what happens to epileptic seizures once you have a hysterectomy

Epilepsy | American Association of Neurological Surgeons

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Epilepsy is a disorder of the brain characterized by repeated seizures. A seizure is usually defined as a sudden amending of behavior due to a temporary change in the electric functioning of the brain. Normally, the brain continuously generates tiny electric impulses in an orderly pattern. These impulses travel along neurons — the network of nervus cells in the encephalon — and throughout the whole torso via chemical messengers chosen neurotransmitters.

In epilepsy the encephalon'due south electrical rhythms have a tendency to become imbalanced, resulting in recurrent seizures. In patients with seizures, the normal electrical design is disrupted by sudden and synchronized bursts of electrical energy that may briefly affect their consciousness, movements or sensations.

Epilepsy is usually diagnosed after a person has had at least 2 seizures that were not acquired by some known medical condition, such as alcohol withdrawal or extremely low claret sugar.

If seizures arise from a specific area of the brain, so the initial symptoms of the seizure oft reflect the functions of that surface area. The right half of the encephalon controls the left side of the body, and the left half of the brain controls the correct side of the body. For example, if a seizure starts from the correct side of the brain in the surface area that controls movement in the thumb, so the seizure may brainstorm with jerking of the left pollex or hand.

Seizures vary then much that epilepsy specialists frequently re-allocate seizure types. Typically, seizures belong in one of 2 bones categories: primary generalized seizures and partial seizures. The departure between these types is in how they begin. Primary generalized seizures brainstorm with a widespread electrical discharge that involves both sides of the brain at one time. Fractional seizures brainstorm with an electrical discharge in one limited expanse of the encephalon.

Epilepsy in which the seizures begin from both sides of the brain at the same time is called primary generalized epilepsy. Hereditary factors are important in fractional generalized epilepsy, which is more likely to involve genetic factors than partial epilepsy — a condition in which the seizures arise from a limited area of the brain.

Some partial seizures are related to head injury, brain infection, stroke or tumor merely, in most cases, the crusade is unknown. One question that is used to further classify fractional seizures is whether consciousness (the ability to respond and remember) is impaired or preserved. The departure may seem obvious, but there are many degrees of consciousness impairment or preservation.

The following factors may increment the hazard of seizures in people predisposed to seizures:

• Stress
• Sleep deprivation or fatigue
• Insufficient food intake
• Booze use or drug abuse
• Failure to take prescribed anticonvulsant medications

Most one-half of the people who have 1 seizure without a articulate crusade will have another one, unremarkably within half dozen months. A person is twice as likely to have some other seizure if there is a known encephalon injury or other blazon of brain abnormality. If the patients does take two seizures, there is about an 80 percentage adventure of having more than. If the first seizure occurred at the time of an injury or infection in the encephalon, it is more likely the patient will develop epilepsy than if the seizure did not happen at the time of injury or infection.

According to the Epilepsy Foundation, epilepsy affects three million people in the U.S. and 50 million worldwide. Epileptic seizures may be tied to a brain injury or genetics, but for 70 per centum of epilepsy patients, the cause is unknown. The Epilepsy Therapy Project notes that x pct of people will have seizures in their lifetime.

Epilepsy affects more than than 300,000 children under the historic period of xv — and more than 90,000 young people in this group have seizures that cannot exist adequately treated. The onset charge per unit starts to increment when individuals age, particularly as they develop strokes, brain tumors or Alzheimer's disease, all of which may cause epilepsy. Reports indicate that more than than 570,000 adults over the age of 65 endure from the disorder.

More men than women have epilepsy. Children and adolescents are more likely to have epilepsy of unknown or genetic origin. Brain injury or infection tin can cause epilepsy at whatsoever age. The Epilepsy Foundation also reports that lxx percent of children and adults with newly diagnosed epilepsy can be expected to enter remission after having gone five years or more without a seizure while on medication. In addition, 75 per centum of people who are seizure-free on medication tin can be weaned from medication eventually. According to the National Plant of Neurological Disorders and Stroke, 20 percent of epilepsy patients have intractable seizures — seizures that do not respond to handling.

The reasons why epilepsy begins are different for people of dissimilar ages. Only what is known is that the cause is undetermined for about half of all individuals with epilepsy, regardless of historic period. Children may be born with a defect in the construction of their encephalon or they may suffer a head injury or infection that causes their epilepsy. Astringent head injury is the most common known cause in young adults. For center-age individuals, strokes, tumors and injuries are more frequent catalysts. In people historic period 65 and older, stroke is the most common known cause, followed by degenerative conditions such equally Alzheimer's disease. Often, seizures do non begin immediately subsequently a person has an injury to the brain. Instead, a seizure may occur many months later.

• Premature nascency or low birth weight
• Trauma during birth (such as lack of oxygen)
• Seizures in the commencement month of life
• Abnormal encephalon structures at birth
• Bleeding into the brain
• Abnormal blood vessels in the brain
• Serious brain injury or lack of oxygen to the encephalon
• Brain tumors
• Infections of the encephalon such as meningitis or encephalitis
• Stroke resulting from blockage of arteries
• Cerebral palsy
• Mental disabilities
• Seizures occurring within days after head injury
• Family unit history of epilepsy or fever-related seizures
• Alzheimer'southward disease (late in the illness)
• Lengthy fever-related (delirious) seizures
• Alcohol or drug corruption

A doctor makes his or her epilepsy diagnosis based on symptoms, physical signs and the results of such tests as an electroencephalogram (EEG), computed tomography (CT or CAT scan) or magnetic resonance imaging (MRI).

