What is Epilepsy?

Epilepsy is a disorder caused by disorders of the central nervous system, which are responsible for controlling the body’s functions. Until causing seizures Epilepsy can occur with all ages. But often found in pediatric patients and the elderly Which the epilepsy cannot be cured But can help calm the symptoms and without seizures if the patient eats …

Epilepsy is one of the most common central nervous system disorders. Caused by a sudden change in electrical current coming from the brain cells at the same time. Together and running through the various brain skin parts Causing seizure in various forms such as spasms or abscesses, etc. If the seizures are more than once without an unprovoked seizure, the patient will be referred to as epilepsy.

1. What is epilepsy?

Epilepsy is a disease caused by seizure syndrome due to The part or all of the brain to work beyond normal from the moment. From the electrical seizures occur and spread in different parts of the brain. The symptoms that occurred. It depends on which part of the brain is stimulated and the symptoms progress for a moment.

2. What are the causes of epilepsy?

1. abnormalities in the brain structure Causes from brain lesions include The scar on the hippocampus (Brain related to memory), brain tumors, abnormal brain veins, after brain injury, oxygen deficiency after birth after labor is difficult.
2. Genetics, which are prominent and beginning to occur. Epilepsy by age, neurological disorders with skin, brain cells develop some types of deformities.
3. Caused by infectious diseases such as encephalitis due to viral infections, bacteria, protozoa infections or Parasites in the brain
4. Cause from metabolic conditions Such as imbalance of water, minerals and sugar Including sodium salt levels in the blood And the level of glucose in the blood is too high or too low.
5. Caused by immunity Causes the immune system of their own, such as encephalitis certain Rasmussen encephalitis, Limbic encephalitis and disease immunity against self (SLE), etc.
6. The cause is not known (Unknown), including epilepsy who do not have lesions in the brain. (Non-lesional epilepsy)

3. What types of seizures will have?

Currently divided into 4 major types

  1. Focal Onset (with local wave origin)
  2. Generalized Onset (origin of electrical activity in the brain)
  3. Unknown Onset (unknown origin of EEG)
  4. Unclassified (unable to identify seizures)

Types of seizures (Epileptic seizures) that are common.

  • Local seizures (Both consciously and unconsciously) with abnormal electrical currents may disturb the brain that controls somewhere in the body. Causing various symptoms Without knowing it, such as numbness or twitching of the arms, legs, or face on either side repeatedly Which cannot be controlled In addition, there may be nausea, stomach aches, fear, strange feelings. Feelings of dreaming, hearing, hallucinations or abnormal heart rhythms
  • Absent-minded seizures Patients tend to have warning symptoms as before as mentioned. Followed by absent-mindedness, patients tend to make their lips spit or chew their mouths or hands flexed or move around. May feel like clothes without knowing Limbs aimlessly without knowing the surroundings Which did not remember the events during that time Absent-minded Will last for a few seconds to several minutes. After that, patients tend to have confused symptoms In some patients, it may be impossible to speak or raise one arm for several minutes before waking up to normal.
  • Focal to bilateral tonic-clonic seizures are caused by abnormal electrical currents that interfere with the entire brain. Will cause seizures known as “Seizures all over” or that is smooth as epilepsy The most common type are Spasms, whole body spasms The patient will immediately lose consciousness. And falling down, the muscles become stiff all over the body. The eyes are left with a saliva drooling, the mouth may bite their own tongue or urinate. The duration of the seizures is about 2-3 minutes. After the seizures, they often become tired and sleep after stopping the seizures.
  • Absence is more common in childhood. Symptoms will occur in a very short period of time. The patient will aim forward aimlessly for a short time. Resembling frown for 2-3 seconds, then come back to do the remaining things, usually without limb movement

4. What is the diagnosis of epilepsy?

Diagnosis Including the examination of the brainwave There are both a regular examination takes approximately 20-30 minutes to record and the test for 2 hours to 24 hours to increase the likelihood of abnormalities in the brain.

