With all the different developments in epilepsy, there are also different diagnosis and treating this condition. The doctor needs to consider a different diagnosis of epilepsy-like syncope, transient ischemic attacks, sleep disorders, and migraine. However, just like anyone else the doctors need to know information on what was happening before, during, and after the event. Videotaping the event is very useful. Aside from the incident, the doctor needs to know if the patient has any other underlying conditions like cardiovascular disease, renal disease, or diabetes and if the patient recently had an infection or head injury. The patient or patient’s family should also be asked about any family history of seizures. While the syncope results when the overall supply of blood and oxygen to the brain is temporarily interrupted the transient ischemic attack is known as a mini-stroke. Some people might have sleep disorders known as episodes that occur during the night with an additional sleep-related condition. A migraine is not only a headache, but it can also be an aura that will help a person know when the next seizure is coming especially when the person feels temporary tingling, numbness, weakness and difficulty speaking (David C. Spencer).
The diagnostic testing for seizures and epilepsy falls into several categories: laboratory testing, electroencephalogram, magnetic resonance imaging, computed tomography, and functional testings. The laboratory testing is used to check the level of medication if the individual takes antiepileptic drugs. It is supposed to show the imbalances in blood electrolytes, high or low level of sodium and calcium, and the level of glucose. While the electroencephalogram (EEG) is standard for all patients after their first afebrile seizure; which shown any abnormalities in the brain, the test can be done either when a person is asleep or awake. “The doctors will find the abnormalities if there is a specific epileptiform discharge on EEG.
Additionally, if the EEG shows spikes on both halves of the brain simultaneously, it shows that the individual has generalized epilepsy” ( David C. Spencer). Whole brain imaging is known as MRIs, and CT scan is only used in severe cases such as a seizure which lasted for more than 15 minutes or suspected tumor, stroke, abscess or vascular malformations. The CT scan is performed to see and identify any abnormalities that are in the brain. It gives a good picture of the brain and can evaluate for some of the causes of seizures like bleeding or tumors. If the CT will not show anything, then the doctor would most likely ask for MRI scan to be performed because it can find little injuries or any focal areas where the brain did not usually form during the brain development. There also another specialized testing that can be used to diagnose epilepsy, but most people do not undergo all of these tests. The specialize category contains positron emission tomography, single-photon emission computed tomography and magnetoencephalography.
Furthermore, the treatment of epilepsy is a vast topic. About 90% of people can identify the triggers for their seizures; the common ones are stress, sleep deprivation, alcohol and drug use, illness, forgetting to take medicine, menses, or flashing lights. Some people are trying to stay away from these triggers but also decreases the number of seizures by taking antiepileptic drugs. The AEDs target the underlying mechanisms like blocking the opening of sodium channels. However, what is AEDs? Antiepileptic drug therapy is a therapy that is supposed to stop the seizures and not cause any new problems in the process. The therapy is supposed to decrease the number of seizures the individual has and remove partial restrictions on driving and other activities. AEDs has its way of selection. The doctor needs to understand what type of epilepsy the individual has so the best treatment can be selected. Most of the times there are some differences in effectiveness between various AEDs, but they might be hard to predict for the specific individual. There are about 30 different drugs that are in everyday use now. The advantage of these drugs is that there is better tolerability, produce fewer short and long term side effects, but also they are metabolized more accessible by the body. Now the treatment is not only ‘what’ medicine but also ‘how many.’ If the doctor diagnosed the individual with epilepsy, he/she has two choices a monotherapy or the polytherapy for the individual. Treatment with medication is done with extreme caution as there is a significant potential for adverse side effects, particularly with those that affect the central nervous system.
Mismanaged treatment can also result in a loss of cognitive function resulting in memory disorders. However AEDs are not the only treatment, the patients often look to surgery as a possible cure. Partial complex seizures are the most likely to be intractable because they are believed to have the lowest seizure threshold. The individuals that can get the surgical epilepsy removal daily are people with mesial temporal sclerosis, temporal lobe epilepsy, and extratemporal epilepsy. The studies showed that people with those types of epilepsy have more than 50% chance of being seizure free. The AEDs and the surgery are useful, but that does not mean that epilepsy will be gone. Medicine and surgery will only reduce the amount of seizures to a lower number.
Living with epilepsy is not the easiest thing to do for the child or adult. The people need to understand that medicine is not going to help in 100%. There are some concerns that people with epilepsy face daily and those are driving, work and relationship. Driving is considered a leading concern with epilepsy. In the society is it a sense of independence that the person can have. “There is a general agreement that the privilege of driving must be balanced in some way with concerns about public safety. If a person has a frequent seizure with loss of consciousness, he or she should not drive. If seizures are well controlled, either on or off antiepileptic drug therapy, drinking should be permitted” (David C. Spencer) although most studies show that accidents rates in healthy teenagers and people after alcohol is higher than for people with epilepsy. Work is another concern because even though people with epilepsy can find and maintain fulfilling work, some people might be discriminated while seeking jobs. Even with the legal regulations of Americans with Disabilities Act passed in 1990 people still might have a problem with the employers treating them differently than others and discriminating them based on their disabilities. Some people might find it hard to keep the relationship because people with epilepsy need to navigate some unique issues that can affect the relationship in either a positive or negative way. Epilepsy can also become a stressor in a relationship. Additionally, individuals might be challenging with anxiety, depression, stress, and other psychological challenges that they are facing knowing that they can have seizures at any moment. Some people might have a problem with identifying themselves. The underlying cause of epilepsy disturbed brain function in areas that regulate mood and behavior which can cause more mood and anxiety problems.
Epilepsy is a common neurological disorder that manifests as some form of either primary generalized or partial seizures. Epilepsy is related to many risk factors and causes. Its cellular mechanisms involve an imbalance of excitatory and inhibitory factors in the brain, which is dependent on the ionic environment. About 80% of patients with the disorder can be treated to some degree of success with medications, while 20% of those diagnosed will have difficulty finding an appropriate treatment. Surgery, usually in the form of a temporal resection, is sometimes an option if a structural abnormality can be determined. Epilepsy can be a challenging diagnosis for the patient and the patient’s family. Patient education is key to medication and treatment adherence.
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