WHAT IS EPILEPSY/ SEIZURE
A seizure is a short period of symptoms due to a sudden burst of abnormal electrical activity in the brain. Typically it lasts from a few seconds to a few minutes.
Epilepsy refers to repeated episodes of seizures. A single seizure, it does not necessarily mean that a person has epilepsy. The definition of epilepsy is the occurrence of more than one seizure
About 1 in 20 people have a seizure at some time in their lives, and might be the only one that occurs.

TYPES OF SEIZURES
Seizures are of two main types – generalized and focal (earlier called partial).

GENERALIZED SEIZURES
As the name suggests, these occur if the abnormal electrical activity affects all or most of the brain. Symptoms usually involve most or all parts of the body. There are different types of generalized seizures

• Tonic-clonic seizure is the most common type of generalized seizure. Here the whole body stiffens, body shakes or convulses due to repeated muscle contractions, and there is loss of consciousness.
• Absence seizure is another type of generalized seizure associated with brief loss of consciousness or awareness. These occur mostly in children. There are no convulsions and there is no loss of consciousness.
• Myoclonic seizure is caused by a sudden contraction of the muscles, like a jerk. It can occur in the whole body but mostly affects just one or both arms.
• Atonic seizure causes the person to become limp and to collapse, and may be accompanied by a brief loss of consciousness.

FOCAL SEIZURES
In focal seizures the burst of electrical activity begins in, and remains in one part of the brain. Therefore, the symptoms are focal or localized to the area affected. Different parts of the brain regulate different functions and the symptoms depend on the part of the brain is affected

• Simple focal seizures cause muscular jerks or abnormal sensations in one arm or leg. The person may also develop an odd taste, or tingling sensation in one part of your body. There is no loss of consciousness.

• Complex focal seizures arise usually from a part of the brain (called a temporal lobe) but may start in any part of the brain. Therefore, it is sometimes called temporal lobe epilepsy. Symptoms include strange behavior for a few seconds or minutes such as mumbling to oneself, fiddling with an object or wander aimlessly. There may be associated odd emotions, feelings, visions, or sensations and fears. There may be loss of consciousness

DIAGNOSIS OF EPILEPSY
HISTORY
Diagnosis of epilepsy requires detailed history such as history of prior episodes, duration, loss of consciousness, associated symptoms such as abnormal sensations, visions, family history, history of alcohol or drug abuse, history of head trauma or injury

DIAGNOSTIC TESTS
CT or MRI scan of brain – A brain scan can show abnormalities such as tumor or other lesions affecting different parts of the brain.
Electroencephalograph (EEG) – This painless and non-invasive test records the brain electricity. Electrodes are placed on various parts of the scalp and connected to the EEG machine. This amplifies the tiny electrical messages given off by the brain and their pattern is recorded on a computer. Some types of seizure produce typical EEG patterns. Furthermore, a normal recording does not rule out epilepsy, and not all EEG abnormalities are caused by epilepsy.

Blood tests and other tests may be taken to check general health status and also to look for other possible causes of the event.

TREATMENT OF EPILEPSY
Aim of epilepsy treatment is to reduce the frequency of seizures, or stop seizures completely.
Treatments include:
• Drugs called anti-epileptics
• Surgery to remove a small part of the brain causing the seizures
• A procedure to place a small electrical device inside the body to control seizures
• A special diet (ketogenic diet) to help control seizures

Some people need treatment for life, but others can stop if the seizures disappear over time. Treatment may not be necessary in patients who know their seizure triggers and are able to avoid them.

ANTI-EPILEPTIC DRUGD (AEDs)
? AEDs are the most common form of treatment for epilepsy. They reduce seizures in about 70% of people. They work by altering the levels of neurotransmitter chemicals in the brain
? The best type of treatment depends on the type of seizures, patient’s age and if patient is pregnant or planning to have a family
? Common types of AEDs include:
• sodium valproate
• phenytoin sodium
• lamotrigine
• ethosuximide
• carbamazepine
• levetiracetam
• oxcarbazepine
• topiramate
? Side effects of AEDs include drowsiness, headaches, tiredness, tremors

VAGUS NERVE STIMULATION (VNS)
Vagus nerve stimulation (VNS) is where a small electrical device similar to a pacemaker is placed under the skin of the chest.
The device is attached to a wire that goes under your skin and connects to a nerve in the neck called the vagus nerve.
Bursts of electricity are sent along the wire to the nerve, and it is believed that this can help control seizures by modifying the electrical signals in the brain.

DEEP BRAIN STIMULATION
Deep brain stimulation (DBS) is similar to VNS, but the device placed in the chest has wires that run directly into the brain.
Bursts of electricity sent along these wires can help control seizures by altering the electrical signals in
the brain.
DBS is a fairly new procedure and it’s still unclear how effective it is for epilepsy.

KETOGENIC DIET
A ketogenic diet is a diet high in fats, and low in protein and carbs. In children, it’s thought to reduce seizures by altering the level of chemicals in the brain
It was one of the main treatments for epilepsy before AEDs, but isn’t widely used in adults because a high-fat diet can cause serious health conditions, such as diabetes and cardiovascular disease

BRAIN SURGERY
If the epilepsy is poorly controlled despite trying several AEDs, the patient may be referred to a neurosurgeon to see if surgery might help

KEY POINTS
Seizures and epilepsy caused by abnormal electrical activity in the brain
Epilepsy refers to several episodes of seizures
Seizures can be generalized or focal
Diagnosis of epilepsy is by detailed history, diagnostic brain imaging and EEG
Treatment includes AEDs, vagus nerve stimulation, deep brain stimulation, ketogenic diet and brain surgery