I

. INTRODUCTION

Epilepsy, also called seizure disorder, chronic brain disorder that briefly interrupts the
normal electrical activity of the brain to cause seizures, characterized by a variety of
symptoms including uncontrolled movements of the body, disorientation or confusion,
sudden fear, or loss of consciousness. Epilepsy may result from a head injury, stroke,
brain tumor, lead poisoning, genetic conditions, or severe infections like meningitis or
encephalitis. In over 70 percent of cases no cause for epilepsy is identified. Some 40 to
50 million people suffer from epilepsy worldwide and the majority of cases are in
developing countries. According to the World Health Organization (WHO), an estimated
2 million new cases are diagnosed each year globally.

Epileptic seizures vary in intensity and symptoms depending on what part of the brain is
involved. In partial seizures, the most common form of seizure in adults, only one area of
the brain is involved. Partial seizures are classified as simple partial, complex partial
(also known as psychomotor), and absence (also known as myoclonic or petit mal)
seizures.

People who have simple partial seizures may experience unusual sensations such as
uncontrollable jerky motions of a body part, sight or hearing impairment, sudden
sweating or flushing, nausea, and feelings of fear.

Complex partial seizures, also called temporal lobe epilepsy, last for only one or two
minutes. The individual may appear to be in a trance and moves randomly with no
control over body movements. The individual’s activity does not cease during the seizure,
but behavior is random and totally unrelated to the individual’s surroundings. This form
of seizure may be preceded by an aura (a warning sensation characterized by feelings of
fear, abdominal discomfort, dizziness, or strange odors and sensations).

Absence seizures, rare in adults, are characterized by a sudden, momentary loss or

impairment of consciousness. Overt symptoms are often as slight as an upward staring of
the eyes, a staggering gait, or a twitching of the facial muscles. No aura occurs and the
person often resumes activity without realizing that the seizure has occurred.

In a second type of epilepsy, known as generalized seizure, tonic clonic, grand mal, or
convulsion, the whole brain is involved. This type of seizure is often signaled by an
involuntary scream, caused by contraction of the muscles that control breathing. As loss
of consciousness sets in, the entire body is gripped by a jerking muscular contraction. The
face reddens, breathing stops, and the back arches. Subsequently, alternate contractions
and relaxations of the muscles throw the body into sometimes violent agitation such that
the person may be subject to serious injury. After the convulsion subsides, the person is
exhausted and may sleep heavily. Confusion, nausea, and sore muscles are often
experienced upon awakening, and the individual may have no memory of the seizure.
Attacks occur at varying intervals, in some people as seldom as once a year and in others
as frequently as several times a day. About 8 percent of those subject to generalized
seizures may have status epilepticus, in which seizures occur successively with no
intervening periods of consciousness. These attacks may be fatal unless treated promptly
with the drug diazepam.

III
. DIAGNOSIS

In persons suffering from epilepsy, the brain waves, electrical activity in the part of the
brain called the cerebral cortex, have a characteristically abnormal rhythm produced by
excessive electrical discharges in the nerve cells. Because these wave patterns differ
markedly according to their specific source, a recording of the brain waves, known as an
electroencephalogram (EEG) is important in the diagnosis and study of the disorder (see
electroencephalography). Diagnosis also requires a thorough medical history describing
seizure characteristics and frequency.

IV.
TREATMENT

There is no cure for epilepsy but symptoms of the disorder may be treated with drugs,
surgery, or a special diet. Drug therapy is the most common treatment—seizures can be
prevented or their frequency lessened in 80 to 85 percent of cases by drugs known as
anticonvulsants or antiepileptics. Surgery is used when drug treatments fail and the brain
tissue causing the seizures is confined to one area and can safely be removed. A special
high-fat diet known as a ketogenic diet produces a chemical condition in the body called
ketosis that helps prevent seizures in young children. Like any medical condition,
epilepsy is affected by general health. Regular exercise, plenty of rest, and efforts to
reduce stress can all have a positive effect on a person with a seizure disorder.

First aid for generalized seizures involves protecting the individual by clearing the area of
sharp or hard objects, providing soft cushioning for the head, such as a pillow or folded
jacket and, if necessary, turning the individual on the side to keep his or her airway clear.
The individual having a seizure should not be restrained and the mouth should not be
forced open—it is not true that a person having a seizure can swallow the tongue. If the
individual having the seizure is known to have epilepsy or is wearing epilepsy
identification jewelry, an ambulance should only be called if the seizure lasts longer than
five minutes, another seizure closely follows the first, or the person cannot be awakened
after the jerking movements subside.

EEG
Electroencephalography, procedure for obtaining a record of the electrical activity of the
brain by means of electrodes attached to the surface of the skull. Normal patterns on the
electroencephalogram, or EEG, include the alpha wave, indicative of a relaxed state, and
the theta wave, usually found in children and thought by some to reflect creative activity
in adults. Medically the most important use of electroencephalography is to aid in the
diagnosis of epilepsy. The EEG tracing can identify a specific site at which damage to the
brain has occurred. Study of EEGs has contributed to research into the nature of sleep,
helping to identify four stages of sleep. Scientists have also analyzed brain waves
stimulated by sensory input, such as a flash of light or a sound, as a means of determining
which parts of the brain carry out various functions. The finding of a flat, or waveless,
EEG in persons in coma has been interpreted as an absence of brain function and used as
legal evidence of death (see Death and Dying).

MRI

Magnetic Resonance Imaging (MRI), medical diagnostic technique that creates images of
the body using the principles of nuclear magnetic resonance. A versatile, powerful, and
sensitive tool, MRI can generate thin-section images of any part of the body—including
the heart, arteries, and veins—from any angle and direction, without surgical invasion
and in a relatively short period of time. MRI also creates “maps” of biochemical
compounds within any cross section of the human body. These maps give basic
biomedical and anatomical information that provides new knowledge and may allow
early diagnosis of many diseases.

MRI is possible in the human body because the body is filled with small biological
“magnets,” the most abundant and responsive of which is the proton, the nucleus of the
hydrogen atom. The principles of MRI take advantage of the random distribution of
protons, which possess fundamental magnetic properties. Once the patient is placed in the
cylindrical magnet, the diagnostic process follows three basic steps. First, MRI creates a
steady state within the body by placing the body in a steady magnetic field that is 30,000
times stronger than the earth's magnetic field. Then MRI stimulates the body with radio
waves to change the steady-state orientation of protons. It then stops the radio waves and
“listens” to the body's electromagnetic transmissions at a selected frequency. The
transmitted signal is used to construct internal images of the body using principles similar
to those developed for computerized axial tomography, or CAT scanners (see X Ray).

In current medical practice, MRI is preferred for diagnosing most diseases of the brain
and central nervous system. MRI scanners provide equivalent anatomical resolution and
superior contrast resolution to that of X-ray CAT scanners. They produce functional
information similar to that of positron emission tomography (PET) scanners but with
superior anatomical detail. MRI scanners also provide imaging complementary to X-ray
images because MRI can distinguish soft tissue in both normal and diseased states.
Although an MRI scan is relatively expensive, it may actually reduce costs to patients
and hospitals by providing diagnostic evaluation to outpatients and thereby frequently
limiting more expensive hospitalization. Because it does not use ionizing radiation, MRI
is risk free except for patients with cardiac pacemakers, patients who might have an iron
filings next to their eyes (for example, sheet metal workers), patients with inner ear
transplants, and patients with aneurysm clips in their brains.