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Epilepsy

VIMPAT® (pronounced “vim-PAT”) is a new medicine in the fight against epilepsy. It is used to treat partial – onset seizures in adults. VIMPAT® is ‘ADD ON THERAPY’ for people who experience seizures despite taking other antiepileptic medications.

 

What is Epilepsy?

  • The word "epilepsy" comes from the Greek word epi meaning "upon, at, close upon", and the Greek word Leptos meaning "seizure". From those roots we have the Old French word epilepsie, and Latin word epilepsia and the Greek words epilepsia and epilepsies.
  • Epilepsy is a common neurological disorder affecting 1%-2% of the population in New Zealand. Anybody of any age can develop epilepsy. Epilepsy is defined as a tendency to have recurrent seizures, (sometimes called fits).
  • One in fifty people have epilepsy at some point in their life. The people affected have recurring and spontaneous seizures. There are different types of seizures but they are always due to bursts of electrical activity in the brain. These bursts are caused by a chemical imbalance responsible for the transmission of impulses. There are three descriptions of seizures, depending on what part of the brain the epileptic activity started:
  • The cause of epilepsy can be due to severe head injury, strokes, birth trauma, brain tumours, toxins, brain infection, brain diseases, genetic condition or drug abuse. In many cases the cause is unknown.
  • Epilepsy is what people with the condition have; it does not define who they are. Epilepsy is only a small part of their life.

Types of seizures

 There are three types of diagnoses a doctor might make when treating a patient with epilepsy:
  • Idiopathic - this means there is no apparent cause.
  • Cryptogenic - this means the doctor thinks there is most probably a cause, but cannot pinpoint it.
  • Symptomatic - this means that the doctor knows what the cause is.

There are three descriptions of seizures, depending on what part of the brain the epileptic activity started:
  • Partial seizure - this means the epileptic activity took place in just part of the patient's brain. There are two types of Partial Seizures:
    • Simple Partial Seizure - the patient is conscious during the seizure. In most cases the patient is also aware of his/her surroundings, even though the seizure is in progress.
    • Complex Partial Seizure - the patient's consciousness is impaired. The patient will generally not remember the seizure, and if he/she does, the recollection of it will be vague.
  • Generalized Seizure - both halves of the brain have epileptic activity. The patient's consciousness is lost while the seizure is in progress.
  • Secondary Generalized Seizure - the epileptic activity started as a partial seizure, but then it spread to both halves of the brain. As this development happens, the patient loses consciousness.

What is a seizure?
A seizure is a sudden burst of uncontrolled or erratic electrical and chemical activity in the brain causing a temporary disruption of the brains normal function.  This disruption results in the brain’s messages becoming changed or mixed up and produces some type of reaction within the person concerned.
 
What is a Simple Partial Seizure?
A simple partial seizure occurs when a small part of the brain is affected with the uncontrolled activity.  The person is fully conscious and aware of what is happening. The area of the brain affected will determine the type of reaction the person experiences. The person may experience:
  • An involuntary tingling or sensation (numbness, jerking, twitching, pain, etc)
  • A stimulation of a sense (visual, auditory, taste, smell)
  • An emotional change (fear, elation, anger, anxiety, depression)
  • An altered psychological or cognitive state (déjà vu, hallucinations, recollections, heightened awareness, rush of thoughts, etc)
  •  A change in an autonomic function (skin cold/hot, pulse slow/racing, etc)
 
Simple partial seizures may spread to become a complex partial or tonic clonic seizure. A simple partial seizure is sometimes called an aura or a warning occurring before the onset of a different type of seizure. 
 
What is a Complex Partial Seizure?
During a complex partial seizure a larger part of the brain is affected and the person’s consciousness is altered or impaired.  The person looks as if they are sleepwalking or drunk or drugged.  They may stand and stare, pick at their clothes, pick up or move objects, smack their lips or make chewing movements, talk in a meaningless fashion, wander about in an aimless manner.  They are unaware of their actions or their surroundings.  After the seizure they will be confused for a time and may not be aware the seizure has occurred.  Sometimes a partial seizure develops into a generalised 'convulsive' seizure. This is called a secondary generalised seizure.
 
