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
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
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
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.
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
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).
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).
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.
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.
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