Epilepsy – symptoms, diagnosis
Epilepsy is a chronic neurological condition that constitutes a major public health problem: its prevalence is 6.8 per 1,000 inhabitants, the overall incidence is between 7.3 and 136 per 100,000 population per year and mortality of patients with epilepsy is 2 – 3 times higher than the general population subjects.
Death can be directly related to epilepsy etiology (alcohol, tumor) or accident occurs during a crisis: status epilepticus, secondary craniocerebral trauma, drowning in crisis, asphyxia, etc. Also recently was observed an increased risk of sudden death, unexplained at epileptic patients.
Epilepsy is a chronic brain disease, manifested by seizures which can be spontaneous, recurrent.
Epileptic episode consists of a sudden, paroxysmal clinical manifestation motor, sensitive, sensory, behavioral and / or change of consciousness, which is due to activation of the sudden, uncontrolled, abnormal, excessive and hyper-synchronous of a neural population.
Morfeice seizures are seizures that occur during sleep.
Repeated seizures occur at short intervals (minutes, hours) that are separated by intervals of normal clinic (free intervals).
Status epilepticus: consists of repeated seizures, uninterrupted by the return to normal (without free interval). In these syndromes, the next crisis begins before the previous one have been fully completed.
Epileptic seizure is the manifestation of the syndrome defined by clinical features, electroencephalographic, neurological status, etiology, prognosis and therapeutic response times.
EEG results should always be interpreted according to the clinical context: a patient’s EEG can sometimes be normal, although EEG examination is repeated several times. Isolated absence of any abnormalities on EEG does not, in consequence, remove the diagnosis of epilepsy. Conversely, some subjects who had never seizures can sometimes have paroxysmal abnormalities on EEG. There is sometimes no relation between severity of seizures and the importance of EEG abnormalities.
Positive diagnosis of seizures
Paroxysmal event (start and end abruptly) has the following features:
- Sudden onset;
- Short: seconds, minutes;
- Distress of brain areas (eg involuntary movements or positions, paresthesia, visual hallucinations, auditory, olfactory);
- And / or alteration of consciousness, with or without maintaining posture, with total amnesia of the episode;
- Sharp end;
- After the crisis: sleepiness, muscle pain, confusion (are transient, with return to pre-crisis stage);