Summary
Highlights
Epilepsy is defined as a seizure disorder where brain neurons are synchronously active when they shouldn't be. This electrical activity involves ions flowing through protein channels, controlled by excitatory neurotransmitters like glutamate and inhibitory neurotransmitters like GABA. Seizures occur due to either excessive excitation or insufficient inhibition.
Dysfunction in neurotransmitter 'receptors and ion channels can be caused by genetic factors, brain tumors, injury, or infection. Seizures can manifest as outward signs like jerking or loss of consciousness, or subjective experiences like fears or strange smells, depending on the affected brain region.
Focal seizures affect only one hemisphere or a smaller area of the brain. They are categorized as simple partial (consciousness maintained) or complex partial (impaired consciousness). Simple partial seizures can involve strange sensations or jerky movements in specific muscle groups (Jacksonian march), while complex partial seizures involve impaired awareness and memory loss.
Generalized seizures affect both hemispheres of the brain. They can either start as generalized or develop from a partial seizure (secondary generalized seizure). Types include tonic (muscle stiffening), atonic (muscle relaxation), clonic (violent muscle contractions), tonic-clonic (most common, combining tonic and clonic phases), myoclonic (short muscle twitches), and absence seizures (brief loss of consciousness, appearing spaced out).
Status epilepticus is a medical emergency where seizures last over five minutes or occur without recovery in between. It's often treated with benzodiazepines. Post-seizure, patients may experience confusion (post-ictal confusion) or temporary paralysis on one side of the body (Todd's paralysis).
Diagnosis involves brain imaging (MRI, CT scans) to check for anatomical abnormalities, EEG to detect electrical activity, and a thorough clinical history. Treatment options include daily anticonvulsant medications tailored to the patient's specific needs, epilepsy surgery to remove seizure-causing areas, nerve stimulation (e.g., vagus nerve), and a ketogenic diet.