmission on human (adapted from http://iseibpsychology2012.wikispaces.com/Explain,+using+examples,+the+effects+of+n eurotransmission+on+human+behavior) Neurons transmit messages when stimulated by signal from our sense organs or when triggered by chemical signals from neighboring neurons. At such times, neurons fires an impulse, called an action potential or exciting state, a brief electrical charge that travel down its axon (Mayers, 2010). For normal electrochemical message pathway to occur nerve cells must create a balance between the inhibiting and inducing
  3. 3. neurotransmitters because failing to accomplish that will result in seizure. A seizure occurs when the brain's nerve cells misfire and generate a sudden, uncontrolled surge of electrical activity in the brain. It is also called hyper excitable state (Schachter, 2006). Hyper excitable state can result from the increase of exciting synaptic neurotransmitters, decrease of inhibiting neurotransmitters or an alteration in voltage- gated ion channels (Bromfield, Cavazos and Sirven, 2006). The irregular body movement during seizure happens when our sense organs receive mixed messages and try to execute all at once. Traditionally, the diagnosis of epilepsy requires the occurrence of at least 2 unprovoked seizures 24 hours apart (Medscape, extracted on 2012). Just before the occurrence of seizure the concentration of glucose and cholesterol in the body decreases (Natelson et al, 1979). As stated above seizures are classified according to the part of the brain seizure starts. If a seizure arises from certain part of the brain, the initial symptoms of the seizure will reflect the functions of those parts. The left part of the brain controls the right side of the body and vice versa. Thus if the seizure arises from the left side of the brain you will first observe the movement of the right hand or thumb (Schachter, 2006). What causes epilepsy? According to national institute of neurological disorders and stroke (NINDS), epilepsy can be caused by anything that disturbs the normal pattern of neuron activity – from illness to brain damage to abnormal brain development. These all can lead to seizures. Researchers believe that some people with epilepsy have an imbalance in nerve signaling chemicals called neurotransmitters. In some cases brain attempts to repair itself after sever injuries, which may generate abnormal nerve connections that leads to epilepsy (Foundation for better health (FBHC), 2012). Research shows that approximately 50% of patients who suffer a severe head 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 epilepsy they are categorised in five main groups. 1. Brain chemistry This is caused by imbalance in neurotransmitters. Neurotransmitters are chemicals found in our nerve cells, which help transport electrical messages across the synaptic gap between adjacent nerve cells. There is a fine balance between factors that spread electrical message and the ones that limit it. When neurotransmitters that induce or inhibit impulse are found at high concentration this balance will break apart causing an abnormal electrical discharge. The abnormal electrical discharge causes a seizure.
  4. 4. 2. Prenatal Injuries Prenatal injuries are damages caused to fetus before birth. The developing brain is very sensitive 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 be highly 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 and nervous system, functions like thinking and movement. 20% of epilepsy in children is caused due to cerebral palsy (FBHC, 2012). Prenatal injuries increase the chance of developing epilepsy. 3. Hereditary causes Some types of epilepsy run in the family which suggest that there is a genetic base for epilepsy. 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 neurotransmitter release reveals that defects in ion channel function could result in altered synaptic transmission (Kapur, 2008). These altered synaptic transmissions can cause imbalanced electrical discharge. In most cases genetic abnormalities are only partial causes. They increase the chance of a person having seizures but never induce seizures. It is other environmental factors that start the seizure (Sánchez-Carpintero Abad R, SanmartíVilaplana FX, SerratosaFernández JM, 2007). 4. Environmental causes There 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 our body. Researchers warned that the risk of seizures may be much higher after consuming 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) (Kotagal 2011). A recent study has also suggested auricular acupuncture as a possible solution to suppress epileptic seizures (He, 2012).
