Seizures with falls and convulsions occur only in a third of epilepsy patients / Article

It is difficult to find another disease around which so many myths and prejudices are wrapped as epilepsy. Although there are still many unknowns about this disease, both the causes of epilepsy and the course of the disease are becoming clearer to researchers. What used to be called “falling disease” is no longer a lifelong sentence for all epilepsy patients.

Translated from Greek, the word “epilepsy” means “seizure”, and these episodes of seizures are what most people definitely know about epilepsy. In Latvia, epilepsy is one of the most common chronic diseases of the central nervous system, and it affects approximately 50 million people worldwide.

Among the causes of epilepsy, a number of genetic factors and injuries acquired during life are mentioned.

“One of the most important things is to understand that epilepsy is not one disease – absolutely not. Epilepsy is rather a group of diseases, and there are dozens of types.

Each type of epilepsy has its own cause, its own investigation, its own treatment and its own prognosis. That’s why there are still people whose epilepsy cannot be solved, they have to learn to live with it, but there are people for whom the prognosis can also be favorable, and you don’t even have to put in much effort – it will resolve itself,” explained Strautmanis.

Epilepsy can be caused not only by hereditary factors or trauma, but also by any structural damage to the brain, such as a tumor or stroke. Epilepsy can also be caused by infections or inflammation.

“Nowadays, inflammation of the brain is even more often caused by an autoimmune disease – that is, it is a reaction of the body’s own immune system against its own tissues, which is usually triggered by an infection. The infection is not the direct cause of the damage, but only a trigger mechanism that upsets the balance of the immune system, and the immune system begins to fight its own tissues,” explained Strautmanis.

The next group of causes is various metabolic diseases. Abnormalities in metabolic processes can also cause epilepsy.

“In general, those causes are more or less grouped and very little is known.

We can’t always point a finger at each specific person in a specific examination – this is the cause of your epilepsy, but in many cases it can be done,” Strautmanis said.

In recent decades, there have been a lot of new discoveries about how to specify the cause of epilepsy, how to specify the place where epilepsy occurs in the brain, how to specify which is the most appropriate method of treating epilepsy, but the most useful invention in the diagnosis of epilepsy as a disease itself is the telephone.

“The phone allows you to quickly, conveniently, easily and cheaply film a seizure event, which can then be shown to the doctor, and the doctor can watch and try to analyze the event, because the diagnosis of epilepsy itself is still clinical in nature. So a person comes in with complaints of seizure states , and then whether or not a seizure-like state corresponds to epilepsy is largely based, so to speak, on ancient observations of what epileptic seizures look like and how they can manifest themselves,” explained Strautmanis.

Of course, such examinations as electroencephalogram, magnetic resonance and genetic tests come to the aid of diagnosis, but all this is in addition to clinical seizures, which are the main indication of epilepsy.

“The basis of that foundation – the seizure – is the main manifestation of the disease, and the analysis of the seizure as a diagnostic basis is unchanged,” admitted Strautmanis.

At first, sometimes the person himself may not be aware of seizures and they may remain undiagnosed and unrecognized for some time.

The doctor pointed out that “falling disorder” is an inaccurate term, since falling seizures occur in less than half of all epileptic seizures. “It’s a myth that a person always has to fall and twitch. Seizures can also just be freezing and unresponsive for 10-20 seconds and that’s it. Seizures can be strange sensations that can be as simple as numbness or numbness , or flashing in the field of vision,” he said.

Also, epileptic seizures can manifest themselves in a relatively complex way – such as feelings of happiness, ecstasy, or even sexual feelings and feelings of religious revelation, Strautmanis pointed out.

“They can also be automatic movements, apparently purposeful actions such as spinning or scrambling. Sometimes they are quite dramatic automatic movements such as kicking, for the child they can be manifested by running, for example.

Only about a third of epilepsy patients have such attacks with convulsions and falls,” said Strautmanis.

Often one epileptic attack can pass into another – it can start with sensations, but continue with automatic movements or convulsions. But all epileptic seizures have one common feature – they occur in the cortex of the brain due to excessive electrical discharges.

“So nothing is suppressed there, it’s the other way around – the balance between the systems that slow down brain activity and the systems that activate it is disturbed, in favor of this activating system. It is impossible to suppress these electrical discharges with will,” explained Strautmanis.

Difficulties in the diagnosis of epilepsy are also caused by the fact that between seizures a person can be absolutely healthy, and no examination can show any deviations from the norm. There are epileptic patients who have seizures relatively rarely, and no examination will show any pathology in the interim period.

Then an observation such as video electroencephalography can come to the rescue – a person lives with electroencephalography sensors for several days or even weeks. Then, if a seizure occurs at that moment, a video recording is made and the electrical activity of the brain is also recorded, and in most cases it can be determined whether it is epilepsy or not.

Epilepsy