By Johneilia Bariffe &
Richele Hardy
What is Epilepsy?
● The word Epilepsy comes from a Greek word which
means, “to seize, possess, or afflict”
● It is classified by having at least 2 seizures within the
timespan of 24 hours with unknown causes
● Seizures are the only visible symptoms of epilepsy
● Next to migraines, it’s the most common neurological
disorder
Within the Nervous System
What is wrong in the brain?
● When you have a seizure there may be too much or too
little activity which causes an imbalance of excitability and
stopping.
● Most of the time the cells in the brain are too excitable
which produces a sudden surge of electrical activity in the
brain.
● Normally the brain has a homeostatic balance of cells that
can excite and those that can stop messages.
Neurological Activity
- Epilepsy is the disorder of the central
nervous system, specifically the brain
- A person with epilepsy experience
glitches in their neurological channels
- The body runs on electrical signals and
with seizures the electrical homeostasis is
all over the place
- Signals either act when they should not or
do not act at all
http://www.chm.bris.ac.uk/webprojects2002/wrigglesworth/brainimaging.htm
https://www.youtube.com/watch?v=THOdtXlQXPU&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrY-YeWM&index=45
Neurological Activity
- depends on how many cells are signaling and
which area of the brain is involved
- also, depends on the seizure threshold which
is the balance between the excitatory and
inhibitory
- the hippocampus is susceptible to epilepsy.
Neurological Activity
-
Glutamate is the brain’s prominent excitatory neurotransmitter in
the body and its receptors are in charge of the neural
communication. As well as indicating for GABA.
-
Glutamate is a ligand, which is an ion that binds to the central
metal atom, that signals Ca 2+ and Na channels so open
-
The prolonged excitability causes the glutamate to become toxic to
the body. All of this due to the overwhelming messages and can
cause a stroke which could lead to epilepsy or lead straight to
Epilepsy
Neurological Activity
-
GABA the brain’s primary inhibitory neurotransmitter
-
Studies show that abnormalities in this neurotransmitter can
initiate the symptoms of epilepsy
-
Also, there is research that reasoned that since there was not a
sufficient uptake of GABA, then the next demand lacks any power.
-
This lack of power causes the overproduction of excitable
neurotransmitters
http://medicine.yale.edu/neurology/people/ognen_petroff-3.profile
History of Epilepsy
Timeline
Timeline continued...
Timeline continued...again
Timeline continued...
21st Century
How would one
diagnosis someone with
Epilepsy?
All epileptologists are neurologists, but not all neurologists are epileptologists.
Epilepsy Syndromes
The type of Epilepsy is classified in
categories depending on:
1.
2.
3.
4.
5.
6.
7.
Type of seizure (ex. twitching or still)
How severe and how frequent
Genetic History
Which part(s) of the brain is involved
Cause of seizure
Age
EGG, MRI, CT scan images
https://www.youtube.com/watch?v=kJOC_ZGKDr8
Types of Epilepsy
Idiopathic - there is no apparent cause (ex
genetics)
Cryptogenic - there is a cause but it hasn't
been identified
Symptomatic - the cause has been identified
Triggers
- Genetics
- A scar, a tangle of blood vessels or anything that
interrupts the flow of electricity in the brain
- Head injury, brain tumor, birth trauma and stroke
- Abuse of substances
- Aftermath of diseases like measles
- brain damage that has not been identified
Generalized v.s. Partial
Generalized
widespread electrical
discharge across both sides
of the brain
Partial
occur in one part of brain
60% of people with epilepsy
have this type
Generalized Epilepsy
- mostly idiopathic which means they have no apparent
cause
- both sides of the brain are affected by the abnormal
electrical activity
- many have loss of consciousness
Benign Rolandic Epilepsy of Children
(BREC)
-
seizures start around the central sulcus or Rolandic fissure (a fold in the
cerebral cortex)
age 3-13
typically involves twitching, numbness, or tingling of the face or tongue
lasts no more than 2 minutes and child remains fully conscious
usually happens at night
common trigger is sleep deprivation
almost all outgrow by age 15
15% of all epilepsy in children
most common in children who have a close relative with epilepsy
the cause is genetics there is a theory that there is a link with the mutation of
chromosome 15q14 which is involved in excitability of nerve cells
How is BREC Diagnosed
Diagnosed with a MRI (magnetic resolance imaging) or EEG
(electroencephalogram)
- usually the MRI appears normal
- on the EGG the child will have spikes in the
