The Disease Epilepsy - Essay Example

Epilepsy The research is on the epilepsy. The research will give a clear definition of the disease. The definition will give an understanding of the disorder. The will give the different causes of the problem. It will show the different causes of epilepsy and the seizures associated with them. The paper will give a clear view of the different classifications of seizure. It will illustrate clearly the symptoms of generalized and partial seizure. It will show the subdivisions of the different classifications. Each type will be illustrated further to give specific symptoms associated with them. The research will give first aid procedures to be used to handle the patients. It will ensure that all patients are catered for. It will give the ways to handle them according to their exact type of seizure. It will also illustrate on how to protect patients that use wheel chairs. It gives advice on how to determine whether to call an ambulance or not. The paper explains the pathophysiology of epilepsy. It will give the different treatment of the disorder. It will illustrate on the ways to ensure that the patients get the best treatment. It will discuss the current state of the treatment measures to the disorder. It will also give a recommendation on how the medical department should improve in terms of epilepsy. Introduction Epilepsy is a disorder that affects the central nervous system of the patient. The patients experience seizure which is caused by the disturbance of the (Milton & Jung, 2003)brain. Seizure leads to abnormal behavior, symptoms and sensation. The patients do lose consciousness during the seizure. The research will ensure that epilepsy patients are given a top list of the health concerns. It will give an illustration on issues that the patients do experience. The epilepsy patients do need a lot of care for them to survive. They need the love from the people around them. The people should not be discriminated or feared with anyone. The research will give different symptoms on the patients with the disease. It will give a clear picture of the different issues the patients do face. It will be able to illustrate the different causes of the disease. It will show how the patients can be treated. The research will illustrate the different ways the disease can be controlled. The research will explain the different pathophysiology of epilepsy. The paper will give a clear picture on how to differentiate an epilepsy infection with the other types of infections. It will give the different clinical manifestations that have been associated with epilepsy. It will explain the different roles of plasma concentrations in anticonvulsant therapy. Body Pathophysiology Epilepsy is a serious disorder that should not be ignored with anyone. The patients do suffer from abnormal reactions which are caused by the mental disorders (Patkanen, Schwarzkroin, & Moshe, 2005). The epileptic shape wave is the electroencephalographic (EEG) hallmark of the focal onset seizures. The paroxysmal depolarization shift (PDS) is the cellular correlate of discharge from in one cortical neurons. The PDS has prolonged depolarization of calcium-dependent. The depolarization leads to creation of multiple sodium-mediated action potential during the depolarization phase (Jallon , Kaplan, & Tatum, 2009). The prominent after- hyperpolarization follows the sodium- mediated action potential that happened at the depolarization phase. The sodium- mediated action causes hyperpolarization of the membrane beyond the potential resting baseline. Hyperpolarization is followed by the Calcium- dependent potassium channel. The multiple neurons fire PDS synchronically causing the interictal spikes. The EEG electrodes record the discharging neurons that are more than several millions. The normal speed for interictals is about 6cm2 of the undetected cerebral cortex (Panayiotopoulos, 2010). So many factors should be considered during the transition process to epilepsy seizure from the interictal spike. The epilepsy patient develops a propensity for repeating seizure incase e has mechanisms that underlie acute seizure. The mechanisms that co-exist to cause focal- inset seizure are decreased inhibition, increased activation and defective activation of gamma- amino- butyric acids (GABA) neurons. The epileptic do develop pharmacological intractable focal- onset epilepsy in case of increased excitability of mechanisms become permanent alterations. Decreased inhibition is the first mechanism of the mechanism causing focal onset seizure. Two mechanisms are used to release GABA from the interneuron terminal inhibits (Schmidt & Schachter, 2011). The first one is the direct induction of an inhibitory postsynaptic potential. It causes the GABA-A chlorides to mediate currently. The other mechanism is indirect inhibition of the release of excitatory neurotransmitter. It happens in the presynaptic afferent projection which is has GABA-B potassium currents. The propensity for recurrent seizure