  • Brain electromagnetic wave X-ray examination To find the cause of seizures from disorders in the brain
  • Nuclear medicine tests for brain disorders that cause seizures, such as PET scans and SPECTs
  • Currently, there is a blood test for genetic causes in certain hereditary epilepsy.

5. Is epilepsy cured?

Some types of epilepsy can be cured. Such as types with found clear causes and can be resolved But most often control the symptoms with epilepsy medication and some patients are resistant to medication Need to be treated with other methods Such as surgical treatment

6. How many treatments are there for epilepsy? Does the drug need to be taken for life or not?

Can be divided into 2 major methods: use of anticonvulsants only, and use of anticonvulsants in combination with other methods, such as surgery, electrical stimulation of the brain, the use of specially formulated foods. The ketogenic diet is a diet with a high proportion of fat. Low carb And sufficient protein
How long the drug is taken depends on the type of epilepsy. And some don’t need medication for life

7. What are the side effects of taking antiepileptic drugs? What is the difference between each drug?

Short-term side effects And side effects in the long run Short-term side effects are most likely to occur immediately after taking the drug, such as dizziness, dizziness, drowsiness due to the drug acting on the brain cells. Long-term side effects include effects on deteriorating liver and kidney function. Cognitive, memory, concentration, weight gain, weight gain, weight gain or loss than usual Each type of antiepileptic drug has different side effects. Current antiepileptic drugs are available in both the first generation and new versions. It can be used to treat epilepsy well, not inferior depending on the type of epilepsy and the appropriate dosage for each person. Therefore, the use of drugs, it is necessary to use the advice of doctors who treat patients is important.

8. Epilepsy if treated with medication for a long time Is there a chance that the disease is more severe?

Generally, the treatment of epilepsy is to use medication for a long time. This means more than 2 years, only when patients with epilepsy that are difficult to treat, such as abnormalities in the brain, skin, and brain. Stopping medication often does not succeed. The epilepsy itself may be stable or more likely to be more severe. Depending on the type of epilepsy

9. The severity of epilepsy to the point of death or not?

Some types of epilepsy, such as local epilepsy That is still not well controlled And have frequent spasms, such as more than 4 times a month Patients are at risk of continuing seizures or death.

10. How should epilepsy patients take care of themselves?

Should use both general self-care principles such as eating healthy food Get enough rest Exercise and take care of yourself, especially epilepsy Which has things to watch out for and must be avoided Not drinking any kind of alcohol, not being sleep deprived, not stressing, exercising too hard, or working too hard and exhausting If you are not comfortable, have a high consumption Should heal as soon as possible Which these factors have the opportunity to cause seizures to relapse In the event that the epilepsy is not calm is still in the period of adjustment of antiepileptic drugs. Patients should avoid activities or situations that may cause danger to themselves when seizures occur, such as driving, swimming, high altitude The use of sharp objects, etc.

11. If I am a spectator who falls to the ground First, what should we do?

What can we do to help patients? And if the patient is aware, what should we do?
Be conscious, shout to others to help, call for help, then hurry to support the patient and carefully follow the steps such as

  1. Position the patient to lie on the right side.
  2. Protect the patient from accidents and injuries.
  3. If wearing glasses or dentures, glasses or dentures should be removed. (If easy to do)
  4. Move the patient away from potentially dangerous areas such as roads, tall poles or wells.
  5. Do not bind or push the patient or do anything. Patients to stop seizures (not leverage, not tangle, do not stretch, do not press).
  6. Do not leave the patient alone while seizure or after new seizures.
  7. Should not give the patient to eat immediately after new seizures
  8. Take care of the confusion During the seizure Or after the seizure until disappear by itself.
  9. Should not rush the patient to stand or walk while recuperating. If the patient is asleep, give enough rest (The alarm may cause the patient Confused and rampant Or may have repeated seizures)

12. If we are relatives with epilepsy patients at home How to look after and act?

  1. People who see seizures Should try to observe and remember the nature of seizures For the benefit of diagnosis and treatment.
  2. Should avoid places and work that are dangerous. While still not controlling seizures, such as near water sources, traffic surfaces, stoves, hot objects, working with machinery
  3. Do not drive cars and motorcycles Until there is no seizure for at least 1 year.
  4. Avoid factors that stimulate the seizures include lack of sleep, stress, exercise that overdo or work hard until tired, drinking all kinds of alcohol. Including pickles Such as pickled vegetables or fruits.
  5. Conduct and take medicine according to doctor’s advice.

