Seizure Disorder/Epilepsy in Severity
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Seizure Disorder
Seizure disorder can as well refer to epilepsy in severity. It is a condition of the brain characterized by susceptibility to paroxysmal events associated with abnormal electrical discharges of neurons in the brain. In such case, the brain cells releasing electrical signals send out the wrong message. However, having only a single seizure does not qualify one to be epileptic, as several seizures are required to diagnose epilepsy. There are two categories of seizure, the partial and generalized seizure. Primary or partial seizure disorder or epilepsy is idiopathic without apparent structural changes in the brain. It involves involuntary twitching of muscles and unusual senses without losing consciousness. Secondary epilepsy is characterized by structural changes or metabolic alterations of the neuronal membranes. It involves more or whole of the brain, with the loss of consciousness, twitching of body and loosening of the bladder. The incidence may last up to twenty minutes and is common in children and at an old age (Ehrlich, nd).
Malfunction of the brain cells may cause a shift in a person’s feeling or actions due to a sudden spark of electrical discharge in the brain. It happens as a onetime instance but if it reoccurs then a person’s chance of having or being diagnosed with epilepsy increases. The seizures can be voluntary or involuntary. Voluntary seizure is caused by an event such as brain injury whereas involuntary seizure is spontaneous and caused by genetic or metabolic factors of the body. Therefore, having two spontaneous or unprovoked seizures will give a conclusion that a person is epileptic. Brain cells send electrical signals while communicating with neurons transmitting information and depend on such transmissions. Any anomaly causing the neurons to send wrong signal causes a seizure. The causes of seizure in most people are unclear, with medics diagnosing possible conditions that may lead to a person having the disorder. Some researchers conclude that congenital and hereditary disorders are some of the contributing factors.
Causes
A seizure is caused by an over-excitement of a brain nerve cell that sends wrong signals to the brain. Previous brain injury, infection, or developing a brain tumor can make one experience seizure. Drug usage, overdose or withdrawal that causes allergic reactions are said to be causing an increase in chances of seizure in a person. Persons with high blood pressure, liver or kidney failure are also cautioned as they too can have a greater chance of experiencing seizure or seizure disorder. People with hypoglycemia and severe brain damage are also more vulnerable. The increased stress and insomnia, alcohol and change in hormones of a person, are likely causes of seizure (Crawford, Hartman, Kossoff, & Singer, 2009).
Over half of the seizure disorder cases are idiopathic and do not cause any structural change in the brain. The inadequacy of oxygen in the brain, blood incompatibility, or hemorrhage during birth, prenatal infection, infectious diseases such as meningitis, or brain swelling, the ingestion of toxins and brain tumors can cause a seizure. Inherited conditions or degenerative disorders, head injury or trauma metabolic disorders such as hypoglycemia and hypoparathyroidism, cerebrovascular accident are also other possible causes. Most people with epilepsy experience seizure throughout their lives. This is a condition that can be experienced across ages, cultural, socio-economic and geographical boundaries. According to Brodie, Kwan & Schachter (2009), most people in old age in developed countries experience seizure disorders and related conditions whereas, in developing countries, people are commonly affected in their early childhood. A seizure is considered a part of brain dysfunction spectrum engulfing cognitive, behavioral and psychiatric disorders, which are conditions that should be managed in parallel with a seizure. There are varied triggers to seizure, which at times is hard to tell. It is therefore important to track the disorder in a person.
Pathophysiology
Some neurons in the brain may depolarize easily or be hyper-excitable where epileptogenic symptoms show more readily than normal when stimulated sending wrong signals to the brain. Electrical current is often shot and spread through the surrounding cells on stimulation with the cells firing in turn. The impulse results in a partial seizure if it replicates on one side of the brain, but if it is on both sides of the brain it leads to a generalized seizure. The brain's metabolic demand for oxygen increases during a seizure, which if not met results in hypoxia and brain damage. Firing of inhibitory neurons slows down excitatory neurons firing which then eventually stop. If this inhibitory action does not occur, then the result is a repeated seizure one after another (Brodie, Kwan & Schachter, 2009). Some cases present with complex behavioral and mood symptoms in the current clinical practice that cannot be attributed to single diagnostic category (Brodie, Kwan & Schachter, 2009).