temporal lobe and motor area
*Since most experience less than 10 seizures in
the 2 - 4 years of the BREC’s peak most children do
not take any medication*
**Medication is optional if seizures are frequent or during the day (neurontin,
tegretol, keppra, vimpat, zonegran, trileptal are most common)**
Childhood Absence Epilepsy (petit mal)
- child has a staring spell and is unaware and unresponsive
- lasts about 10 seconds
- episodes can occur 1 to 50 times per day
- begin between ages 4-8
- 2%-8% of people with epilepsy
**predominantly genetic**
10% chance of a child developing if a close relative has a past
- treatment includes Zarontin and Depakote
- 65% of children with CAE respond to the treatment and the
seizures disappear by mid adolescence
Myoclonic
- “myo” means muscle and “clonic” means jerk
- three specific types (juvenile, progressive, and LennoxGastaut syndrome)
- they happen due to an increase in muscle tone
- the rapid change from relaxing to contracting in a
muscle
- usually cause abnormal jerking or twitching movements
on both sides of the body but can be only one sided
- genetic
Continued
● react as they have
been hit by a single
jolt of electricity
● often drop the
objects in their
hands
● mistaken for
clumsiness or
tremors because
they last only for a
second
Juvenile Myoclonic (JME)
-
emerge from mid to late childhood
they can have staring spells or full on convulsions seizures
involved neck, shoulders, and upper arms
usually after they wake up
genetically determined
controlled with medication but continued throughout life
the most common triggers are flashing lights, stress, and
sleep deprivation
- important to have an outlet for stress and get plenty of rest
to reduce chances of seizures
Clonic
- Clonic means jerking
- Rare; varies in age, even newborns can develop this
-sometimes the seizures are brief and disappear on
their own or some may last into adulthood
- Causes constant, rhythmic jerking of the arms and legs
- Sometimes it affects both sides of the body
- Cannot be stopped if the person is restrained
- Don’t mistake it with jitteriness because a person with
clonic is less alert than a person who is jittery
- Different from Tonic-Clonic because a period of tiredness
or confusion doesn’t follow the episode
Tonic
- Muscle “tone” is the muscle’s normal tension at rest but
a “tonic” seizure causes the tension to increase in the
body, arms and legs, thus everything stiffens.
- Occurs most often during sleep and involves all or most
of the brain, which affects both sides of the body
- Can last < 20 seconds
- Common in people who have Lennox-Gastaut syndrome
but can occur in anyone
- After an episode the person can be either sleepy or
confused
Tonic Continued...
- Some people might have one seizure per episode or back
to back seizures in one episode
- EEGs are used to diagnose the seizures
- Medicines can be used to treat these.
Tonic-Clonic (Grand Mal)
- First: Tonic Phase- All muscles stiffen, air is being
forced out so a groan or cry is heard, person loses
consciousness, may turn blue, and there might be blood
due to biting of the tongue or cheek,
- Second Phase: Clonic- the rapid and rhythmic jerking of
the limbs, causes one to relieve themselves
involuntarily, consciousness returns and person maybe
drowsy, depressed or irritated
- Can last for 1 to 3 minutes
Tonic-Clonic (Grand Mal)
- affects both adults and children
- the severity of the illness depends on the
person (add a little tidbit)
- The only way to truly tell if a person has
Tonic-Clonic is through video EEGs
- Special medicines can be used in
preventing further seizures
- VNS can help with this type of epilepsy
https://www.youtube.com/watch?v=BvqA3vbNYPc&index=12&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrY-YeWM
Atonic (Akinetic)
- Muscle “tone” = normal muscle tension
- Atonic means “without tone” so during a seizure the
muscles lose strength. Akinetic means “without movement”
- Called “drop seizures” or “drop attacks” since they become
limp as they fall
- Person usually remains conscious and it lasts < 15 seconds
- Begins in childhood and can last into adulthood
- Can be treated by surgery or medicines and devices
- EEGs are used but checking blood pressure and BPM is
needed
Partial Epilepsy
- partial seizures may
affect one small part
(simple) of the brain or
the whole hemisphere
(complex)
Simple Partial
● Simple Partial seizures can either be motor or sensory
● Motor seizures involve abnormal twitching or stiffening of
the muscles
● Sensory seizures involve smelling and tasting things that
are not there. Clicking and ringing are the most common
experiences during a sensory seizure but visual
hallucinations may happen as well.