negatively may be affected by different molecules that regulating the function. The different mechanisms the lead to decrease inhibitions includes defective GABA-A Inhibitions, defective GABA-B inhibitions, and defective inactivation of GABA neurons and defective intracellular buffering of calcium (Engel , Pedley, & Aicardi, 2008). The defective GABA- A involves lack of expression of different receptor subunit. It also has change in distribution of its subunits. Defective GABA-B inhibition form a current with relatively long duration of action compared with GABA-A activation (Valentin & Alarcon, 2012). The defective GABA-B may be located at different area from the normal one which is presynaptic element of an excitatory projection. Defective activation of GABA neuron is the other mechanism. It is the activation of GABA neurons by means of feedback and feed forwarding projection in the excitatory neurons (Milton & Jung, 2003). Lastly, defective intracellular buffering of calcium is when recurrent seizure is induced by methods that result to a pattern of interneuron loss in the hilar polymorphic region (Wheless, Clarke, & McGregor, 2012). The action leads to striking loss in the neurons without calbindin and calcium binding protein palvalbumin. The second mechanism that coexist causing seizure is increased activation. The problem is caused with different mechanism that includes increased activation of NMDA receptors, increased synchrony between neurons caused by emphatic interactions and increased activation due to excitatory collaterals. Increased activation of NMDA receptors is one of the main causes of increased activation (Cataltepe & Jallo, 2011). Glucometer being the main excitatory transmitter of the neuron in the brain causes EPSP postsynaptic neurons. It accomplishes it by activating of the NMDA, glutaminergic receptors and metabotropic receptor. The fast achievement of neurotransmission is through activation of the first two types of receptors. Some epileptic patients may have an inherited predisposition for long-lasting or fast activation of channels of the NMDA that alters seizure. The other alterations are the ability of intracellular proteins to buffer calcium which increases the vulnerability of neurons. It causes any kind of injury that may not lead to neuronal death. Increased synchrony between neurons caused by emphatic interaction is the other mechanism of increased activation. Increased excitability of neighboring neurons is caused by electronic fields. The electronic fields are created by activation of pyramidal neuron found in laminar synchronously. The possibility of nonsyn (Valentin & Alarcon, 2012)aptic interaction is through changes in extracellular ionic concentration of calcium and potassium. It is the mechanism that predisposes to seizure. The other mechanism is increased activation and/or synchrony from recurrent excitatory collaterals. The epileptic patients are diagnosed by abnormal limbic system. It is particularly found in the hippocampal formation (Fisher & Kaplan, 2005). It causes loss of gliosis and neuronal which affects the hilar polymorphic region and the CA1 pyramidal region. The changes are associated with relative sparing of CA2 pyramidal region and severity of the intermediate lesion in the CA3 pyramidal region. It also affects the dentate granule neurons. Pathophysiology of generalized seizure is mainly understood by the thalamocortical interaction that may lead to absence of seizures. It has normal oscillatory rhythms with periods of relatively increased excitation and those with relatively increased inhibition (Cataltepe & Jallo, 2011). Primary generalized onset seizure can be caused by altered thalamocortical rhythms. A clinical problem of the epilepsy the association of GABA levels with an exacerbation of absence seizures (Engel , Pedley, & Aicardi, 2008). Increased GABA level increases thalamocortical circuit degree of synchronization and pool of T-calcium channel for activation is enlarged. Etiology of Epilepsy Researchers have made different observation on the current state of epilepsy. It has been discovered that 60-70% of the epileptic patients don’t know the cause (Fisher & Kaplan, 2005). The types of patients are noticed as idiopathic patients. The patients whose first degree relatives have epilepsy have an increased risk of 2-3 times to get it. Brain tumor at elderly age is one of the main causes of the problem (Jallon , Kaplan, & Tatum, 2009). Young adults are mainly affected trough head trauma, infections, brain tumor and arteriovenous malformations. In infants or childhood the main causes are parental injuries, development of neurological disorder and metabolic effects. Diagnosis of Epilepsy There are different steps involved in the diagnosing process of epilepsy. The first one is to confirm the patient is has epilepsy (Milton & Jung, 2003). The doctor should consider drug toxicity, hemiplegic migraines and transient ischemia attack. The next step is to follow the factors from the first