The disorder frequently present with elusive psychiatric symptoms with the persons affected more likely to experience other psychotic disorders than the general population. The often occurrence of seizure is experienced in the ictal periods, and before seizure symptoms manifests there is likeliness of altered consciousness and deregulated behavioral symptoms. It may be sometimes difficult to distinguish between pre-existing psychiatric disease if it presents with seizure, as they are multi-factorial and with the varied clinical presentations. Use of less distinctive clinical criterion with the vague temporal association between the diseases and use of antipsychotics present a challenge in distinguishing between the conditions. Patients with preexisting seizure disorder are said to be at a higher risk of postoperative complications. It is, therefore, necessary to identify patients with the disorder to maximize care in the course of operation to minimize any risk of seizure occurrence and any related complication.
Prognosis
Seizure and related conditions are a common psychiatric condition affecting up to 70 million people globally, with high-income countries recording 0.06% developing advanced level seizure while 0.05% develops new-onset annually. Developing nations, however, record a rate higher than 1%, which can be attributed to small obstetric services and likelihood of cerebral infection and head trauma. There are higher incidence rates in early childhood and older age while there are minimal cases in adult life. According to Brodie, Kwan & Schachter (2009) there has been a significant decrease in the number of children affected by a sharp rise in the number of the old population. It is, therefore, most important to focus on the old age in the current time as the condition is commonly manifesting at the stage.
The condition remits at one time in most people, even though in some it progresses to the epileptic condition. Approximately, 60% - 70% of patients who receive antiepileptic treatment become seizure-free even on the first initiation of the treatment and throughout their life after that even after drug withdrawal. On the other hand, some people have a fluctuating course of the disorder while others continue experiencing the disorder in its varied rate and severity. With the differences in the underlying factors that increase susceptibility to the disease, the response of the people to the management of the condition also differs with the individual. As a result, some people can experience seizure reoccurrence even after freedom. The mortality ratio of those that have suffered seizure is double that of the general population though measured at its advanced stage. There are epileptic related deaths resulting from seizure, which are unexpected, witnessed or not witnessed, non-traumatic, non-drowning, and even with autopsies not revealing anatomic or toxicological cause of death. The evidence of the seizure-related deaths is the higher number of instances of uncontrolled seizure (University of Maryland Medical Center, 2015).
Signs and symptoms
The signs and symptoms of the seizure disorder are related to the categories of the conditions. In the primary group where only a part of the brain is involved a person shows involuntary twitching of muscles and limbs, a shift in focus with developed unusual senses. At one point, a person can further lose consciousness for some time, or repeatedly do something (Kwan, Schachter, 2009). On the other hand, a person may fall, stiffen and shake in the secondary seizures with staring and loss of consciousness experienced. The person may also continually jerk or twitch both sides of the body and lose bladder control triggering urination. There is often a change of mood or feeling before the start of seizure, and it can last for up to twenty minutes. An incident of seizure disorder can result in the airway occultation, traumatic injury, brain damage, depression and anxiety causing hypoxia or anoxia in the event (Cantor & Evans, 2013).
Management
A practitioner regularly inquires about the medical history and any possible causes or any other risk factor to establish the development of the disorder. There are tests that are conducted to determine the electrical activity of the brain, with further complications subjected to advanced examination (Cantor & Evans, 2013). There are no known remedies to prevent the occurrence of all the seizures, but there are treatments that can help prevent the disorder or any related risk factor. Doctors prescribe antiepileptic drugs, which includes phenytoin and carbamazepine. The therapies aim at preventing the occurrence of seizures, reduce drug reactions and side effects and avoid any re-emergence of the condition. In most instances, a patient is kept on the trial of drugs to find the best remedy for their conditions, and in some instances combinations of two or more drugs that work. Anticonvulsants and sedative are prescribed drugs for a patient with the disorder and failure of drugs to control seizure; a doctor may proceed to perform vagus nerve stimulation.
Surgery is also an option where the medication fails, together with a person changing what is eaten. Low carbohydrates and protein food with higher fat content is considered best for changing the body chemistry as the diet results in the decrease of the frequency of seizure. A person needs to stay calm around a seizure victim without restraining. The area around the individual must be cleared to avoid any injury, and the person should not be touched to the end of the activity after which the individual should rest. Any tight clothing or garment should be made loose, and the person lay by side if the seizure is not much (University of Maryland Medical Center, 2015). A doctor’s consultation is necessary in the event of a seizure, as getting the right attendance and treatment helps.