Dr. Lecanda, a prestigious specialist in Neurology, and an expert in the treatment of pathologies such as Parkinson’s, Alzheimer’s, Migraines, Stroke and Multiple Sclerosis, among other pathologies, describes in this article another of his specialties, Epilepsy.
Epilepsy is a “pathology characterized by recurrent epileptic seizures (two or more), not caused by an immediate identifiable cause”, as defined by the ILAE (International League Against Epilepsy) in 1993. In addition, it also defined epileptic seizures as “a clinical manifestation caused by an abnormal and excessive discharge of a group of brain neurons. The clinical manifestations consist of sudden and transient abnormal phenomena that can produce alterations in the level of consciousness, motor, sensory, sensory, sensory, autonomic or psychic, perceived by the patient or an observer”.
Epilepsy is much more common in men than in women, and it is estimated that in Spain there are 300,000 epileptics and about 15,000 new cases each year.
Etiology of epilepsy
A large percentage of epileptic seizures are idiopathic, of genetic origin. On the one hand, there are hereditary cases, in which the epileptic seizure is just another manifestation of the systemic disease. In other cases epilepsy is conditioned by an anomaly in a specific gene that is transmitted by a certain pattern of inheritance (chromosome 6 in juvenile myoclonic epilepsy). A certain familial predisposition to seizures may also be transmitted in response to stimuli such as sleep deprivation or fever.
The etiology of epilepsy differs with age. In infants and preschoolers seizures are the consequence of congenital malformations, metabolic disorders, meningoencephalitis, and birth trauma. In children and young people, genetic cases predominate, while in adulthood secondary epilepsies increase, being of special importance stroke (Cerebrovascular Accidents) in people over 60 years of age. In young people and adults, the most common causes of epilepsy are tumors, trauma and toxic substances (especially alcohol).
What are epileptic seizures?
Epileptic seizures are divided into partial and generalized seizures. Partial seizures include simple and complex seizures. The former are those presenting motor signs, somatosensory or special sensory hallucinations, with autonomic and psychic signs and symptoms.
Generalized seizures are those in which both cerebral hemispheres are activated and are usually associated with an initial loss of consciousness. Within this group are included absences, myoclonic and atonic and tonic seizures. And the presence in the E.E.G. of bilateral synchronous and symmetrical diffuse discharges.
Absences are characterized by disconnection from the environment of a few seconds duration, tonic-clonic seizures are presented with sudden loss of consciousness followed by tonic muscle contractions in flexion or extension, tongue biting, foaming at the mouth and sphincter relaxation. Myoclonic seizures are characterized as abrupt, mild muscle twitching, sometimes triggered by a light stimulus.
Neurological specialists state that depending on the location of the irritative epileptic focus, the symptoms can be very variable: motor, sensory, sensory, etcetera.
Treatment of epileptic seizures
Depending on the type of seizure, antiepileptic drugs with various cerebral mechanisms of action are recommended. Monotherapy or polytherapy drugs control seizures. Knowledge of the various mechanisms of action such as GABAergic facilitation, glutaminergic inhibition, inhibition of sodium and calcium T channels and others make possible a good management and control of seizures.
Neurosurgical treatments, after studying the focus and the brain lesion by means of PET, SPECT, or Functional Resonance Imaging and Spectroscopy, make it possible to treat seizures and epilepsies that are rebellious to medical treatment. Vagus nerve stimulation and ketogenic diets are a plausible alternative.
Genetic investigations provide first-order information for the study of some epilepsies.