Spotlight on Epilepsy: Brushing up on the Biology of the Disease
The two most common neurological conditions are epilepsy and stroke. Epilepsy is a neurological disorder affecting the central nervous system (CNS). It is result of sudden persistent firing of CNS neurons causing change in behavior, movement and loss of consciousness. People who suffer from epilepsy do not have brain damage, but a transient brain dysfunction causing unnecessary spike potentials.
A person is considered to have epilepsy if they meet either of the following conditions: at least 2 unprovoked seizures occurring ˃24 hours apart, or a single unprovoked seizure, with a probability of further seizures. Doctors take into consideration four factors: neurological history, physical examination, electroencephalogram and MRI plus CT findings. Careful consideration of results from all of these sources is required to correctly diagnose epilepsy; this condition is often misdiagnosed, for instance as cardiovascular syncope.
Neurological history helps the doctor get a better look at the person’s previous brain activity. Physical examination helps to localize the part of the brain which is not working appropriately, as the part of the body controlled by the affected region of the brain region will also have loss of function.
Electroencephalogram is a neurological test which shows the electrical activity of the brain. Spikes on an EEG mark hyper excitable parts of brain that identify the location of seizures. Presence of abnormal spikes confirms the diagnosis of epilepsy provided the history is also convincing. If an EEG shows spikes, but history does not support it, then it is not conclusive for epilepsy.
Brain MRI and brain CT provide further insight into the biology of the disease. Once the diagnosis is made, 60% of epilepsy cases are treatable. Generic anticonvulsant drugs are the preferred choice of treatment. Surgery is performed if the part of the brain involved does not control vital functions such as speech, language, motor function, vision or hearing.
Vagus nerve stimulator is a device also in use, which can reduce seizures by up 20-40%. A ketogenic diet which is high in fat and low in carbohydrates also allows children to remain seizure-free. A number of future treatments are also under development, including radiosurgery and pacemaker for epilepsy.
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