Epilepsy and epileptic crisis
Epilepsy is a syndrome characterized by the repetition of epileptic seizures due to the hyperactivity of some brain nerve cells (so-called "neurons").
- MIOCLONICS: minor spasms;
- TONICS: more intense contractions;
- TONICI / CLONICI: violent muscle spasms followed by the relaxation of the musculature itself. The alternation of these two states is responsible for the typical rhythmic muscle twitches ('convulsions') associated with epileptic seizures.
Pathophysiology
Epilepsy is caused by the abnormal alteration of the electrical activity of some neurons, generally located at the level of the cerebral cortex (the "outermost layer" of the brain).
FILI EPILETTOGENI is defined as the points at which epileptic seizures originate; in this location the neuronal population with abnormal activity is concentrated. These foci can remain silent for prolonged periods since the healthy neurons that surround them tend to inhibit or neutralize their abnormal electrical discharges. When the activity of these neurons is overwhelmed and the so-called "convulsive threshold" is overcome, the typical symptoms of the disease arise. It should be noted that this threshold varies from individual to individual and is particularly low in epileptics.
Types of Epilepsy
Over 150 types of epilepsy have been described in the literature, which can be classified as partial and generalized.
- PARTIAL EPILESSIE : the epileptogenic focus affects only one cerebral hemisphere. They can be further classified as simple or complex. In the first case they are characterized by light attacks, which never translate into loss of knowledge; on the contrary, complex epilepsies involve more severe manifestations, always accompanied by a loss of consciousness (generally of short duration - a few seconds -) and by more intense muscular contractions.
- GENERALIZED EPILESSES : the neurons that cause the attacks affect both hemispheres. They are almost always accompanied by loss of consciousness (absence) associated with contractile manifestations and myoclonic / tonic and tonic / clonic spasms.
An epileptic state is defined as the succession of epileptic manifestations in a frequent and lasting way (various episodes can be noticed even within a few hours). In this case we are faced with a real medical emergency that must be treated as soon as possible, in order to avoid the death of the subject due to respiratory failure.
Causes
There are many different causes that can determine the onset of epileptic manifestations; let's see the main ones:
- CONGENITAL ALTERATIONS (generally they originate during the development of the central nervous system; they can therefore be established already during the development of the fetus, also due to the abuse of alcohol and drugs during pregnancy)
- CRANIAL TRAUMAS: they cause an immediate epileptic form; particularly dangerous are obstetric patients, due to the application of forceps or excessive compression suffered by the fetal skull during particularly prolonged parts
- ABSCESS OR CEREBRAL TUMOR
- ANOSXIA TO BIRTH: breathing difficulties during labor
- ISCHEMIA OF CEREBRAL VASES - reduced supply of blood, therefore of oxygen, to the brain - OR CEREBRAL EMORRAYS
- ALTERATIONS INDUCED BY INFECTIOUS DISEASES: especially those affecting early childhood, especially when they occur with a certain gravity (exanthematous diseases: measles, chickenpox, rubella).
Less than one percent of the population experiences epilepsy during their lifetime, while in the same period of time isolated episodes, without pathological significance, reach about 5% of the population. In most cases, epilepsy is caused by an organic suffering of the brain, with the exception of a fair percentage of idiopathic cases, which are still discussed, which can heal spontaneously during the age of development (when epilepsy is of simple type).
Diagnosis
The diagnosis of epilepsy makes use of various instrumental tests, first of all the electroencephalogram (EEG) with which the electrical activity of the brain is recorded; in about half of the cases these signals are changed even in the absence of symptoms.
Other tests, such as CT or MRI, aim to investigate the presence of possible brain injuries. Also fundamental is the analysis of the patient's clinical history which, given the frequent state of unconsciousness associated with the epileptic episode, should make use of the contribution of external observers close to him.
Care
See also. Epilepsy - Drugs to treat epilepsy
For the treatment of epilepsy, doctors have numerous drugs that work with different mechanisms of action:
- INCREASE THE GABA SIGNAL (an inhibitory neurotransmitter), facilitating the opening of chlorine ions to the brain level
- REDUCE THE ACTIVITY OF SODIUM CHANNELS AND SOCCER CHANNELS
- REDUCE THE SIGNAL OF AMINO ACIDS EXCITERS (glutamate and glutamic acid)
By inhibiting the neuronal electrical signals, and with them the excitatory activity of epileptogenic foci, these medicines allow a clear improvement of epileptic manifestations and allow the patient to lead a normal life. However, the therapy must be personalized and continued for long periods of time, often for life.
Side effects common to all anti-epileptic drugs include skin rashes (redness of the skin), itching, mild sedation and dyspepsia (digestive disorders). There are also specific side effects for each medicine (phenytoin - dintoina ® is, for example, toxic in the liver). Particular attention during pregnancy.
Lifestyle
Those who suffer from epilepsy should moderate their alcohol consumption, keep themselves well hydrated, follow a balanced diet and do not overdo physical activity, especially in the summer months during which it is essential to replenish fluids and salts lost through sweating. It is also important to control both physical and mental stress and ensure proper night rest.
Surgery
Only in certain cases (which must be carefully selected) can the area of the brain from which the epileptic seizure begin be removed with a surgical procedure. This type of intervention, which in 70-90% of cases leads to complete recovery, is indicated in the presence of epilepsy resistant to drug therapy, in which the origin of epileptogenic foci and the absence of serious neurological deficits in following their removal.