step. The presence of consciousness loss and rapid recovery are used to determine the facts (Panayiotopoulos, 2010). The presence of pseudoseizure makes the diagnostic process difficult. The next step is to correct the type of seizure type and epileptic syndromes. Causes of Epilepsy Epilepsy is a disorder that is caused in different ways. it mainly involves injury of te different brain parts. Epilepsy is mainly caused by:- Different head injury during birth or accidents during adulthood. People with brain tumor may be a cause of epilepsy. Children who experience low oxygen during birth are at risk. Infections from meningitis or encephalitis. Generic conditions such as tuberous sclerosis. Stroke that affects the brain. Abnormal body substances like sodium or blood sugar. On the other hand seizures do have its causes. The main causes include: Heavy use of alcohols. Lack of enough sleep. Use of other drugs that interfere with seizure medication. Missing of medication doses. Classifications of Seizure There are different types of seizure. The seizure is classified into two main parts. The generalized seizure and the partial seizure are the main classifications of seizure (Patkanen, Schwarzkroin, & Moshe, 2005). The generalized seizure is divided into different types. The most common type is the convulsion. It is commonly known as the grand- mal seizure. Here the patient usually collapses and loses consciousness. The consciousness loss leads body stiffening for 30 to 60 seconds (Schmidt & Schachter, 2011). The patient then goes into a deep sleep. Injuries like tongue biting and urinary incontinences may occur during seizure. The other type is absence seizure. It causes loss of consciousness in a very short time with no symptoms or few symptoms. It causes the patient to stare on something blankly. It problem begins and ends jat several times of day without the patient noticing (Valentin & Alarcon, 2012). A Myoclonic seizure is formed with sporadic jerks on both sides of the body. When the jerks are violent the patients may end up throwing objects involuntarily. Clonic Seizure is the same as myoclonic one. The difference is that the repetitive jerks affect both parts of the body at the same time (Wheless, Clarke, & McGregor, 2012). Tonic seizure causes stiffening of the muscles. Lastly the atonic seizure is the one that causes general loss of muscle tone mainly in the arms and legs. It might result to the patient falling. The other classification of seizure is the partial seizure. It usually affects a small part of brain. It is further classified into simple, complex and partial seizure with secondary generalization (Cataltepe & Jallo, 2011). Simple type retains the awareness. It has the simple motor where the patient experience muscle rigidity, spasms, jerking and head- turning. Simple sensory is the one that affects the sensory organs of the patient (Engel , Pedley, & Aicardi, 2008). It affects the touch, hearing, smell and taste, and vision sense. The other type of simple seizure is the simple psychological. It is characterized by disturbance of memory and emotional. The other type of partial seizure is the complex seizure. Here the patient experiences impairment of awareness (Fisher & Kaplan, 2005). The patient has automatisms characteristics. They include chewing, lip smacking, walking and fidgeting. The patients experience repetitive, involuntary movements that are co-ordinated. Lastly, partial seizure with secondary generalization is the other type of partial seizure (Jallon , Kaplan, & Tatum, 2009). The patient has symptoms that are associated with preservation of consciousness. The preservations do evolve to loss of consciousness and convulsions. First Aid for seizure Different types of seizures are handled differently. Each of them is handled according to the characteristics of the seizure patients. The tonic and clonic patients experience characteristics like losing of conscious, the person going stiff and falls on the ground (Milton & Jung, 2003). The patients should be protected from injury by removing harmful objects near them. Cushioning of the head of the patients will help. Find the epilepsy identity card or identity jewelry to help you in making recovery faster (Patkanen, Schwarzkroin, & Moshe, 2005). Gently place the patient in a recovery position to aid the breathing after the seizure. Stay with the patient until recovery and be calmly reassuring. The person in charge of the first aid should avoid restraining the movement of the patient. He should not put anything in the mouth of the patient to avoid chocking. No food or drink should be given to the patients till they fully recovered (Schmidt & Schachter, 2011). In case the situation persists an ambulance should be called so that the patient receives medical attention. The patients with partial seizure have a way to be handled. Most of the patients are not aware of what they are doing. The patients should be guided from danger. The person offering first aid should stay with the patient till the