Information technology is essential that the type of epilepsy and the type of seizures both are diagnosed properly. At that place are several major classifications of seizures and most are associated with specific forms of the disorder.

Epilepsy may be treated with antiepileptic medications (AEDs), diet therapy and surgery. Medications are the initial treatment pick for nearly all patients with multiple seizures. Some patients who only have a single seizure and whose tests do not indicate a high likelihood of seizure recurrence may not demand medications. The medications treat the symptoms of epilepsy (the seizures), rather than curing the underlying status. They are highly effective and completely command seizures in the majority (approximately 70%) of patients. The drugs prevent seizures from starting by reducing the trend of brain cells to send excessive and dislocated electrical signals.

With many different antiepileptic drugs currently available, choosing the right medication for an private patient has go complicated. Choice of medication depends on a variety of factors, some of which include the type of seizure and type of epilepsy, the probable side effects of the medication, other medical conditions the patient may have, potential interactions with the patient'southward other medications, historic period, gender and price of the medication.

Before any drug is prescribed, patients should hash out potential benefits, side effects and risks with their doctors.

Diet therapy may be utilized in some patients with specific forms of epilepsy. The most common diets utilized are the ketogenic nutrition and the modified Atkins diet. The ketogenic diet is a special high-fat, adequate poly peptide and low carbohydrate diet that is initiated over three to iv days in the infirmary. The modified Atkins diet is like to the ketogenic diet but is slightly less restrictive. It can be initiated as an outpatient. Both diets have been shown to reduce seizures in approximately half the patients that are identified to be advisable candidates. These are mainly children with refractory epilepsy who are not surgical candidates.

While approximately seventy percent of patients take well-controlled seizures with these modalities, the remaining 30 percent do not and are considered medically-resistant. Patients with medically-resistant epilepsy are oftentimes treated at specialized epilepsy centers in a multi-disciplinary fashion.

The team of trained specialists that collaborate to provide these patients with comprehensive diagnosis and treatment of epilepsy may include:

• Adult epileptologists
• Pediatric epileptologists
• Epilepsy nurse practitioners
• Epilepsy neurosurgeons
• EEG technicians
• Clinical neuropsychologists
• Psychiatrists
• Neuroradiologists
• Nuclear medicine radiologists
• Dietitians
• Neuroscience nurses

In patients whose seizures are medically resistant, surgery provides the best chance of complete control of seizures. However, non all patients with refractory epilepsy are suitable candidates for surgery. In addition to beingness refractory, they demand to have partial, rather than generalized epilepsy (i.e. their epilepsy arises from a single part of the brain, rather than from both sides or from all over the brain).

Furthermore, the epileptic region should be in a role of the brain that, if removed, is unlikely to result in major neurological complications. Whether or non patients are probable to benefit from surgery is determined past detailed testing (pre-surgical evaluation).

Pre-surgical evaluation consists of a one- or two-phase process to determine if surgery is the all-time selection and can provide good seizure control with minimal risk. Phase I involves all non-invasive (non-surgical) tests. Phase 2 testing involves invasive tests (requires surgery) that are used in select patients.

Not every patient requires every test available in the Phase I evaluation. Adult and pediatric epilepsy patients are evaluated past epileptologists who determine the necessary and advisable tests on an individualized basis. The post-obit tests may be required in the phase I evaluation:

This is the initial test performed in every patient and is normally done every bit an outpatient procedure (pictured here). It is used not only to diagnose epilepsy, just also to determine if the epileptic seizures are coming from a small part of the encephalon (fractional seizures), or all over the encephalon ( generalized).

Although nearly patients exercise not have seizures when the EEG is being recorded, they frequently have abnormal encephalon activity in the EEG (spikes or abrupt waves) that indicates they have a tendency to have seizures. The location of this action allows the physician to determine whether patients have partial or generalized seizures.

This is the most important pre-surgical test and is performed with electrodes attached to the scalp (noninvasive monitoring). Patients are admitted to the hospital for several days and the purpose is to record seizures with simultaneous video and EEG. All the information are analyzed by a trained epileptologist. Detailed analysis of the symptoms during seizures besides as the location of EEG changes during seizures (ictal EEG onset), and abnormalities noted in betwixt seizures (interictal), indicate the likely location where seizures originate within the brain.

This may detect an abnormality that could be the cause of the epilepsy (lesional epilepsy) or may be normal (not-lesional epilepsy). With more powerful MRI machines and utilise of special protocols and software, subtle brain abnormalities are increasingly being identified.

PET scans look at the metabolic activity of the brain and allow physicians to determine if the brain is performance normally. In patients with epilepsy, decreased brain function is seen in the region where seizures originate, when the patient is not actually having a seizure. On the other paw, if the patient has a seizure during the exam, increased brain role is seen. PET browse may show abnormalities even if the encephalon MRI is normal. PET scans are commonly done in the outpatient setting.

