Electroencephalography in Treating Epilepsy - Case Study Example

"Epilepsy and Electroencephalogram" Introduction Epilepsy is a condition of the nervous system causing instability of electrical signaling in the brain that affects 2.5 million Americans. Data depicts the prevalence of epilepsy that 180,000 people are diagnosed with epilepsy every year (What is epilepsy). It is evident that the human brain is powered by 80 pulses of energy per second. Movement of pulses between nerve cells produces thoughts, feelings and memories. Any disturbance in this energy perturb the normal pace of pulse movement and it can become as high as 500 per second for a limited period. This generate an electrical seizure, the affected person may lose consciousness or seem unaware of what's going on, and make involuntary motions (movements the person has no control over, such as jerking or thrashing one or more parts of the body), or experience unusual feelings. After a seizure, he or she may feel tired, weak, or confused (What is epilepsy). These changes are known as epileptic seizures (What is epilepsy). They occur due to the disruption of electrical activity of overactive electrical discharges, causing momentary communication problem. Due to recurrence of seizures epilepsy is also known as seizure disorder (What is epilepsy). It is manifested that seizure is a symptom of epilepsy but not all seizures cause epilepsy as some seizures are triggered by drug, high fever, severe head injury, diabetes, some heart conditions and narcolepsy. When a person experiences repeated seizures without any obvious reason, it is the case of epilepsy. Epilepsy is not a fainting disorder or a momentary confusion, forgetfulness, or a lack of concentration or any kind of catatonia. It is not contagious nor it causes any kind of mental illness (What is epilepsy). Causes of epilepsy Epilepsy is not contagious. There is no clear demarcation to outline causes of epilepsy in a particular individual. But through research results, scientists have given pinpoint reasons where individuals are likely to develop epilepsy: a brain injury (ABI) due to accidents, an infection or illness that affected the brain development in fetus or due to lack of oxygen to infant during birth, meningitis encephalitis, brain tumor or strokes, poisoning are a few causal reasons (Epilepsy). Seizures Seizures are not painful but affect different people in different ways. Two broad categories of epileptic seizures are: partial and generalized (Epilepsy). Partial seizures they start in one part of the brain and may either remain localized and stay in one area until the seizure is over or budge the electrical disturbances to other parts of the brain (Epilepsy). A person having a partial seizure may lose consciousness and there is a twitching of finger or several fingers, a hand or arm, or a leg or foot even some facial muscles may twitch. Under this condition, speech might become slurred, unclear, or unusual (Epilepsy). Epilepsy temporarily affects vision and the patient may feel tingling throughout one side of the body. This indicates the condition of the brain where abnormal electrical activity is taking place (Epilepsy). Partial seizures encompass- simple partial seizures, complex partial seizures, secondarily generalized seizures (Types of seizures). Generalized seizures in this, electrical disturbances happen all over the brain at the same time. Under this condition the individual appear to be either daydreaming, or may stare into space, or may pass out. Due to stiffening of muscles the person might make sudden jerking motions by flinging the arms outward. The condition further worsens as the individual may suddenly go limp and slump down or fall over (Epilepsy). Primary generalized seizures encompass- absence seizures, atypical absence seizures, myoclonic seizures, atonic seizures, clonic seizures, tonic clonic seizures (Types of seizures). Treatment A neurologist performs a physical examination, taking into consideration about the past health of the individual and family and kind of medication one is taking especially for allergy. To measure the electrical activity in the brain, an electroencephalogram or EEG test, is performed. For further investigations, scans of the brain, (CT) scan or magnetic resonance imaging (MRI) test, may also be done (Electroencephalogram). On confirmation of epilepsy, medications are recommended to control further incidence of seizures and to enable a person leading normal life. In critical conditions, doctors implant a nerve stimulating device called a vagus. This device sends signals through the vagus nerve in the neck to control seizures. As long as epilepsy is under medical control, people with epilepsy are able to drive (Electroencephalogram). Electroencephalogram (EEG) (electro= electric, encephalo= brain, gram= record): It is a non-invasive, investigative test which records electrical activity on the surface of the brain, and can recognize the position of the unusually firing neurons. The EEG machine magnifies the size of these signals, without affecting the brain, so that the information can be recorded on paper or computer. This rhythmic electrical activity is called brain wave. If the particular area is affected the brain shows abnormal activity called as "epileptic activity", these could be generalized or focal. A neurologist identifies the location, severity, and type of seizure disorder based on this record. The test is important in providing an understanding that even an abnormal EEG report does not diagnose epilepsy nor a normal EEG report excludes the possibility of epilepsy as EEG measures only abnormal electrical activity during the test period (Electroencephalogram). It is evident that a different pattern of activity in the scalp indicates different kinds of epilepsy (Electroencephalogram). It is manifested that normal infants and young children may display minor irregularities. Neurological and behavioral problems are reported in children with cerebral palsy, autism, speech delay. Therefore, EEG plays main role in evaluation of