### Date : 2024-06-28 12:57 ### Topic : Epilepsy #medicine #neurology ---- ### Epilepsy (뇌전증) Overview **Epilepsy**, or **뇌전증** in Korean, is a chronic neurological disorder characterized by recurrent, unprovoked seizures. These seizures are caused by abnormal electrical activity in the brain. Epilepsy can affect people of all ages and can have a significant impact on a person's quality of life. ### Etiology **Possible Causes:** 1. **Genetic Factors:** - Inherited genetic mutations can make individuals more susceptible to seizures. - Certain epilepsy syndromes are known to be hereditary. 2. **Structural Brain Abnormalities:** - Congenital brain malformations. - Acquired brain injuries from trauma, stroke, or infections (e.g., encephalitis). 3. **Metabolic Conditions:** - Disorders of metabolism such as mitochondrial diseases, hypoglycemia, or electrolyte imbalances. 4. **Infections:** - Central nervous system infections like meningitis, encephalitis, or neurocysticercosis. 5. **Tumors:** - Brain tumors can disrupt normal electrical activity. 6. **Unknown Causes:** - In many cases, no specific cause is identified, known as idiopathic epilepsy. ### Pathophysiology **Abnormal Electrical Activity:** - Seizures occur due to sudden, excessive, and synchronous discharge of neurons in the brain. - This can result from imbalances between excitatory and inhibitory neurotransmitters, structural brain changes, or genetic abnormalities affecting ion channels. **Types of Seizures:** 1. **Focal Seizures (Partial Seizures):** - Originate in a specific area of the brain. - Can be simple (without loss of consciousness) or complex (with impaired consciousness). 2. **Generalized Seizures:** - Involve both hemispheres of the brain from the onset. - Includes tonic-clonic (grand mal), absence (petit mal), myoclonic, atonic, and tonic seizures. ### Clinical Features **1. Seizure Symptoms:** - **Focal Seizures:** - Simple: Motor, sensory, autonomic, or psychic symptoms without loss of consciousness. - Complex: Altered awareness, automatisms (repetitive movements), and confusion post-seizure. - **Generalized Seizures:** - Tonic-Clonic: Sudden loss of consciousness, body stiffening (tonic phase), followed by rhythmic jerking (clonic phase). - Absence: Brief, sudden lapses in awareness, often mistaken for daydreaming. - Myoclonic: Sudden, brief jerks or twitches of the muscles. - Atonic: Sudden loss of muscle tone, causing the person to collapse. - Tonic: Muscle stiffening without the jerking phase. **2. Aura:** - Some individuals experience a warning sensation (aura) before a seizure, such as a strange feeling, smell, taste, or visual disturbance. **3. Postictal State:** - After a seizure, a person may experience confusion, fatigue, headache, or temporary neurological deficits. ### Diagnosis **1. Clinical Evaluation:** - Detailed history of seizure episodes, including frequency, duration, triggers, and type of seizure. - Neurological examination. **2. Electroencephalogram (EEG):** - Measures electrical activity in the brain. - Can detect abnormal brain waves characteristic of epilepsy. **3. Imaging Studies:** - **MRI or CT Scan:** To identify structural abnormalities, such as tumors, malformations, or areas of brain damage. **4. Laboratory Tests:** - Blood tests to rule out metabolic or infectious causes. ### Example Case Study **Patient Profile:** - **Name:** Jee Hoon Ju - **Age:** 20 - **Occupation:** Student **Medical History:** - Recurrent episodes of sudden loss of consciousness with convulsions over the past year. - No significant past medical history or family history of seizures. **Clinical Evaluation:** - **Symptoms:** Generalized tonic-clonic seizures occurring approximately once a month. - **Physical Examination:** Normal between seizures. **Diagnostic Tests:** - **EEG:** Shows generalized spike-and-wave discharges. - **MRI:** Normal brain structure. **Diagnosis:** Based on clinical presentation and EEG findings, Jee Hoon Ju is diagnosed with generalized epilepsy. ### Management **1. Medication:** - **Antiepileptic Drugs (AEDs):** - First-line treatment to control seizures. - Common AEDs include valproate, lamotrigine, levetiracetam, and carbamazepine. - The choice of AED depends on the type of seizures and individual patient factors. - **Medication Adherence:** Importance of taking medication regularly to prevent seizures. **2. Lifestyle Modifications:** - **Regular Sleep:** Ensuring adequate and consistent sleep. - **Avoiding Triggers:** Identifying and avoiding known seizure triggers, such as flashing lights, stress, or certain foods. - **Safety Measures:** Precautions to prevent injury during a seizure, such as avoiding swimming alone or using protective gear. **3. Surgery:** - **Resective Surgery:** Removing the area of the brain causing seizures, considered for patients with focal seizures not controlled by medication. - **Vagus Nerve Stimulation (VNS):** Implanted device that stimulates the vagus nerve to reduce seizure frequency. - **Deep Brain Stimulation (DBS):** Electrodes implanted in specific brain areas to control seizures. **4. Monitoring and Follow-Up:** - Regular follow-up appointments to monitor seizure control, medication side effects, and overall health. - Periodic EEGs and blood tests to assess treatment efficacy and safety. **5. Psychosocial Support:** - **Education:** Providing information about epilepsy to the patient and family. - **Support Groups:** Connecting with epilepsy support groups for emotional support and practical advice. - **Counseling:** Addressing psychological and social issues related to living with epilepsy. ### Prognosis - **Variable Course:** Prognosis depends on the type of epilepsy, response to treatment, and underlying cause. - **Good Control:** Many patients achieve good seizure control with medication and lead normal lives. - **Refractory Epilepsy:** Some patients may have seizures that are difficult to control, requiring more intensive treatment. ### Conclusion Epilepsy is a chronic neurological disorder characterized by recurrent seizures due to abnormal electrical activity in the brain. Diagnosis involves clinical evaluation, EEG, and imaging studies. Management includes antiepileptic medications, lifestyle modifications, and sometimes surgical interventions. Understanding the etiology, pathophysiology, clinical features, and management strategies is essential for providing comprehensive care to individuals with epilepsy, ensuring better seizure control and improved quality of life.