Epilepsy

Epilepsy is one of the most common neurological diseases in the world,

There are lots of causes of epilepsy, including a head injury, genetics, viral or bacterial infections, and metabolic disorders.

Seizures could result from your immune system turning on you – or they could occur for a completely unknown reason.

“People of all ages develop the disease,”

“However, there are two peaks among age groups: one in childhood and teenage years, and at that stage of life the most common causes are genetics or birth injury.

The other peak is among the elderly, and its causes include stroke and degenerative diseases such as Alzheimer’s disease.”

How the brain works and how to keep it healthier for longer.

So what triggers a seizure and what happens in the brain during one?

A seizure occurs from an abnormal discharge of brainwaves.

“Our brains constantly create brain waves.

These are minute electrical discharges,” “In normal people, these waves are harmonious and even.

However, in people who suffer epilepsy, the brain outputs waveforms which are chaotic and can result in seizures.”

This can happen in one small part of the brain and last just seconds, or it can spread right across the brain and keep going longer, for minutes.

This burst of erratic brain energy scrambles messages, which is why seizures are often accompanied by uncontrollable movement and changes in behaviour.

These can be very distressing for the sufferer, who can feel disoriented and exhausted after the event, and can result in accidents.

A “tonic-clonic”. This type of seizure, which is also called a convulsion, “great illness”, is what most people think of when they hear the word “seizure”.

The tonic phase comes first: muscles stiffen, air is forced past vocal cords which can cause a cry or groan, there will be loss of consciousness and likely a fall to the floor, and the sufferer may bite their tongue or the inside of their cheek.

Then comes the clonic phase: limbs begin to jerk, a person may start to turn blue if breathing is an issue, and there may be loss of bladder or bowel control as they begin to relax. Consciousness returns slowly. Seizures of this type usually last one to three minutes.

Life is life and it is to be lived, rather than feared. I think that’s the message: find your own way to manage whatever it is as best you can

Petit mal (“little sickness”) seizures are less serious than tonic-clonic seizures. They present as lapses in awareness – so are often put down to daydreaming to begin with, and sometimes aren’t diagnosed for months in children. These generally last only a few seconds.

Seizures aren’t just dangerous because their sudden and unpredictable onset could put a sufferer at risk physically, such as from a fall, traffic accident or even drowning,

“If the seizure doesn’t stop, it can result in a condition called status epilepticus, which requires ICU care.”

Status epilepticus is a seizure that lasts longer than five minutes, or multiple seizures without recovery between attacks.

The worst outcome of a seizure is abbreviated as SUDEP: sudden unexpected death in epilepsy patients.

Some scientists think death could be from irregular heartbeats caused by the abnormal brain discharges.

Depression

Death Rate for People with Heart Disease and Depression Double Than for  Non-Depressed Heart Patients | Intermountain Healthcare

Depression is a common and serious medical illness that negatively affects how you feel, the way you think and how you act.

Depression is unrecognized and under-treated among patients with epilepsy!

Depression causes feelings of sadness and/or a loss of interest in activities you once enjoyed. It can lead to a variety of emotional and physical problems and can decrease your ability to function at work and at home.

Depression symptoms can vary from mild to severe and can include:

Feeling sad or having a depressed mood

Loss of interest or pleasure in activities once enjoyed

Changes in appetite — weight loss or gain unrelated to dieting

Trouble sleeping or sleeping too much

Loss of energy or increased fatigue

Increase in purposeless physical activity (e.g., inability to sit still, pacing, handwringing) or slowed movements or speech (these actions must be severe enough to be observable by others)

Feeling worthless or guilty

Difficulty thinking, concentrating or making decisions

Thoughts of death or suicide

Symptoms must last at least two weeks and must represent a change in your previous level of functioning for a diagnosis of depression.

Fortunately, it is treatable by Homeopathic treatment

A New Perspective on Two Closely Related Disorders

Depression is the most frequent psychiatric comorbidity in epilepsy.

Yet, it remains under-recognized and untreated in a significant number of patients.

It may mimic primary depressive disorders, but in a significant percentage of patients, depression presents with atypical pleomorphic characteristics.

Timely recognition and treatment of depression is of the essence in epilepsy patients, as its persistence is an independent predictor of poor quality of life, increased suicidal risk, greater use of health services, and higher medical costs not related to the psychiatric treatment.

