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Neurology

Epilepsy

It is estimated that 50 million people worldwide suffer from epilepsy – a common disorder which results in seizures. These are caused by an abnormal electrical discharge which interrupts normal mental activity.

Few medical conditions have attracted so much attention and generated so much controversy as epilepsy. Throughout history, epilepsy has been considered many things including a curse from the gods and a severe type of insanity. Coping with the disorder has been made all the more difficult by peoples’ prejudices.

The seizures vary in terms of frequency, appearance, severity, cause and outcome. To prescribe the most appropriate anti-epileptic drug (AED), these factors must be studied closely.

General facts about epilepsy

Epilepsy is more prevalent in men and the highest incidence of the condition occurs during the first decade of life. Most newly diagnosed cases are children less than two years of age, and 30% of new cases are less than 18 years of age.

The incidence of epilepsy declines upon reaching adulthood and can remain low for many years. It then rises to a second peak when the sufferer reaches the age of 65 and above due to brain tumours, Alzheimer’s Disease and stroke.

Causes

During an epileptic seizure, a breakdown occurs in the systems that maintain the balance of electrical activity in the brain resulting in abnormal electrical discharges. During most seizures, a group of abnormal cells causes changes in neighboring cells, activating the entire group of cells at once. This linkage of electrical discharges creates a "storm" of electrical activity in the brain.

Most scientists believe that the process leading to the development of seizures occurs over a period of years. Abnormal electrical currents in the brain progress over a period of years, initially causing no measurable change in the brain’s activity or a person’s behavior, but gradually leading to more intense "electrical storms" and seizures.

The role of Genetics/Heredity Genetics is an important factor in some cases of epilepsy, particularly in individuals who develop epilepsy at a young age or who have primary generalised epilepsy as opposed to partial epilepsy.

The chance that a child of a parent with epilepsy will have unprovoked seizures by age 25 is 6%, compared with 1-2% in the general population. Epilepsy is roughly twice more common among children of women with epilepsy than among children of men with epilepsy.

Types of seizures

The International League Against Epilepsy (ILAE) has compiled a standard system of seizure classification known as the International Classification of Seizures.

Seizures are broadly divided into:

  • Partial seizures
  • Generalized seizures

Partial seizures

Most common type of seizure, occurring in about two-thirds of individuals with epilepsy. The origin of epileptic activity is localised within a limited area on one side of the brain. Partial seizures may be divided into three main groups:

  • Simple partial seizures
    • brief duration
    • consciousness is unimpaired
    • frequently accompanied by an aura
  • Complex partial seizures
    • brief duration
    • consciousness is impaired
    • characterised by automatism (e.g. lip smacking)
  • Secondary generalised partial seizures
    • evolve from simple or complex partial seizures
    • localised epileptiform (resembling epilepsy) activity spreads to other areas of the brain

Generalized seizures

Involves both sides of the brain and may be subdivided into:

  • Absence seizures (formerly called 'petit mal' seizures)
    • Onset in childhood
    • Brief periods of cessation of normal activity and blank staring
    • Recovery and resumption of normal activity without any memory of the attack
    • May be further sub-divided into typical and atypical absence seizures on the basis of the EEG and the likelihood that seizures will continue into adulthood.
  • Tonic-clonic seizures (formerly called 'grand mal' seizures)
    • Features for the tonic phase that occurs first:
      • bilateral muscular contractions and body rigidity
      • lasts less than one minute
      • loss of consciousness
      • cynosis (bluish discoloration of the skin and mucous membranes resulting from an inadequate amount of oxygen in the blood)
      • loss of consciousness
      • may be preceded by a cry or grunt as the respiratory muscles of the chest contract forcing air out through the larynx.
  • The clonic phase then follows
    • bilateral rhythmic jerking of the muscles of the face and limbs
    • may last for several minutes
    • irregular breathing
    • with or without excessive salivation and/or incontinence
    • the affected individual may be drowsy or may sleep for several minutes or hours after the attack
  • Tonic seizures - characterised by features of the tonic phase of a tonic-clonic seizure
  • Clonic seizures - characterized by features of the clonic phase of a tonic-clonic seizure
  • Myloclonic seizures
    • brief duration
    • consciousness impaired
    • characterised by jerky muscular contractions in the trunk, limbs or face
  • Atonic seizures
    • characterised by sudden loss of muscle tone and consciousness
    • usually occur in individuals who also experience other seizure types

Treatment

There is no known cure for epilepsy. Anti-epileptic drugs can control seizures in most people by suppressing and preventing them. Before medication is prescribed, an accurate diagnosis is required.

GSK offers lamotrigine, a drug within the phenyltriazine class. It can be used for a wide range of seizure types in both adults and children aged two to 12. It is available in 93 countries and has been used to great success on millions of patients worldwide.

Mental Illness in Malaysia

According to Dr Lee Aik Hoe, Consultant Psychiatrist and President of the Malaysian Mental Health Association, the most prevalent mental illness is depression. Mental illnesses should never be mistaken as being a product of weak character, but rather a mixture of factors including genetics, biology and an interplay with psycho-social factors.

In the past two years, the focus of the World Mental Health Day has been on stress at work and mental health. "Mental health is very much part of business, production and the profit margin," said Dr Lee.

"More companies have become aware of mental problems and do send the staff involved for treatment." Dr Lee said that the average cost of treating mental illnesses is similar to treating diabetes or hypertension. "However, for long term illness, a person could require treatment for a number of years," he said, adding that according to the World Health Organisation, one in four persons who seek any health services have a kind of mental illness.

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