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Let’s Learn about

Epilepsy Treatment
Facts about Epilepsy
• Epilepsy affects 2.7 million Americans, more Americans than cerebral palsy,
multiple sclerosis and Parkinson’s Disease combined.
• Approximately 200,000 new cases of epilepsy occur each year.
• Everyone's brain has the ability to produce a seizure under the right
conditions.
• Epilepsy can develop at any age. However, it is diagnosed most often
before the age of 20 and after the age of 60.
• With the appropriate treatment, up to 70% of people with epilepsy could be
seizure free.
• Only a few percent of people with epilepsy are affected by flashing lights–
this is called photosensitivity.
• The Greek philosopher Hippocrates (460-377 BC) was the first person to
recognize that epilepsy starts in the brain.
• Ten percent of the American population will experience a seizure at least
once in their lifetime. 1 person in 20 will have a seizure at some time in
their life

Source: http://www.epilepsynse.org.uk/PAGES/info/leaflets/epfacts.cfm
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Classification of seizures
Seizure Classification

Partial Generalized
seizure activity starts in one area of the seizure involves whole brain &
brain consciousness is affected

Simple Complex
Retains awareness Altered awareness and behavior

Secondary generalization
(spreading from one area to the whole
brain)

Tonic Clonic Absence Tonic or Atonic Myoclonic


‘drop attack”
“grand-mal” or convulsion “petit mal” or starting fit or Sudden muscle jerks
Abrupt fall, either with
Loss of consciousness, trance like state
stiffening (tonic) or with
stiffening of body then
loss of muscle tone (atonic
jerking of limbs
or “astatic” attacks)

Source: http://www.epilepsy.org.au/fact_sheets/seizure%20Classsification.pdf
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Prevalence of seizure types
Generalized Simple Partial,
tonic clonic, 14%
23%

Other
generalized,
8%

Partial
unknown, 7%

Absence, 6%
Complex
Partial, 36% Myoclonic, 3%
Unclassified,
3%

Source: www.med.uc.edu/neurology/epilepsyinfo.htm
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Types of epilepsy (I)
1 Partial epilepsies 2 Generalized idiopathic epilepsies

These are epilepsies with a clearly defined Generalized epilepsies are those which have
focal area within the brain. As a result, they no defined focal area within the brain.
have high characteristic symptoms, such as Idiopathic is a medical term meaning that
visual hallucinations, or motor difficulties on there is no clear environmental cause for the
one side of the body epilepsy and it is presumed that genetic
factors predominate

Types of Partial epilepsy Types of Generalized idiopathic epilepsy


•Benign occipital epilepsy •Benign myoclonic epilepsy in infants
•Benign rolandic epilepsy •Juvenile myoclonic epilepsy
•Frontal lobe epilepsy •Childhood absence epilepsy
•Occipital lobe epilepsy •Juvenile absence epilepsy
•Mesial temporal lobe epilepsy
•Parietal lobe epilepsy

Source: http://www.mynchen.demon.co.uk/epilepsy/Types/Types%20of_epilepsy.htm
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Pathophysiology (I)

•Normal brain function involves "communication"


between millions of nerve cells (neurons)
•A nerve cell is made up of a cell body and branches
called axons and dendrites which join other
neurons at junctions called synapses
•At any one time, there are nerve cells which are
resting, exciting or inhibiting other nerve cells
•Electrical signals are sent from the cell body along
the axon to the synapse, these electrical signals
being the result of ion (Na+, K+ , Ca2+) currents
across channels in the nerve cell membrane
•Chemical signals (neurotransmitters) pass across
synapses between neurons