  5. 5. 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. These include insertion of medical devices and in most difficult scenarios surgery will be performed. 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 is carefully planned with nutritionist and must be started in hospital. Patients on the ketogenic diet have to take a lot of vitamins because the diet is imbalanced. The diet mimics 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 are transported 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 will replace carbohydrates as energy source. The buildup of these ketone bodies will decrease the frequency of epileptic seizures (Wilder and Winter, 2012). Half of the children who stop the diet within a year have reduced epileptic seizures and 20 percent of these had become seizure-free without surgery (March et al, 2006). Vagus nerve stimulation (VNS) is another method used to treat epilepsy. A pacemaker type device is inserted to generate continuous electrical impulse to stimulate the vagus nerve cell. The vagus nerve cell is one of the 12 cranial nerves found in our body. Nerve cells that emerge from the brain are called cranial nerves cells. The device contains lithium battery and microprocessor enclosed in titanium case. It transmits electrical impulse according to the program set before the insertion. The program is set according to the person’s heartbeat and blood pressure (Kotagal, 2011). Around 40 % of patients experience 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. Mild cases can be treated by antibiotics (EL et al, 2009). Current estimate shows that 20 % to 30 % of patients with epilepsy can’t control their seizures 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 candidate for surgery are those who have certain characteristics that suggest surgical intervention can be curative (Cosgrove and J. Cole, 2005). Surgery only works when a small area of damaged brain like a tumor, or a scar, or a tangle of abnormal blood vessels is causing the seizures. Presurgical evaluations are done on each patient before surgery. These evaluations include detailed clinical history and physical examination, advanced neuro- imaging, video-EEG monitoring, neuropsychological testing and assessment of psychosocial functioning. The goal of epilepsy surgery is to identify area of cortex that is affected and remove it without causing any significant damage to the brain (Cosgrove and J. Cole, 2005).
  6. 6. In this report I will not discuss the different types of anti-epileptic drugs but one should know that anti-epileptic drugs are the most common method of treating epileptic seizures 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 in about one quarter to one third of patients (Kwan and Brodi2, 2000). Therefore, currently combinations of the above treatments are being used. Conclusion As seen from the report epilepsy is one of the very common chronic disorders affecting 50 million people worldwide. An estimated 2.1 to 2.7 million of these live in North America. 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 sex or race/ethnicity for susceptibility to epilepsy. From my research I have concluded that the public lacks proper understanding of the causes and symptoms of epilepsy. The study looking at the prevalence of epilepsy in 19 US states shows that 1 out of 3 adults reported for not seeing a neurologist despite having a recent seizure (Thurman, 2008). This report explains the history of epilepsy and important discoveries made about epilepsy. I have as well given a detail explanation for the chemistry of seizures. I hope you find the report comprehensive and you were able to understand your son’s condition very well. The various treatment options discussed will give you a clear picture of the available options for your son’s treatment but keep in mind that there are many different solutions for this condition. You have to speak with your neurologist to determine which one is better suited for your son Dawit.
  7. 7. References Adam Zeman. (2008). A portrait of the brain. London, England: St Edmundsbury press. Bromfield EB, Cavazos JE, Sirven JI. (2006). Basic Mechanisms Underlying Seizures and Epilepsy.NCBI. Retrieved on April, 01, 2012 from http://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, from http://www.mayoclinic.com/health/epilepsy/DS00342/DSECTION=causes Cendes, F. (2005).progressive hippocampal and extra hippocampal atrophy in drug resistance epilepsy curropinneurol 18,172-7. D.Purpura, J. Penry, R.D. Walter (eds.).(1975.) Raven the problem, prevalence, and contributing factors. In Advances Focal epilepsy in Neurology,pp. 11-22. New York Press. Early Ketogenic Diet Helps in Some Epilepsy Types. (n.d.).Retrived April 01, 2012, fromhttp://www.medscape.com/resource/seizuresStacy chillemi. (2012) Epilepsy :- the most 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, From http://www.theuniversityhospital.com/healthlink/archives/articles/epilepsy.html published in january 2003 Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy:
  8. 8. definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE).Epilepsia, 46, 470-490. Gu W, Brodtkorb E, Piepoli T, Finocchiaro G, & Steinlein OK (2005) LGI1: a gene involved 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 Innovative Methods. Evidence-based complementary and alternative medicine Kotagal P (2011) Neurostimulation: vagus nerve stimulation and beyond. Seminars in pediatric neurology 18(3), 186-194 Kwan 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, from http://www.epilepsy.dk/Handbook/Introduction-uk.asp MOGENS DAM 2003 Ramsey RE, Uthman B, Ben-Menachem E, et al Efficacy of vagal nerve stimulation in partialseizueres: double blind comparison of two stimulus paradigms. Epilepsia (suppl) 32:90-91,1991 S, Natelson, D.J. Miletich, C.F. Seals, D.J. Visintine, and R.F. Albrecht: Clinical biochemistry of epilepsy. I. Nature of the disease and a review of the chemical findings in epilepsy. Clinical Chemistry, 25, 889-897 Siobhan Scott and Kevin Maume. (2008). Biology:- New senior. Dublin, Ireland: Folens.
  9. 9. Steven C. Schachter, (2006, December 15). vagus nerve stimulation. Epilepsy therapy project. Retrived on April. 01, 2012, from http://www.epilepsy.com/epilepsy/Vns Tellez-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 gene involved 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.

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