Epilepsy Treatment: Causes, Seizures & Therapy

Epilepsy

What Is Epilepsy?

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. A seizure is a sudden, uncontrolled burst of electrical activity in the brain that can cause changes in a person’s behavior, movements, sensations, or level of consciousness.

Causes of Epilepsy

In many cases (around 6 out of 10), the cause of epilepsy is unknown, and it’s referred to as idiopathic epilepsy. However, in other cases, epilepsy can be linked to various factors:

Genetic Factors: Some types of epilepsy run in families, suggesting a genetic predisposition. Genetic mutations can directly cause epilepsy or increase a person’s susceptibility to other triggers.
Structural Brain Abnormalities: These are visible changes in the brain’s structure that can disrupt normal electrical activity. They can be:
- Acquired: Resulting from conditions like:
  - Traumatic Brain Injury (TBI): Especially severe head injuries
  - Stroke: The leading cause of epilepsy in adults over 35, as it can damage brain tissue
  - Brain Tumors: Both cancerous and non-cancerous.
  - Brain Infections: Such as meningitis, encephalitis, cerebral malaria, or HIV.
  - Lack of oxygen to the brain: For instance, during birth complications or cardiac arrest.
Congenital (present at birth): Developmental abnormalities in the brain’s structure, like cortical dysplasia (where neurons don’t migrate properly during brain development).
Metabolic Disorders: Problems with the body’s metabolism can affect brain function and lead to seizures. Examples include glucose transporter 1 (GLUT1) deficiency or certain enzyme deficiencies.
Immune Disorders (Autoimmune Epilepsy): The body’s immune system mistakenly attacks brain cells, causing inflammation and seizures. This can sometimes be triggered by infections or tumors.
Perinatal Injuries: Injuries sustained around the time of birth, such as lack of oxygen during deliver

Symptoms of Epilepsy (Seizures)

The symptoms of epilepsy are diverse and depend on where in the brain the abnormal electrical activity originates and how far it spreads. Seizures are typically classified into two main types:

Focal Seizures (Partial Seizures): These originate in one specific area of the brain.
- Focal Aware Seizures (formerly Simple Partial Seizures): The person remains conscious and aware during the seizure. Symptoms can include:
- Changes in sensation: unusual smells or tastes, tingling, numbness, visual disturbances (flashing lights, spots).
Motor symptoms: involuntary jerking of a limb or part of the body, muscle stiffness.
Focal Impaired Awareness Seizures (formerly Complex Partial Seizures): The person’s consciousness or awareness is impaired or lost. Symptoms can include:
- Staring blankly.
- Repetitive, non-purposeful movements (automatisms) like lip-smacking, chewing, hand rubbing, picking at clothes, or walking in circles.
Appearing confused or unresponsive.
- Generalized Seizures: These involve widespread electrical activity affecting both sides of the brain simultaneously from the onset.
Other symptoms: Loss of consciousness, loss of bladder/bowel control, sometimes frothing at the mouth. After the seizure (post-ictal phase), the person may be confused, sleepy, or have headaches.
Absence Seizures (formerly Petit Mal Seizures): Brief, sudden lapses in consciousness, often appearing as a staring spell. The person may blink rapidly or have slight facial twitching. They typically last a few seconds and the person may not remember them. More common in children.
Atonic Seizures (Drop Attacks): Sudden loss of muscle tone, causing the person to suddenly go limp and fall.
Myoclonic Seizures: Sudden, brief, shock-like jerks or twitches of a muscle or group of muscles.
Tonic Seizures: Sudden stiffening of the body, arms, or legs, typically lasting less than 20 seconds.
Clonic Seizures: Rhythmic jerking movements, less common than tonic-clonic seizures.

Physiotherapy for Epilepsy

While physiotherapy does not directly treat the underlying cause of epilepsy (like anti-epileptic medications do), it plays a supportive and crucial role in managing the symptoms, improving physical function, reducing risks, and enhancing the overall quality of life for individuals with epilepsy.

Physiotherapy

Falls Prevention and Injury Reduction:
- Balance and coordination training: Exercises to improve static and dynamic balance, reducing the risk of falls during or after a seizure.
- Environmental assessment and modification: Advising on making the home or workplace safer (e.g., removing tripping hazards, padding sharp corners).
Motor Skill Enhancement and Strength Training:
- Addressing muscle weakness or spasticity: If seizures lead to motor deficits, or if underlying brain damage causes these issues, physiotherapists can implement strengthening exercises, stretching, and neuro-facilitation techniques.
- Improving coordination and fine motor skills: Especially important if seizures affect specific motor areas of the brain.
- Gait training: If walking patterns are affected, physiotherapists can help retrain gait, improve stability, and recommend assistive devices if necessary.

Exercise Prescription

Tailored exercise programs: Encouraging regular physical activity, which has been shown to improve overall health, reduce stress (a potential seizure trigger), and potentially even reduce seizure frequency in some individuals.
Safe exercise choices: Guiding patients on appropriate types of exercise (e.g., walking, swimming with supervision, cycling on a stationary bike, yoga) while advising caution with activities that could be dangerous during a seizure (e.g., swimming alone, climbing heights, operating heavy machinery).

Respiratory Management

In some severe generalized seizures, breathing can be temporarily affected. Physiotherapists may provide breathing exercises to improve respiratory efficiency.

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