  • Should not stop medication, reduce medication or take medication irregularly
  • If you do not understand how to take the medicine Should inquire immediately
  • If you forget to take the medication for one meal or one day, take the medicine as soon as you think. But if approaching the next meal, skip the next dose as usual
  • Should not take other drugs Together with antiepileptic drugs without consulting a doctor
  • In the case of changing treatment locations Should take the current drug to the doctor for consideration as well.

  6. Although having good control of seizures Do not stop the medication by yourself before the doctor recommends Because the disease may still not disappear or relapse again.
  7. When pregnant Or other illnesses Should inform the doctor treating the disease And all medications currently consumed.
  8. If there are any abnormal symptoms Who are suspected of having an allergic reaction to medication such as a rash or fever, should call the hotline immediately. And returned to the doctor who treated Along with taking the medicine taken with

13. I would like the doctor to advise more about epilepsy patients.

Epilepsy is a common disease that can be found at all ages, from birth to old age, especially in poor countries, as many as 1% of the population. Most epilepsy is a curable disease. Is to control the symptoms and prevent relapse by taking antiepileptic drugs Or if the cause is resolved, it may be cured

Epilepsy has a direct impact on patients. Family and people around Resulting in stigma Feeling lost in self-confidence And self-worth because of the convulsions that appear in front of the general public May affect learning Duties, opportunities and social rights

Therefore, both people within the family, relatives, siblings, colleagues should understand about patients with epilepsy. And help to be aware of the dangers that may occur if the patient has seizures In order to help each other to take care of the basics correctly Before the patient will receive further care with the doctor. Source by Dr. Yodpin Roj, neurologist Epilepsy Sub-branch

Treatment and medication used to treat epilepsy

In addition to surgery Treatment of epilepsy through medication Anticonvulsant Drugs to prevent recurrence of seizures are a standard method used throughout the world. However, the use of anticonvulsants must first be diagnosed by a physician as to what type of epilepsy is. If it is just a seizure that does not occur frequently, it may not be necessary to use medication. It is found that 70% of patients if continuous medication can come back to disappear. The goal of antiepileptic drugs is to control the seizures with minimal side effects. In some patients it may be necessary to use more than 1 antiepileptic drug to control seizures.

There are many types of anticonvulsants, which have different properties for the appropriate use in treating epilepsy. In general, antiepileptic drugs act by altering the level of chemicals that are involved in nerve conduction within the brain. Can reduce the chance of seizures Antiepileptic drugs can be divided into 2 large groups as follows