● Anyone can get them but more likely after a head injury
● Lasts no more than 2 mins and the person remains fully
aware
Complex Partial
- start in one specific area (ex. frontal lobe) and spread to
other areas of that hemisphere that can affect awareness
and memory
- lasts up to 2 minutes and the person may feel tired or
confused afterwards in extreme cases they may not return
to feeling normal for hours
- during the seizure most people start to lose awareness
and smack their lips or do other meaningless movements
https://www.youtube.com/watch?v=WP4NZcfadIk&index=11&list=PLQ2LF5nDPNka_vhRn25vMBZG-HrYYeWM
Temporal Lobe
- most common of partial epilepsy
- auras or warnings often are the first sign (up to one minute long)
● might experience hallucinations of people, music, voices, smells or
tastes
- most common form of temporal epilepsy is medial
- internal structures of temporal lobe
- begins with hippocampus and surrounding structures
- resistant to medications so surgery is the best way to go
- mostly found by an MRI
- hippocampal sclerosis is considered a factor in the development of
this type of epilepsy
Frontal Lobe Epilepsy
- 2nd most common form of epilepsy
- Lasts for less than a minute
- These are considered partial but the symptoms vary depending
on the area
- someone could be experiencing a tonic-clonic seizure, while
someone else could be laughing or cry or not be able to speak
- Often occurs during sleep and can cause them to unconsciously
scream, do bicycle movements et cetera
- Treatment is dependent on what symptoms are exhibited
Occipital Lobe Epilepsy
- Accounts for 5-10 % of epilepsy syndromes
- occurs in both adults and children
- Can be either idiopathic or symptomatic
- Begin with visual hallucinations (flickering , colored
light or anything that is related to eyes or vision
- Usually spontaneous but can be triggered by flashing
lights or a repeating pattern
- Symptoms: nausea/ vomiting, partial blindness, eye
jerking, pain in the eyes, et cetera
Parietal Lobe Epilepsy
- Considered a rare form of epilepsy
- Occurs at any age and any gender
- since this part deals with touch, sensory information
and planned movements, these operations are affected
- Can last for a few seconds and up to a few minutes
- Somatosensory seizures: patients feel numbness,
tingling, heat, pressure and on rare occasions pain.
Sometimes they experience involuntary marching
- Somatic illusions: Feel like posture is abnormal, or that
they are missing body parts
Parietal Lobe Epilepsy
- Vertigo: the environment begins to spin or
its their body that is moving’
- Visual Illusions/ Hallucinations: objects
being too far or too close while other
objects appear to be there but are
nonexistent
- Language Disturbances: difficulty
understanding words and language,
reading and doing basic math
Treatments
Besides the common treatments include:
1.
2.
3.
4.
5.
6.
7.
Antiepileptic Drugs
Bromides
Barbiturates
Ketogenic Diet
Vagus Nerve Stimulator (VNS)
Responsive Neuropace Stimulator
Surgery
Anti-epileptic Drugs
- There are around 26 AEDs used to treat seizures, and different
AEDs work for different seizures.
