2. What is Epilepsy?
Epilepsy, commonly known as a seizure disorder, is a neurological
condition which affects the nervous system. An individual who has two
unprovoked seizures in a ten year period is considered to have epilepsy.
A seizure is a caused by a disruption of normal communication
between neurons in the brain. This disruption can cause changes in
awareness, behavior, and/or abnormal movement.
Epilepsy can be inherited genetically, as well as result from a traumatic
brain injury. However, most cases are considered idiopathic and a
cause cannot be determined.
Over 2 million people in the United State have epilepsy and 1 in 26
people in the US will develop epilepsy at some point in their lifetime.
One-third of people with epilepsy live with uncontrolled seizures
because all available treatments fail.
3. Physiology of a Seizure
A neuron or nucleus in the brain
becomes hyperexcitable (loses
inhibition)
Depolarization is sustained
An influx of extracellular Ca2+
signals the opening of voltage-
gated Na+ channels
Repetitive action potentials are
generated
Action potentials are discharged
irregularly and without control
4. Types of Seizures Common to
Epilepsy
Primary generalized seizures
Occur in both sides of the brain
Partial seizures
Occur in one localized portion of
the brain
Simple - interruption of one main
brain function or motor skill
Complex - able to travel
throughout the brain, affecting
multiple brain functions
Absence seizures
A lapse in the brain - a person may appear dazed
or repeat a movement such as blinking or chewing
Tonic seizures
Cause a sudden and dramatic stiffening of the
muscles
Clonic seizures
Cause a sudden and dramatic jerking of the
muscles
Tonic Clonic seizures (Grand Mal seizures)
Combined symptoms of tonic and clonic seizures
Long recovery period and can be dangerous if
they go on too long due to the stress they inflict on
the body
Psychosomatic seizures
Seizure-like activity becomes the body's default
reaction to stress
5. Potential Symptoms
of a Seizure
Loss of awareness
Loss of consciousness
Feelings of distraction, confusion or
memory lapse
Inability to speak or confused speech
Dilated pupils
Hyperactivity or lack of activity in the
eye and eyelids
Increased flexion or relaxation of
muscles
Involuntary tremors or automatisms
Convulsions
No two seizures are identical and
symptoms can manifest very
differently from one person to the
next. Some people show almost no
symptoms at all while others are
completely debilitated with every
seizure.
6. Common Causes of
Epilepsy
Genetic inheritance
Influencing genes are currently unknown
Change in brain structure
Reason for change often unknown
Autism spectrum
A specific connection between epilepsy
and autism is unknown but suspected
Brain infections
Head injuries
Stroke
Brain tumor
In approximately 60% of epilepsy
cases, a cause for the development
of epilepsy cannot be determined.
7. Treatments for
Epilepsy
Traditional Treatments
Anti-epileptic drug therapy
Approximately 26 AEDs used to treat seizures
Diet
Ketogenic diet, medium chain triglyceride diet, modified
Atkins diet, low glycemic index diet
Surgery
Removal or disconnection of abnormal area of the brain
Separation of the hemispheres of the brain by cutting of
the corpus callosum
Vagus Nerve Stimulation
Electrical stimulation of the brain via the vagus nerve to
counteract the effects of overactive nerve tracts
Alternative Treatments
Melatonin
Cannabis
Acupuncture
While many treatment options are
available, in approximately 30% of
epilepsy cases, no known treatments
are effective in controlling seizures.
8. Case Study
Megan is a 26-year-old white female who has
been living with epilepsy for the past 11 years.
Megan developed post-traumatic epilepsy after
a moderate closed head injury in 2003. Over the
years, Megan has been put on more than 10
different anti-epileptic medications, none of
which relieved her seizures.
In the summer of 2013, Megan changed
medications and began a ketogenic diet. Within
6 months, she had stopped having seizures and
has now been seizure free for over a year.
9. Case Study – Cont.
Additional Possible
Contributing Factors
Polycystic Ovarian Syndrome
It is estimated that 25%-30% of
epileptic women have or exhibit
symptoms of PCOS
Genetic Tendency
Maternal Great-Aunt and Great-
Uncle also have post-traumatic
epilepsy
Chiari Malformation
A structural defect in the cerebellum
Part of the cerebellum is located
inferior to the foramen magnum
Active Treatments
Controlling Seizure Activity
Lamictal
Anti-epileptic medication
Ketogenic Diet
10. The Ketogenic Diet
The diet structure is high fat, adequate protein, and low
carbohydrates, which causes metabolic changes similar to
starvation.
Levels of plasma ketones, insulin, glucose, glucagon, and free fatty
acids change.
Which metabolic change is responsible for seizure control is not yet
known although it is likely multifactorial.
In a 2006 analysis of 19 separate studies, it was found that the
ketogenic diet was effective in reducing seizures regardless of age
or seizure type.
After six months, approximately 60% of patients had a greater than 50%
reduction in seizures, while 30% had a greater than 90% reduction in
seizures.
11. References
McCormick DA, Contreras D. On the cellular and network bases of
epileptic seizures. Annu Rev Physiol 2001; 63:815.
Wilfong MD. Overview of the classification, etiology, and clinical
features of pediatric seizures and epilepsy. UpToDate Nov 2014.
Schachter MD. Overview of the management of epilepsy in adults.
UpToDate Nov 2014.
Kossoff MD. The ketogenic diet. UpToDateNov 2014.
http://www.epilepsy.com
http://www.ncbi.nlm.nih.gov
http://neuropathology-web.org
http://www.epilepsymatters.com
http://www.epilepsysociety.org.uk