Source: edycsepilepsy.intnet.mu/how_epilepsy.html
library.thinkquest.org/J001619/history.html
http://www.rch.org.au/cep/treatments/index.cfm?doc_id=3242#more_pics
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Pathophysiology (II)
•Neurotransmitters cross the synaptic gap between neurons and fix to
receptor points of the adjoining neuron
•Some neurotransmitters function to excite the joining neuron (eg.
glutamate) to send a further electrical signal. Other neurotransmitters
function to inhibit the joining neuron (eg. GABA) and inhibit electrical
signals passing down that neuron
•It is by these electrical and chemical pathways that the millions of neurons
within the brain communicate and function normally
•seizures occur when there is an imbalance within these excitatory and
inhibitory circuits in the brain, either throughout the brain (generalised
epilepsy) or in a localised part of the brain (focal epilepsy), such that
neurons fire off in an abnormal fashion
•Mechanism of AEDs to prevent
–Altering electrical transmission along neurons by affecting ion
(Na+, K+ , Ca2+) channels in the cell membrane.
–Altering chemical transmission between neurons by affecting
neurotransmitters (GABA,glutamate) in the synapes

Source: http://www.rch.org.au/cep/treatments/index.cfm?doc_id=3242#more_pics
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Treatment Options
• There are four main categories of epilepsy
treatments

Ø Medications
Ø
Ø Surgery
Ø
Ø Ketogenic Diet
Ø
Ø Vagus Nerve Stimulation
Source :http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm
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Medications
• Each medication has benefits and side effects and different
medications are appropriate for different types of epilepsy.

• No one medication is proven to be the best treatment for
epilepsy. Only a complete evaluation can determine which
medication will work best for each patient.

• Approximately

– 50% of seizures are eliminated by medication

– 30% of seizures are reduced in intensity and frequency by
medication
Source: http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm
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Seizure type and Drug selection
Seizure type First line drugs Second line drugs

Partial (simple, complex, with or Lacosimide Clobazam


without secondary Leveiiracetam Clonazepam
generalisation Carbamazepine Gabapentin

Sodium valproate Lamotrigine

Phenytoin

Tiagabine

Topiramate

Vigabatrin

Pregabalin

Zonisamide

Generalized absence Sodium valproate Clobazam

Ethosuximide Clonazepam

Lamotrigine

Generalized tonic-clonic Levetiracetam Carbamazepine


Sodium valproate Clobazam
Gabapentin

Lamotrigine

Phenytoin

Topiramate

Vigabatrin

Myoclonic Leveitiracetam  Phenobarbital


Sodium valproate

Source: http://www.pjonline.com/Editorial/19990327/education/epilepsy_treatment.html
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Surgery
lve removal of epileptogenic tissue from the area where seizures arise or interruption of nerve pathways alon

nd Cortical Resection
Hemispherectomy
most common form of epilepsy surgery is a lobectomy or cortical resection.
•The operations usually involve removal of a relatively small area of the brain s
part of a left or right lobe may be removed surgically

Source:http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm
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Surgery
Multiple Sub- pial Transection
•This operation also seeks to control seizures by cutting nerve pathways
•It is used when the seizure focus is located in a vital area of the brain that cannot be

to identify a single epileptic focus


but leaves some connections in place. If the generalized seizures stop, no further surgery is done. If they continue, a

Source: http://www.epilepsyfoundation.org/answerplace/Medical/treatment/surgery/benefitsrisks.cfm
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Ketogenic Diet
• The ketogenic diet is primarily used in childhood epilepsy.

• The mechanism of ketogenic diet is unknown. The high-fat,
low-protein, no-carbohydrate diet mimics some effects of
starvation that seem to inhibit seizures.

• The diet is very rigid and carefully controlled and must be
supervised by a physician -- sometimes in a hospital
setting.

• Ketogenic diets have been used for children with epilepsy for
many years with a success rate of approximately 50
percent.
Source: http://www.mayoclinic.org/epilepsy/index.html
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Vagus Nerve Stimulation (VNS)
•Vagus nerve stimulation (VNS) is approved to
treat partial seizures in patients 12 years of
age or older
•Approximately 30 to 50 percent of patients can
be expected to have less seizure activity with
VNS
•The vagus nerve stimulator is surgically
implanted under the skin in the chest. The
device is attached to a wire that is tunneled
under the skin and attached to the vagus
nerve, which is located in the left side of the
neck
•The vagus nerve stimulator is adjusted to
automatically stimulate the vagus nerve from
every few seconds to every few minutes.
•The device does not detect seizure activity. It
can be adjusted easily in a physician's office
using a laptop computer

Source:http://www.mayoclinic.org/epilepsy/diagnosis.html
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