Mr. A, a man in his 70s, recently visited the neurology department of a hospital with symptoms of twisting his body and screaming while sleeping. At first, it was thought to be ‘REM sleep behavior disorder’, a type of sleep disorder, but after a detailed medical history and EEG test, it was confirmed to be epilepsy.
Epilepsy is a disease in which brain nerve cells temporarily experience excessive electrical excitement, causing seizures or convulsions. When these seizures occur spontaneously and repeatedly more than twice, it is defined as epilepsy. Epilepsy symptoms are largely divided into generalized seizures and partial seizures, depending on the area of the brain where abnormal electrical signals occur and the intensity.
Generalized seizures are characterized by loss of consciousness, rigidity of the entire body, regular tremors of the limbs, and cyanosis, and may cause tongue biting or urination. Partial seizures may cause stiffness and twitching of one side of the face, arms, and legs without loss of consciousness. Abnormal electrical signals originating in one side of the brain may spread to the entire brain and develop into generalized seizures. In addition to motor symptoms, there are also cases where abnormal sensations such as vision, hearing, smell, and discomfort are present.
The prevalence of epilepsy increased from 3.4 to 4.8 per 1,000 people between 2009 and 2017. In particular, the increase in the prevalence rate among the elderly aged 75 and over was notable as we entered an aging society.
The causes of epilepsy are largely structural, genetic, infectious, metabolic, and immune abnormalities. In children, the main causes are genetic, congenital malformations, developmental disorders, central nervous system infections, and neuronal migration disorders. In adolescents, it often appears idiopathically, and in adults, there are many structural causes such as cerebrovascular disease, brain tumors, central nervous system damage, and degenerative brain diseases. More than half of all patients have unknown causes.
Professor Yoon Ji-eun of the Department of Neurology at Soonchunhyang University Bucheon Hospital explained, “One of the biggest misconceptions about epilepsy is that it is congenital and only occurs at a young age. However, epilepsy can occur at any age.”
If epilepsy is left untreated, repeated seizures can cause physical damage and psychological problems. In addition, in severe cases, if the seizures last more than 5 minutes and consciousness is not restored, ‘status epilepticus’ occurs, serious brain damage can occur and ‘sudden epileptic death’ can occur.
Diagnosis of epilepsy is made through patient questioning, medical history, physical and neurological examination, electroencephalography, and brain magnetic resonance imaging (MRI). Epilepsy can be diagnosed when unprovoked seizures occur more than twice with an interval of more than 24 hours without any specific trigger. In addition, even for a single unprovoked seizure, if the risk of recurrence within 10 years is 60% or higher, it can be diagnosed as epilepsy.
Professor Yoon said, “It is important to differentiate syncope, transient ischemic attack, and psychogenic seizures that appear similar to epileptic seizures.”
Epilepsy treatment is mainly drug therapy. If medication is taken regularly, symptoms can improve and remission can be achieved in about 70% of patients. At least 2 to 5 years of consistent medication is required. If medication is ineffective, surgical treatment and neuromodulation therapy (vagus nerve stimulation) can be performed. In children, ketogenic diet therapy can be used in parallel.
If an epileptic seizure occurs for the first time but no particular abnormalities are observed, the course can be observed without drug treatment. If two or more unprovoked seizures occur, drug treatment is performed primarily. However, drug treatment is started in the following cases: ▲Even if it is the first seizure, if seizure waves are observed in the EEG, ▲If structural abnormalities are observed in the brain imaging, ▲If neurological abnormalities are observed, ▲If there is a family history of epileptic seizures, ▲If there is a history of brain infection or trauma accompanied by loss of consciousness, ▲If there is currently an active brain infection, ▲If the first seizure is ‘status epilepticus’.
In the case of patients with ‘epilepsy’, anticonvulsants must be maintained at a certain concentration in the blood to be effective, so regular medication is most important. In addition, because lack of sleep can cause seizures, regular and sufficient sleep of at least 7 to 8 hours is required. Excessive drinking also causes seizures, so it is prohibited. Considering the possibility of seizures, it is recommended to avoid dangerous places or objects such as hot water, sharp knives, and water.
Professor Yoon said, “It is also important to correct the misconception about epilepsy. Epilepsy patients can live a normal life and work, and epilepsy is a neurological disease, not a mental illness. It is important for patients not to blame themselves or feel frustrated, but to take their medication consistently and receive regular checkups.”
2024-09-19 12:03:11