What is a treatment for white discharge

Disease with many facets: recognizing and treating epilepsy

Seizure disorders

01/25/16 (ams). Epilepsy, also known as seizure disease, is a fairly common neurological disease: an estimated five to ten out of 1,000 residents are affected by it, according to the German Society for Epileptology (DGfE). Every year around 400,000 people in Germany see a doctor because of their epilepsy. However, out of shame, ignorance or fear of stigmatization, some affected people forego possible help. The chances of getting epilepsy under control are good if it is recognized and treated accordingly.

A person suddenly falls to the ground and his limbs twitch - a seizure doesn't always look like this. Because epilepsy has many facets: the symptoms vary depending on the region of the electrical discharges. In this way, those affected can only slide briefly into a state of twilight - without falling and cramps. Or they suddenly make strange movements and noises, smack their lips or hum to themselves. Sensitive disorders, such as tingling or numbness, or sensory changes, such as visual disturbances, or vegetative symptoms, such as sweating, can also occur. After a few seconds or minutes it is mostly over. "What all these different types of seizures have in common is that nerve cells in the brain suddenly discharge at the same time," explains Dr. Christiane Roick, deputy head of the medicine department in the AOK Federal Association.

There are many reasons why the nerve cells suddenly fire synchronous impulses. The tendency to epileptic seizures can be genetic. In some families, epilepsy occurs over several generations. "Brain damage caused by pregnancy or birth complications, malformations or developmental disorders, injuries, strokes, brain tumors or inflammation of the brain or meninges can also cause epilepsy," says AOK doctor Dr. Roick. Often, however, no clear cause can be identified. It is important to clarify with a neurologist whether an attack is epilepsy or not. Because if certain external or internal factors act on the brain, anyone can have an epileptic seizure without having epilepsy. Such occasional seizures can occur, for example, when the blood sugar level is too low or other severe metabolic imbalances, but also with massive sleep deprivation or with withdrawal symptoms in the context of alcohol, drug or medication addiction. According to the DGfE, it is estimated that five percent of all people will have at least one epileptic attack in their lifetime. However, one speaks of epilepsy only if at least one epileptic seizure has already occurred and there is a permanent tendency for further epileptic seizures. This is either the case if epileptic seizures have repeatedly occurred spontaneously or if electroencephalography (EEG, measurement of brain waves) or magnetic resonance imaging (MRI, sectional images are generated from the inside of the body using magnetic fields) show an increased probability of further seizures. Epilepsy can appear for the first time at any age. It often begins in the first year of life or beyond the age of 60.

Clarify possible causes exactly

For the diagnosis, the doctor will gladly fall back on eyewitnesses who observed the attack. Those affected often cannot remember it well themselves. "The different symptoms can be used to determine whether it was a partial seizure that affects a specific region of the brain, or a generalized attack that affects both cerebral hemispheres," says Dr. Roick. In addition, it must be asked under what circumstances the seizure occurred and whether birth complications, developmental disorders or previous illnesses occurred that could be a cause of the seizure. In addition, laboratory tests, an electorencephalogram, and imaging tests are performed to clarify possible causes of the seizure. The doctor must be able to classify the seizure precisely in order to find the right medication. Mainly, the following types of seizures are distinguished:

  • Generalized seizures include the classic grand mal seizure, which consists of two phases: the person affected suddenly becomes unconscious, falls to the ground, and limbs, face and body tighten. Then rhythmic jerks of the entire skeletal muscles occur, which become increasingly violent. The attack is usually followed by a sleep or twilight phase.
  • The so-called absences (petit mal seizures) are also generalized seizures, but have a milder course. Its main distinguishing feature is a brief, abrupt disturbance of consciousness. Since the eyes are open and activities such as speaking or writing are interrupted, these attacks can also be misinterpreted as lack of concentration or daydreaming.
  • In the case of a partial seizure, the symptoms differ depending on the region of the brain affected. Motor or sensitive symptoms such as unilateral muscle twitching or numbness are possible, but also changed sensory perceptions such as flashes of light or certain smell or taste sensations, and vegetative symptoms such as sweating or wetting.

In the case of a complex partial seizure, consciousness is also clouded. Automated movements such as chewing, smacking or messing with clothing often occur.

Seizure control medication

A number of seizure control medications are available called anti-epileptics or anticonvulsants. The selection depends in particular on the type of seizure, individual tolerance and possible interactions with other medications. A large number of patients can thus lead a seizure-free life. If freedom from seizures is not achieved, a change of medication or combination therapy may be necessary. In the case of focal epilepsies that cannot be treated satisfactorily with medication, an epilepsy surgery center can check whether the affected brain area can be removed in an operation. If it is not possible to achieve freedom from seizures with medication, neurostimulation can also be considered, in which structures in the brain or structures leading to it, such as the vagus nerve, are repeatedly stimulated with low current in order to reduce the overexcitability of the nerve cells and thus the frequency and severity of epileptic nerves To lessen seizures. In some patients with clinically minor or very rare seizures and a long-term stable overall situation, treatment may be waived if the risks of treatment are higher than its expected benefit.

What those affected can do

  • Seizures can be avoided by first carefully observing the situations in which seizures occur (for example, predominantly at a certain time of the day or during certain activities).
  • In addition, it should be observed which factors increase the likelihood that an attack will occur in these situations (e.g. lack of sleep, alcohol consumption, stress or external stimuli such as flickering lights from monitors or certain optical patterns).
  • From these observations it can be individually deduced how one can behave fearlessly and without excessive everyday restrictions in such a way that seizures are avoided as far as possible.
  • Some sufferers also experience harbingers of an attack, so-called auras, such as a tingling sensation in the arm or perception disorders. You can learn to interrupt the onset of an attack early by taking countermeasures specially tailored to your symptoms.
  • Keeping an seizure calendar can help identify possible triggers.

What eyewitnesses can do

  • Remove sources of danger, such as sharp-edged objects or furniture, on which the person concerned could be injured, from the area around the person concerned.
  • Do not try to hold on to the convulsant as this may break bones. Also, do not try to force objects between the victim's jaws.
  • After the seizure, place the victim in a stable position on their side, check that they are breathing normally, and do not leave them alone until they are conscious and fully oriented again.
  • Usually epileptic seizures end on their own after a few minutes. However, an ambulance must be called if the patient has convulsions for more than five minutes, if the seizure repeats in less than an hour, or if the patient does not regain consciousness. In addition, an emergency doctor must be called immediately if the attack has obstructed the airways and if it is unclear whether the attack is due to epilepsy or another cause, for example severe hypoglycaemia.

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