Depression is the most common comorbid psychiatric disorder in patients with epilepsy (1), yet it remains under-recognized and under-treated.

Depression in people with epilepsy can be atypical, the most frequent cause for the under-recognition is the failure of clinicians to inquire about it and of patients or families to report it.

Identifying Depression in Patients with Epilepsy

Depressive disorders in patients with epilepsy can mimic the primary mood disorders

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), which classifies depressive disorders into four types: MDD, dysthymic disorder , minor depression, and depressive disorder.

The differences between MDD and dysthymic disorder is based largely on severity, persistence, and chronicity, with symptoms in both disorders sharing common features, such as depressed mood, anhedonia, worthlessness, guilt, decreased ability to concentrate, recurrent thoughts of death, and neuro vegetative symptoms (i.e., weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue).

In contrast, dysthymic disorder is more chronic but less intense, with symptoms persisting on most days for at least 2 years.

Bipolar disorders also afflict epilepsy patients but with a lower frequency than the depressive disorders

It also includes bipolar disorders in the family of mood disorders;

Bipolar disorders are of two types depending on the occurrence of manic (type I) or hypomanic (type II) episodes in addition to major depressive episodes.

Manic episodes require a distinct period of abnormally and persistently elevated mood of sufficient severity to cause marked impairment in social functioning and lasting at least 1 week.

The diagnosis of hypomanic episodes requires a distinct period of persistently elevated mood that is observable as a disturbance by others and lasts at least 4 days.

In addition to bipolar disorders, DSM-IV-TR lists the diagnosis of cyclothymic disorder, which should be considered in the presence of recurrent hypomanic and minor depressive episodes that last for at least 2 years.

Cyclothymic disorder may occur with epilepsy, 50% of mood disorders identified in patients with epilepsy present with atypical clinical characteristics that fail to meet any of the DSM-IV-TR criteria.

In patients with epilepsy, depressive, manic, and hypomanic episodes are categorized according to their temporal relation with seizure occurrence into peri-ictal (i.e., symptoms that precede, follow, or are the expression of the ictal activity) or interictal episodes (i.e., occur independently of seizure).

The degree to which peri-ictal symptoms contribute to the overall clinical semiology of depression in epilepsy patients remains unknown, as large studies characterizing their clinical manifestations have not been performed.

Interictal depressive episodes are the most frequently recognized and can be identical to those described in primary mood disorders or may present with atypical clinical semiology.

Atypical Expressions of Depression in Epilepsy

The atypical presentation of depressive disorders in people with epilepsy has been recognized for a long time.

Affective symptoms consisting of prominent irritability intermixed with euphoric mood, fear, and symptoms of anxiety, as well as anergia, pain, and insomnia.

Impact of the Bidirectional Relationship Between Depression and Epilepsy

How to Recognize Depressive Disorders and Epilepsy in the Neurology Clinic

Clearly, depression in epilepsy is not a homogeneous condition.

How can a neurologist identify a depressive disorder in patients with epilepsy?

First, inquiring about anhedonia, that is, the inability to find pleasure in most activities, is an excellent predictor of the presence of depression.

Second, the use of self-rating screening instruments is typically revealing, which recently was validated to screen for major depressive episodes in patients with epilepsy .

Why Should Neurologists Identify Depression in Epilepsy?

Failing to treat and identify depressive disorders in people with epilepsy has serious consequences at several levels:

Increased suicidality risk depression in patients with epilepsy is associated with a significantly higher suicide rate than in the general population.

Conclusion: Emotional Well-Being in Epilepsy

The challenge of supporting patients with epilepsy is enabling them to maintain their emotional well-being and life satisfaction when dealing with seizures which are, as of yet, untreatable.

This requires a complex adaptation of attitudes and behaviours of patients and affected families toward actively coping with the given situation; adequate use of medical and non-medical support; strengthening resilience; and maintaining pleasant activities.

Many patients will find their way with support of their families and friends while others rely on their doctor’s advice, psychotherapy, or patient groups.

Antiepileptic drug treatment eventually must be reconsidered with regard to possible psychiatric side effects and possible seizure-related impairments of mood regulation. Even if more evidence is required for the efficacy and safety of antidepressive drugs, experts consistently recommend their use in depressed epilepsy patients based on clinical experience. In general, drugs might contribute to but will probably not replace the difficult process of adjusting the conduct of life to the conditions of active epilepsy.


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