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Epilepsy

Epilepsy is a common neurological disorder caused by disturbances in the normal electrochemical functions of the brain. In normal brain function, orderly electrochemical information is passed via nerve cells in the brain to other parts of the body. In patients with epilepsy, this pattern is interrupted by sudden and synchronized bursts of electrical energy, which, if intense enough, may briefly affect a person's consciousness, bodily movements or sensations. These physical changes are called epileptic seizures. About 2.5 million people in the United States have epilepsy, and as many as 9 percent of the entire population may experience a seizure at some point in their lives. There are many types of epilepsy – a few common types are described below.

Types of Epilepsy

Partial (or focal) epilepsy

Partial (or focal) epilepsy is the most common type of epilepsy and begins in only part of the brain. The patient may be awake. These seizures may become generalized if the electrical activity spreads to the rest of the brain.

Idiopathic generalized epilepsy

Idiopathic generalized epilepsy often starts during childhood or adolescence, although it may not be diagnosed until adulthood. In this type of epilepsy, there are no nervous system (brain or spinal cord) abnormalities other than seizures. The brain is structurally normal. This condition is generally treated with medications and may be outgrown.

Idiopathic partial epilepsy

Idiopathic partial epilepsy affects children, usually between the ages of 5 and 8, and may have a genetic cause. Children frequently outgrow this mild form of the condition by the time they reach adolescence.

Diagnosis

Diagnosis is made by a neurosurgeon based on symptoms, physical signs, and results of tests such as an electroencephalogram (EEG), computed tomography (CT or CAT scan), or magnetic resonance imaging (MRI). It is essential that the type of epilepsy and the type of seizures are both diagnosed properly. There are several major classifications of seizures, and most are associated with specific forms of the disorder.

Treatment

Epilepsy may be treated with drug therapy, surgery, biofeedback or a ketogenic diet. The wide range of antiepileptic drugs (AEDs) remains the cornerstone of treatment. AEDs treat the symptoms of epilepsy (the seizures), rather than curing the underlying condition. The drugs act on the brain to prevent the seizures from starting by reducing the tendency of the brain cells to send excessive and confused electrical signals. Brain surgery may be a viable alternative for some people whose seizures cannot be controlled by medication. A person who has been given adequate dosages of several seizure medications, for an appropriate period of time without good results, is unlikely to achieve complete seizure control with any other medication. Epilepsy surgery can benefit patients who have seizures associated with structural brain abnormalities, such as benign brain tumors, malformations of blood vessels (including disorders known as arteriovenous malformations, and cavernous angiomas), and strokes. Improved technology has made it possible to identify more accurately where seizures originate in the brain (epileptogenic regions), and advances in surgery have made operative management safer. The benefits of surgery should always be weighed carefully against its risks, because there is no guarantee that it will be successful in controlling seizures.

Epilepsy in Childhood

Most children categorize good days as those when they have won a baseball game, received an "A" on a book report or were allowed to order pizza and stay up late. Other children categorize a good day as one in which they are seizure-free. These are epileptic children. According to the Epilepsy Foundation, more than two million Americans have epilepsy and 181,000 people are diagnosed with the condition each year. A substantial number of these people are children. In fact, there are thousands of children who do not respond to antiepileptic medications, and who are excellent candidates for surgery. Over the past decade, tremendous advances have been made in the success and safety of epilepsy for children. There is no known cause for epilepsy in children. Frequently identified causes may include: trauma at birth or a high fever, head injuries that cause scarring of the brain tissue and certain drugs or toxic substances when taken in large doses. Symptoms of epilepsy, though difficult to detect early on, can include strange sensations, emotional or behavioral problems, convulsions, muscle spasms and loss of consciousness. The main symptom of a child with epilepsy is a seizure. Seizures may occur throughout a person's lifetime from infancy to old age. Children may develop seizures at the time of a high fever. In some cases, severe head injury can lead to seizures or epilepsy. Seizures in children are very common, estimated to occur in 4 percent of children nationwide. They are defined as individual events or episodes, indicative of a temporary electrical "misfiring" in the brain. When seizures occur repeatedly, the child is said to have epilepsy. Many children with epilepsy or recurrent seizures will benefit from initial conservative treatment with antiepileptic medications that reduce or eliminate the number of seizures. There are many children who do not respond to high doses of multiple medications, and have continued seizures. Significant evidence now indicates that recurrent seizures, which are poorly controlled by medications, are harmful to the development of the brain of a child. Moreover, the medications used to treat these seizures may have sideeffects such as lethargy or behavioral changes. For these reasons, there has been a growing interest in surgery to cure seizures in children and improve their developmental outcome.

An Overview of Epilepsy Surgery for Children

Infants, children and young adults with frequent seizures may be considered for epilepsy surgery when conservative treatment with antiepi leptic med ication fails . Neurosurgical intervention at an early age can very frequently cure children of their seizures that can result in dramatic improvements in their development. There are two main surgical procedures performed to treat children with epilepsy. Resective surgery removes the source of seizures, whereas disconnection surgery disrupts the pathways that spread seizures. In resective surgery, a team of epilepsy specialists will identify the part or region of the brain that causes an infant's or child's seizures and then remove this area. The goal of this procedure is to cure the seizures. In disconnection surgery, neurosurgeons will disrupt seizure pathways in order to reduce spreading throughout the brain. The most common type of disconnection surgery is corpus callosotomy, a disruption of a structure that connects the two hemispheres of the brain. Disconnection surgery is rarely curative. Hemispherectomy is another type of epilepsy surgery performed in children. This procedure is commonly performed in children whose origin of epilepsy is located only in one hemisphere (half) of the brain. Hemispherectomy has a very high success rate for curing seizures. While epilepsy is not 100 percent curable, for some people it does eventually go away. A recent study found that children with idiopathic epilepsy, or epilepsy with an unknown cause, had a 68 to 92 percent chance of becoming seizurefree 20 years after their initial diagnosis. It is important to take precautionary steps to avoid severe head injury such as wearing seat belts in cars and using helmets when riding a bicycle or playing competitive sports. Following these simple precautions can protect people from epilepsy and additional problems that result from head injury.

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