recovery (Valentin & Alarcon, 2012). He should be calmly reassuring and explain everything that the patients might have missed. The patient should not be restrained. The person performing first aid should avoid doing things that may frighten the patient or making of abrupt movements or shouting at them. They should not assume that the patient knows what has happened or is happening (Schmidt & Schachter, 2011). You should avoid bringing them around or giving them food or drinks. Being a short time reaction ambulance should be called in case the patient seizure for than five minutes or is injured during the process. The patients using the wheel chairs should also be protected. The chair should have brakes to avoid it from moving during the seizure period. The patient should be left seated on the wheel chair to avoid injuries for both the patient and the person offering the care (Schmidt & Schachter, 2011). The patients’ seat belts or harness should be left on to support then so they don’t fall. The head of the patient should be supported gently and cushioned. The person giving care should avoid restraining the movement of the person. Nothing should be placed in their mouth nor no attempts of bringing them around. Treatment of the Patients Epilepsy treatment is mainly through controlling of the seizures. Not all the patient do need the treatment. Being a short timed problem treatment is not really necessary (Schmidt & Schachter, 2011). The patients just have to control the seizure by avoiding things that trigger it. The problem might just appear in one stage of life then becomes rare or disappears completely (Panayiotopoulos, 2010). Most of the people who have the problem in childhood do not experience it as they grow older. The people with epilepsy might be controlled to reduce the chances of seizure from happening completely. The medicines work by stabilizing the electrical activity of the brain. The patients need to ensure that they use the medication every day to be stable. Treatment is done in different ways. Therapy can really help in the step. Drug therapy is an important strategy used for epilepsy treatment. Most of the drugs have been released recently. The use the anticonvulsant drugs is mostly preferred with the doctors despite the fact that its cost is not covered with the insurance (Wheless, Clarke, & McGregor, 2012). The different drugs do help to reduce the chances of seizure. Patients should start using the medicine at the early time of the infection. In case the medicine does not work as expected it is advisable to change the brand. The drug therapies do have specific goals that control them. The primary goal is to complete the suppression of seizure in the absence of disabling side- effects (Jallon , Kaplan, & Tatum, 2009). They work to ensure that at least 70% of the newly diagnosed patients are expected to be successful. The other goal is to achieve best compromised way to ensure maximum seizure control in case the disorder cannot be treated completely (Schmidt & Schachter, 2011). The last goal is to maintain the lifestyle of the patient and their ability to live an active life. Different drugs have been used to treat the epileptic patients. The first medicine is clonazepam. It is in group of drugs called benzodiazepine (Cataltepe & Jallo, 2011). It works by affecting chemicals in the brain that may become unbalanced and cause anxiety. The medicine should be avoided in case of severe kidney infections. It is not good for pregnant women for it may cause harm to the unborn baby. The user should take it as prescribed by the doctor. Not more or less. The other medicine is lamotrigine. It is used with other medications to treat seizure (Engel , Pedley, & Aicardi, 2008). It reduces the time between episodes of depression and seizure attacks. The medicine may cause rashes to the skin of the patient. It has to be started at low dose as it progressively increases. Gabapentin is also used to control seizure. It is used to control seizure of the epileptic patients. It is also used to relieve the pain of postherpetic neuralgia. It is always taken with a glass of water with or without food three times a day. The medicine should be taken in evenly distributed time (Fisher & Kaplan, 2005). Phenytoin is a drug that control and treat seizure that can happen during or after brain surgery. It is taken between one and four times a day. It always starts with low doses then gradually not often than once in 7 to 10 days. The other medicine is Sodium Valproate. The medicine is used to treat all types of epilepsy and treating mania in people with bipolar disorder (Milton & Jung, 2003). It is used to control electronic activities in the brain. The medicine dose should not be changed unless with the doctor’s prescription. The medicine is not suitable to everyone. Some people can just use it under special care. The other medicine used is the phenobarbitone. It belongs to a group of medicines known as barbiturates (Panayiotopoulos, 2010). It treats epilepsy by