  1. The traditional treatment of epilepsy ( the Classic anticonvulsants,) viz.
    • Sodium valproate ( Depakene ® ) acts to inhibit the enzyme that destroys the GABA (Gamma-aminobutyric acid) GABA transaminase and closes the sodium transport channel (Na +) resulting in nerve impulses in the brain. Decrease Commonly used as the first drug chosen by doctors for treating spasms and spasms Specific spasms Absent-minded seizures And the seizures This drug is contraindicated in pregnant women as it can cause birth defects. There are side effects causing hair loss and gastrointestinal discomfort.
    • Carbamazepine ( Tegretol ® , Mazepine ® ) inhibits sodium transport channels (Na +) as the main drug used for the treatment of convulsive and convulsive seizures. Specific spasms And trigeminal neuralgia. This drug is contraindicated in pregnant women in the first trimester. Due to the effect of congenital babies Side effects cause edema and hematopoietic disorders.
    • Carl C. climb out bar ( Oxcarbazepine; Trileptal ® ) This drug is a derivative of the drug Carr Obama’s climb. Acts to block the electric potential caused by the exchange of ions of sodium salt in the nerve cells And inhibiting abnormal nerve transmission to muscle cells Commonly used with specific spasms
    • Ethosuximide ( Zarontin ® ) acts to inhibit the calcium neurotransmitter channel. The voltage-gated calcium channels (T-type) in the brain of the Thalamus (Thalamus) causes nerve impulses in the brain to decrease. Is the main drug used for treating absent-minded seizures.
    • Phenytoin ( Dilantin ® ) reduces the activity of sodium transport channels (Na +), commonly used for the treatment of convulsive and convulsive seizures. And used to prevent continuous seizures for more than 5 minutes without stopping seizures (status epilepticus) with side effects causing gingival hyperplasia
    • Benzodiazepines climb diacetate active ingredient binds to receptors, GABA-A receptor channel open more often, thus increasing the amount of GABA in the brain. Used to treat continuous seizures
  2. Treatment of epilepsy group ( No comments: Newer anticonvulsants,) has been developed to give better effect. While side effects are reduced, drugs in this group include
    • Alamo Sai China ( Lamotrigine; Lamictal ® ) action to block the function of the channels transport sodium (Na +) and decrease the secretion of the neurotransmitter glutamate (glutamate) and aspartame treatment (aspartate) from the central nervous system. Used as the main medication for treating spasms. Side effects may cause blurred vision. And the Stevens Johnson syndrome (Stevens-Johnson syndrome), which is a disorder of the skin and mucous membranes, severe epithelial
    • Phenobarbital ( Phenobarb ® ) reduces the activity of sodium transport channels (Na +), commonly used for the treatment of seizures in children. Convulsions and spasms And specific spasms This drug has side effects, which can cause the child to be more miserable.
    • Lewis Tyra C. Latham (Levetiracetam ; Keppra ® ) stimulate the release of neurotransmitters in Communications through binding to a carrier protein in the brain SV2A used for treating convulsions in the long run.
    • Pit Master Mold Mate (topiramate, ; the Topamax® ) action potentials resulting from the exchange of sodium ions in neurons. And increasing GABA amount. Popular for treating spasms and spasms and specific spasms This drug has side effects causing insomnia. Increase the Risk of Glaucoma ( Glaucoma) and kidney (Kidney Stones)
    • Tiagabine ( Gabitril ® ) inhibits the collection of GABA neurotransmitters, resulting in longer GABA content in the brain. Commonly used in the treatment of specific spasms, both types of patients with and without consciousness. This drug has side effects causing nausea, vomiting, diarrhea , insomnia and weight changes.
    •  Gabapentin ( neurontin ® ) inhibits neuronal calcium channel carrier signal. (voltage-gated calcium channels; T-type and L-type) in the thalamus It is commonly used as the second option for treating spasms. This drug has side effects causing dry mouth, insomnia and nausea.
    • Vigabatrin ( Sabril ® ) acts to inhibit the GABA transaminase-destroying neurotransmitter GABA transaminase, used as the primary treatment option for spasms that are ineffective or ineffective. Not This medicine may have side effects that cause permanent vision loss.

How to take medication to treat epilepsy correctly

  1. Continuous medication Because it can cause seizures if lack of medicine
  2. Do not stop or adjust the dose by yourself. Except with drug allergy such as suffocation, diphtheria, rash on the body Mild mucosa under the mouth and eyes swollen If there are any of the above symptoms, stop the drug immediately. And take the medicine samples to see a doctor
  3. Should see a doctor continuously to follow up on treatment results Prevent side effects and seizures that may occur Even if no seizures occurred at that time If you have seizures while taking medication, you should inform your doctor. The doctor will determine whether the drug should be changed or not.
  4. Almost all epileptic drugs often have side effects that cause drowsiness. Should be careful when driving vehicles and operating machinery.
  5. Do not take the medicine with milk Because milk has a reducing effect on drug absorption
  6. Stop drinking alcohol while taking epilepsy medication

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