An encounter with Epilepsy…

Background

According to the World Health Organisation(WHO), epilepsy affects about 50 million people across the globe, of all ages, causing it to be the most prevalent neurological disease. In the United States of  America, the increasing trend of epilepsy is expected to escalate through 2020.Although the leading diseases in Singapore are cardiovascular diseases and cancer, neurological disorders take the third place. KKH(Kantang Kerbau hospital) also reveals that there are about 150 new cases of epilepsy and seizures diagnosed each year.

table
Epilepsy cases in US(Adapted from WHO, 2015)

History

The term Epilepsy is derived from the Greek word ‘epilepsy’ which means ‘to take hold of’ or to ‘seize’. For many centuries in the past, the Greeks believed that epilepsy was caused by a curse from god whereby it was treated as a sacred disease. The Babylonians however, believed that a person who suffered from epilepsy was submissive to supernatural forces. It was believed that epilepsy was a result of the existence of demons and the different types of epileptic attacks depended on the type of demons that attacked a person. There wasn’t a proper treatment available in the past, and the only treatment that was used was using the blood of a murdered person to treat the epileptic patient. Sounds spine-chilling isn’t it? However, with the invention of anti-epileptic drugs, the blood-treatment practice was terminated.

What  is epilepsy exactly?

Epilepsy is a chronic disorder of the brain that is defined by recurrent seizures. Seizures are short episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness. Brain injuries, chemical imbalances in the brain, multiple gene abnormalities or a gene abnormality are the triggers of epilepsy. Some symptoms include loss of awareness or odd sensations.

table-1

Basic units of the brain

A typical nerve cells or neuron, is the simplest units of the brain. A neuron is made up of 3 defined regions, the cell body(soma), dendrites and the axon. The cell body contains the nucleus and other crucial organelles required for protein synthesis and energy production. Dendrites receive incoming signals from other nerve cells. The axon, generates and conducts impulses, causing excitation of the neuron, giving rise to action potentials. The axon transmits signals over a distance and the axon terminal transmits signals to other dendrites.

Neurons send electrochemical signals to other neurons or directly to tissues such as muscle fibres through highly structured networks. Neurons are connected to one another accounting for their potency. Each neutron is able to turn on or off its neighbouring neuron depending on the signal it sends, and the resulting stable pattern of neurons firing is what represents memories, thoughts and images. However, misfiring of these neurons due to triggers cause the stable pattern to be disrupted, resulting in seizures.

neuron-1
A typical neuron
neuron
Neurons firing causing a stable pattern

 

Action potential

The cell membrane surrounds the neuron, and controls the movement of charged sodium   (Na+) and potassium (K+) ions(refer to A in graph). The incoming electrical current from the dendrites accounts for the negativity of the of the membrane potential. Once the depolarisation reaches -55mV, the cell membrane opens up, allowing the Na+ ions to flow in, forming a temporary positive action potential(refer to B in graph). The cell membrane opens up again allowing the k+ ions to leave, resulting in the repolarisation  of the membrane’s potential(refer to C in the graph). Due to the loss in permeability of the cell membrane for the k+ ions, the potential falls below 70mV, causing hyperpolarization (refer to D in the graph). The action potential then stabilises at the resting potential, and it is then transmitted to the other neurons by the axon.

picture1
Action potential graph

Electroencephalogram

Through Electroencephalogram(EEG) electrical recording of the brain, it has been  identified that epileptic seizures occurred due to unusual discharges in the brain as a result of misfiring of neurons. EEG signals have since been used to study the physiological conditions of the brain.Electrodes are placed on the scalp of the patient, with the help of a paste, in certain areas to extract the EEG data. This data is then studied extensively, using computer algorithms, which aid significantly in planning treatments for epileptic patients.

electrode

Electrodes on scalp

 

Social Stigma

A study conducted reveals that the quality of life in epileptic patients is impaired to a certain extent. Unemployment, including finding and maintaining a proper job, fertile female patients with epilepsy fretting about having an increased risk of miscarriage, congenital malformations, perinatal death, and frequency of seizures associated with pregnancy, antiepileptic drug side effects involving the central nervous system are all he major challenges that epileptic patients face, having antiepileptic drug side effects involving the central nervous system as the major concern of all. Hence they are subjected to social stigma where employers are reluctant to employ them and people around them perceive them differently.

Wrap-up

Epileptic patients need to dismiss the stigma and need to come forward to get treated and gain support. Scientific and clinical research need to continue to advance to improve our knowledge related to epilepsy and brain disorders leading to an even better treatment that has little or no side effects to the central nervous system.Life still goes on and it is essential for one to enjoy life and be able to grow old and to be able to look back and say that life was fantastic, despite being epileptic! Life is short after all!

References

  1. Link: http://www.science-meets-society.com/wissenschaftsnews/epilepsy-a-way-of-living/
  2.  An action plan for epilepsy. News from Singapore’s academic tertiary hospital for women and children. July-August 2013.Volume 62. Issue 4.Retrieved from www.kkh.com.sg/AboutUs/Publications/Documents/01_SD_Jul-Aug2013.pdf
  3. Moog, F.P., Karenberg, A.: Between Horror and Hope: Gladiator’s Blood as a Cure for Epileptics in Ancient Medicine. Journal of the History of the Neurosciences 12 (2003) 137-143.
  4. World Health Organisation.; Epilepsy Fact sheet. May 2015

    Retrieved from http://www.who.int/mediacentre/factsheets/fs999/en

  5. Seizures

    Retrieved from https://www.youtube.com/watch?v=ZdX8vUZB7dc

6.   Link:https://www.youtube.com/watch?v=ZAmUjvgoO0A

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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