- There are around 4 generations of AED, some were mentioned
in the timeline
- they help to decrease the severity of the seizures and/or the
frequency of these seizures
- They attack the Na channels, Ca 2+ channels as well as
enhancing the GABA mechanisms in the body. Block any
repetitive actions which causes inactivity
- Examples: Acetazolamide (partial,tonic-clonic & absence),
Phenytoin (everything but absence)
Bromides
- Sodium Bromide (NaBr) and Potassium Bromide (KBr)
- used as a sedative and anticonvulsant
- used until replaced by barbiturates
- still used today but primarily by veterinarians
- 1st medical treatment geared toward epilepsy
Barbiturates (Phenobarbital)
- comes from barbituric acid
- it suppresses the activity of the CNS
- they enhance the activity of GABA (inhibitory
neurotransmitter)
- used to treat all types of seizures except for absence seizures
Used to Treat
- Temporal Lobe Epilepsy
- Clonic Seizures, Tonic Seizures and Tonic-clonic Seizures
- Simple Partial Seizures
- Et Cetera
Ketogenic Diet
- ketogenic means that it produces ketones in the body
- ketones are what the body uses fat as its source of
energy instead of carbohydrates
- successful mostly on children 2-12 with difficult to
control seizures or do not respond to medication
- not a cure justs reduces the chance for a seizure
- the ratio of fat to carbs and protien is 3:1
- the diet is very strict and hard to follow
Ketogenic Diet (continued)
- the diet is not long term but typically used for 2 years
- mineral supplements are important (ex calcium and
vitamin d to prevent bone thinning)
- one of the oldest treatments
Vagus Nerve Stimulator
● sends regular mild pulses of electrical
energy to the brain via the vagus nerve
● vagus nerve controls involuntary functions
like heart rate
● passes through neck as it goes from
between chest and abdomen and lower part
of brain
● device is placed under the skin on chest
● wire from the stimulator is wound around
the vagus nerve on the left side of neck
● alternates from sending signals to resting
● lasts 5 - 10 years
Responsive Neuropace Stimulator
● should be treated for people who
do not respond well to medicine
and who cannot have surgery to
remove part of the brain
● device is placed onto skull
● when a seizure is identified then
the device tries to stop the
seizure activity by sending an
electrical current
● not a cure just an aid
Surgery
- This option is here because sometimes the seizures cannot be
controlled by medicines
- Also, it can reduce the frequency of some seizures
- The earlier a surgery is performed, the better the outcome
- Beneficial to those suffering from epilepsy induced by brain
tumors, strokes or blood vessels degradation
- Every surgery is tailored to the individual
- At least single drugs or 2 combinations must be tried
before performing surgery
Surgery: Types
- Resection or resective surgery: removes the part of the brain
that causes the seizure to happen
- most common form is temporal lobectomy
- frontal lobectomy
- parietal and occipital lobectomy
Surgery: Types
- Disconnection surgery: the surgeon interrupts the nerve
pathways that allow the seizures to spread
- more of a relief than a cure
- Corpus callosotomy: severs the pathway that seizure can
travel on
- Multiple subpial transections: great for when some areas
that the seizures begin are too important to remove
- Thermal Ablation: laser surgery which utilizes MRIs in order
to pinpoint where in the brain there will be an operation
- has a very high accuracy rate
Florence Griffith Joyner (Flo-Jo)
-
-
-
Considered the fastest woman in the world
suffered from the tonic-clonic form of
epilepsy in 1990
treated for it in 1993 and 1994
she had a brain abnormality which caused
her to experience these seizures
Cavernous hemangioma is what she
suffered from
This was the malformation of blood vessels
and causes leakage in the brain
She died in 1998 due to suffocation during
an epileptic seizure
Prince
-
-
He was born with epilepsy and suffered
throughout his infancy
These episodes lasted until he was 7 years old
Even though he grew out of the seizures, the
isolation that he felt made him turn to music
He tried to restrict being flashy in his early
years
He tried to being flashy and loud in his later
years in order to make up for the illness
About ⅓ of childhood epilepsy disappears in
childhood
https://www.youtube.com/watch?v=agD9qVUVHrI#t=23
Organizations
● Organizations provide the tools to raise
awareness for epilepsy and raise money for
further research.
● http://www.epilepsy.com/ is the largest
foundation geared to helping this disorder but
there are others such as
https://www.epilepsyct.com/
http://www.epilepsynewengland.org/