epilepsy to distinguish focal from generalized seizures and epilepsies and also to help to diagnose specific syndrome in a child with epilepsy. EEG can rarely create confusion, particularly if unfocused abnormalities or epileptic activity is seen in a child without seizures (Electroencephalogram). But to diagnose and route out the type of seizures occurring, EEG is a helpful tool to carryout diagnosis. It also helps to check problems associated with loss of consciousness or dementia, it helps to tell the chances of recovery after a change in consciousness. It also helps us to find if the person in coma is brain dead, for sleep disorder. It helps to monitor brain activity while a person is under general anaesthesia during brain surgery. It aids to find out any physical or mental problem associated with brain, spinal cord, or nervous system (Epilepsy health Centre- Electroencephalogram). The EEG machine records signals through wires connected to electrodes, which are put on at key points on the patient's head. These electrodes accept signals produced by electrical expulsion of neurons in the associated areas of the brain (Electroencephalogram). In case of electrical expulsion or if the discharge is excessive, then it shows sharp spike or series of spikes, forming a pattern for e.g. the 3-per-second spike and wave of absence seizures are depicted in the figure. EEG recordings are carried out when the patient is awake, with open eyes and also with closed eyes. To understand the photosensitivity, flashing light is used, to know if an individual has a seizure in response to the stimulus of a flashing light. Another trigger is hyperventilation (rapid over breathing) and is also an attribute of EEG assessment. Patients with distinctive absence seizures who are not receiving antiepilepsy medication show the typical 3-per-second spike wave EEG pattern during hyperventilation. During investigation, patients are also asked to sleep as EEG abnormalities are expected to turn up during sleep. It happens that under standard conditions no evidence is produced, therefore 24-hour EEGs, or portable home EEG monitoring devices may be used. In some cases nasopharyngeal and sphenoidal electrodes (long wires inserted through the nose or inserted into the jaw muscle) are used to obtain information about the seizures, also grid or depth electrodes are implanted in the brain during surgery for evaluation of epilepsy(Epilepsy health Centre- Electroencephalogram). Again, if the type and cause of the seizures are not identified then intensive monitoring is performed. During this procedure, individuals are videotaped during an EEG recording session. It aid physician to diagnose epilepsy and identify affected areas of the brain. Intensive closed circuit TV and EEG monitoring of this type helps to discriminate between true epileptic seizures induced by electrical discharge and non-epileptic seizures by psychological reasons (Epilepsy health Centre- Electroencephalogram). Diverse ictal (seizure) and interictal (between seizure) EEG patterns match to specific seizure types and types of epilepsy, even though the correlation varies. While the EEG is almost always atypical during a seizure, it may be normal between seizures. It is therefore, lack of interictal EEG abnormalities does not prohibit a analysis of epilepsy. Though, at some time, most epilepsy patients have abnormal EEG discharges, whereas, some persons with EEGs that show epilepsy-like activity never have seizures. Thus, physicians interpret EEG results within the context of other information they are gathering (Epilepsy health Centre- Electroencephalogram). Regardless of some limitations, however, the EEG remains the most important clinical tool in evaluating patients with suspected seizures (Epilepsy health Centre- Electroencephalogram). Ictal EEG recording of seizure in a child with BPEI-CPS showing initial discharges beginning in the left temporal area with spread to adjacent unilateral regions. (Watanabe et al, 1987). Conclusion The electrical activity of the brain is transmitted in the wave pattern through the EEG machine. This measures the pattern of irregularities in the brain. As compared to normal brain activity which shows a regular pattern, epileptic activity depicts wavy or jagged lines, abnormal patterns called as spike or polyspike, sharp waves and spike and wave complexes. These patterns provide the information about the seizures to carry out appropriate treatment (Importance of EEG test). Therefore, EEG explanation is a critical skill for most practicing neurologists, as well as for an increasing number of specialists in other practice settings. It is therefore various reference books are used to analyze the EEG patterns for the proper treatment, one of the most prevalent books is Handbook of EEG Interpretation, is used as a portable handbook to discuss all aspects of clinical neurophysiology. It has become an important means of quick reference in EEG interpretation. At once more concise, illustrative, and portable than other texts on EEG and provides immediate information (William, O., Tatum, I.,V.,). References 1. EEG (Electroencephalogram) http://www.epilepsy.org.uk/info/eeg.html 2. Electroencephalogram http://www.epilepsyontario.org/client/EO/EOWeb.nsf/web/EEG+(Adults) 3. Electroencephalogram(EEG) http://www.stanfordhospital.com/clinicsmedServices/COE/neuro/epilepsy/diagnosticServices/EEG.html 4. Epilepsy http://kidshealth.org/teen/diseases_conditions/brain_nervous/epilepsy.html 5. Epilepsy health Centre- Electroencephalogram http://www.webmd.com/epilepsy/electroencephalogram-eeg-21508 6. Epilepsy Foundation http://www.epilepsyfoundation.org/about/diagnosis/eeg.cfm'renderforprint=1& 7. Types of Seizures http://www.epilepsy.com/epilepsy/types_seizures 8. What is epilepsy' http://www.ehealthmd.com/library/epilepsy/EPI_whatis.html 9. William, O., Tatum, I.,V., Hand Book of EEG Interpretation. 10. Watanabe K, Yamamoto N, Negoro T, Takaesu E, Aso K, Furune S, Takahashi I. 1987. Benign Complex Partial Epilepsies of Infancy. Pediatric Neurology. Volume 3. 208-211. Read More