What is a tonic clonic seizure?
A tonic clonic seizure, (previously known as a grand mal seizure), is where the person may;
  • become unconscious and fall if standing
  • become stiff (muscles contract), breathing may be shallow or stop, may become pale, blue around the mouth, followed by –
    • rhythmical muscle contracting (jerking/shaking) of the whole body
    • breathing may be shallow or noisy
    • may be saliva or froth from mouth
    • bladder or bowel control may be lost
    • usually last 1 to 5 minutes
    • consciousness is regained slowly
    • confusion and tiredness is usual
 
What are the symptoms of epilepsy?
The main symptoms of epilepsy are repeated seizures. There are some symptoms which may indicate a person has epilepsy. If one or more of these symptoms are present a medical exam is advised, especially if they recur:
  • A convulsion with no temperature (no fever).
  • Short spells of blackout, or confused memory.
  • Intermittent fainting spells, during which bowel or bladder control is lost. This is frequently followed by extreme tiredness.
  • For a short period the person is unresponsive to instructions or questions.
  • The person becomes stiff, suddenly, for no obvious reason
  • The person suddenly falls for no clear reason
  • Sudden bouts of blinking without apparent stimuli
  • Sudden bouts of chewing, without any apparent reason
  • For a short time the person seems dazed, and unable to communicate
  • Repetitive movements that seem inappropriate
  • The person becomes fearful for no apparent reason, he/she may even panic or become angry
  • Peculiar changes in senses, such as smell, touch and sound
  • The arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements

The following conditions need to be eliminated as they may present similar symptoms, and are sometimes misdiagnosed as epilepsy:
  • A high fever with epilepsy-like symptoms
  • Fainting
  • Narcolepsy (recurring episodes of sleep during the day and often disrupted nocturnal sleep)
  • Cataplexy (a transient attack of extreme generalized weakness, often precipitated by an emotional response, such as surprise, fear, or anger; one component of the narcolepsy quadrad)
  • Sleep disorders
  • Nightmares
  • Panic attacks
  • Fugue states (a rare psychiatric disorder characterized by reversible amnesia for personal identity)
  • Psychogenic seizures (a clinical episode that looks like an epileptic seizure, but is not due to epilepsy. The EEG is normal during an attack, and the behavior is often related to psychiatric disturbance, such as a conversion disorder)
  • Breath-holding episodes (when a child responds to anger there may be vigorous crying and subsequent apnea and cyanosis - the child then stops breathing and skin color changes with loss of consciousness).
     
  •  
    What are the treatments for epilepsy?
    When a diagnosis of seizures or epilepsy is made, the doctor will then discuss with the patient or the patient's family what the best treatment options are. If an underlying correctable brain condition was causing the seizures, sometimes surgery may stop them. If epilepsy is diagnosed (ongoing tendency to have seizures), the doctor will prescribe seizure-preventing drugs or anti-epileptic drugs.
     
    Many people have their seizures successfully controlled with anti-epileptic medication (AEDs). This is the most common way that epilepsy is treated. AEDs do not cure epilepsy. Their aim is to prevent seizures by acting in some way to control the working of the brain. How they do this is not totally understood but their effectiveness in treating epilepsy has been scientifically proven. There are several different anti-epileptic drugs available, some of which are more suitable for different seizure types than others. Your health professional can inform you as to the best medication for your seizure type. If drugs do not work, the next option could be surgery, a special diet or VNS (vagus nerve stimulation).
     
    • Surgery to remove a cause of seizures in the brain is an option in a small number of cases. It may be considered when medication fails to prevent seizures. It is only possible for certain causes in certain areas of the brain. So, only a small number of people are suitable for surgery. Also, there is risk involved in brain surgery. However, techniques continue to improve and surgery may become an option for more and more people in the future. 
    • Vagal Nerve Stimulation is an option for some people 
    •  The Ketogenic diet, a diet that needs to be supervised by an experienced dietician, is useful for some children and adults with particular types of epilepsy that will not respond to medication. 
    • Complementary therapies such as aromatherapy may help with relaxation and relieve stress, but have no proven effect on preventing seizures.
     
     
     
    Note: Information on this site is not intended to replace the advice given by your doctor or other health professional.
     


    Helpful Link


    Epilepsy NZ
    everybody.co.nz – Epilepsy
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