stabilizing the electrical activities of the brain. The patient using the medicine should using machineries and alcoholic drinks. Lastly, oxcarbazepine is also used to treat epilepsy (Patkanen, Schwarzkroin, & Moshe, 2005). It is used alone or with combination of other medicines to control seizure. It reduces abnormal electrical activities. It is taken twice in a day. Doctor’s prescription should be followed to the end. The medicine is used with a glass of water and the syringe should be used with clean water after use. Therapeutic index is the ratio used to compare the level of blood concentration that makes the drug toxic (Patkanen, Schwarzkroin, & Moshe, 2005). It also determines the concentration that the specific medicine is declared effective to the patient. The dosage of drugs should be done carefully and be monitored. Phenytoin, carbamazepine, sodium valproate and phenobarbitone need careful use (Schmidt & Schachter, 2011). The patients using the medication need to be monitored closely to ensure that there is no under or overdose. The patients should use the medication in an effective way only. Epilepsy medical care has experienced many changes. Currently there are many different medications for the patients (Schmidt & Schachter, 2011). Each patient has their own different medication. The medication is better and reliable. All the patients have been catered for. Currently the patients have the rights to ask for better medication. The medical status and patient reaction to medication is considered as an important thing (Wheless, Clarke, & McGregor, 2012). The new medical guideline and treatment mainly deal with the patient issue individually and not generally. Australia has the medicines in a right dosage. Patients in the country get good epileptic treatment. Monotherapy Monotherapy is use of one drug to treat the patients. The Monotherapy of the patients is preferred for most patients (Milton & Jung, 2003). Monotherapy is more advantageous than the polytherapy. Monotherapy reduces the cost, enhances ability to correlate response and reduces the frequency adverse effects. Monotherapy reduces the risk of birth defects. It improves the compliance and less intrusive regimens. Monitoring Therapy The epileptic patients should be encouraged to keep their daily records. They should be able to keep time, type and duration for the seizure (Panayiotopoulos, 2010). They should always consider the change in seizure frequency, time of occurrence alteration and change in seizure type. The other monitoring way is to educate the patients on the adverse effects they are expected to experience (Valentin & Alarcon, 2012). Laboratory test should be done to the patients to determine the exact problem they face. Lastly, the AED plasma concentration should be used to monitor the patients. Conclusion The research has been really useful to the different epileptic patients. It gives an understanding on the symptoms of the patients. It shows the different ways the disorder can be treated and controlled. It is clear that it is not a guarantee for someone to be born with the disorder live with it forever. The patients do have the chances of recovering from the problem completely as they grow older. All the patients need to be handled with care. People around them should learn the different first aid measures to reduce the chances of the problem becoming worse. The patients should be able to follow each step of treatment to the end. They should not ignore the treatment at any step. Recommendation The future of the epileptic patients should be improved. Organizations should be created with the purpose of supporting such patients. The patients should be under supervision to avoid injuries to themselves or others. The people around the patients should be trained to love and care for the patients. It is the work of all the involved people to give the patients support during their seizure time. References Cataltepe, O., & Jallo, G. I. (2011). Pediatric Epilepsy Surgery. London: Triton Press. Engel , J., Pedley, T. A., & Aicardi, J. (2008). Epilepsy: A comprehensive Textbook. New York: Demon Health. Fisher, R., & Kaplan, P. (2005). Imitator of Eplepsy. Oxford: Oxford University Press. Jallon , P. M., Kaplan, P., & Tatum, W. O. (2009). Epilepsy A to Z: A Concise Encyclopedia; Second Edition. Cambridge: Cambridge University Press. Milton, J., & Jung, P. (2003). Epilepsy as a Dynamic Disease. New York: Demos Health. Panayiotopoulos, C. P. (2010). A Clinical Guide to Epileptic Syndromes and their Treatment. New York: Jayjo Books. Patkanen, A., Schwarzkroin, P. A., & Moshe, S. L. (2005). Models of Seizures and Epilepsy. Maryland: Johns Hopkins University Press. Schmidt, D., & Schachter, S. C. (2011). Puzzling Cases of Epileplsy. New York: Fountain publishers. Valentin, A., & Alarcon, G. (2012). Introduction to Epilepsy. New york: Fountain Publishers. Wheless, J. W., Clarke, D. F., & McGregor, A. L. (2012). Epilepsy in Children and Adolescents. Oxford: Oxford University Press. Read More