When a person has a seizure, an increased corporeality of claret flows to the brain region where the seizure begins. SPECT scans performed during seizures tin identify the encephalon region where claret flow increases and thus signal where they begin. SPECT scans are performed when the patient is admitted to the hospital for video-EEG monitoring.

Neuropsychological evaluation, functional MRI: Neuropsychological evaluation and functional MRI are used to appraise cognitive functions, especially language and memory function prior to surgery, to see which side of the brain is ascendant for language and to determine if there is decreased memory function in the epileptic region. This allows prediction of cognitive deficits later on surgery. Functional MRI (fMRI) measures blood flow changes in areas of the brain during the performance of specific cerebral tasks.

This test involves the injection of a medication such as sodium amobarbital or methohexital into one carotid artery at a time and is performed in selected cases. The medication causes temporary (1-five minutes) paralysis of one one-half of the brain assuasive contained testing of linguistic communication and memory role in the other half. This test is also used to predict mail service-operative deficits in linguistic communication and retention function.

Results of video-EEG monitoring are compared with those obtained from the other tests to see if they all point to the same region of the encephalon equally being the origin of epileptic seizures. If all the exam results are concordant, the patient is likely to be a adept surgical candidate. Thus, the Phase I evaluation is designed to find the surface area of the brain that is likely to be generating the seizures (the focus), to determine if that area can be safely removed, and predict what kind of event might exist expected with regard to seizure reduction or seizure freedom.

After the Phase I evaluation, the epilepsy team meets to discuss patient direction options in a multi-disciplinary setting to individualize treatments. At that time, based on the results of the Phase I evaluation, patients may be deemed good or poor surgical candidates. In some cases, it may be unclear and more testing is needed. This boosted testing is called Phase II evaluation and is performed in select cases, where despite all prior tests, the seizure focus is not defined well enough for surgical treatment.

Phase Two evaluation involves video-EEG monitoring with electrodes that are placed inside the skull (invasive monitoring). As there is more than run a risk from invasive monitoring, the decision virtually the necessity for a Phase Two evaluation is unremarkably made by the epilepsy team as a whole and discussed in detail with the patient.

There are several surgical implantation options. Each involves the implantation of electrodes either on the surface of the brain, or within the brain. The benefit of these electrodes is that they are closer to the expanse producing the seizures than those placed but on the scalp. After surgical placement of electrodes, the patients are transferred to the epilepsy monitoring unit and epileptologists perform video- EEG monitoring in a like fashion to the phase I monitoring.

The electrode types and implantation arrays differ and may include:

A subdural electrode filigree is a sparse sheet of material with multiple small (couple millimeters in size) recording electrodes implanted inside information technology. These are placed directly on the surface of the brain and have the advantage of recording the EEG without the interference of pare, fat tissue, muscle and bone that may limit scalp EEG. Shapes and sizes of these sheets are chosen to best conform to the surface of the brain and the area of interest.

These are pocket-sized wires which are implanted within the brain itself. Each wire has electrodes which environs it. These electrodes are able to record encephalon action forth the entire length of the implanted wire. They accept the advantage of recording activity from structures deeper in the brain. They can be implanted through small skin pokes.

In a number of instances, it is beneficial to implant a combination of subdural electrodes and depth electrodes.

Increasingly mutual, invasive monitoring may be done using the stereoelectroencephalography approach (stereoEEG). With this approach, multiple depth electrodes are implanted in a specific pattern that is individualized to the patient. The 3-dimensional space which is covered past the depth electrodes is designed to cover the seizure focus.

This is usually performed in patients with implanted subdural electrodes while they are in the EMU. After a sufficient number of seizures are recorded, brief electrical stimulation is provided through each electrode separately to determine the normal function of the part of the brain underneath the electrode. This is painless. The purpose is to map out critically important areas of the brain such as those necessary for motor, sensory and language functions and to decide if there is any overlap with the seizure-generating regions. This allows tailoring of surgical resections to minimize the risk of major neurological deficits later on surgery.

Surgery for the handling of epilepsy involves resection, disconnection, stereotactic radiosurgery or implantation of neuromodulation devices. Within these categories, there are multiple options depending on the clinical scenario.

Surgical resection (removal of abnormal tissue) for epilepsy may fall into the following wide categories:

Lesionectomy
A lesion is a generic term for brain abnormalities that show up on imaging. Some types of lesions — such as cavernous malformations (blood vessel abnormality) and tumors — are decumbent to cause seizures. When the pre-operative testing indicates that these lesions are the cause of the epilepsy, they can be removed surgically.

Lobectomy
Each hemisphere, or half, of the brain is divided into four master lobes — the frontal, temporal, parietal and occipital. Seizures may arise within whatsoever of the lobes. A lobectomy is an operation to remove a lobe of the brain. Removal of one of the temporal lobes — chosen a temporal lobectomy — is the nigh common type of epilepsy surgery performed. Other types of lobectomies may rely on more than specialized testing and surgery to prove a lack of vital role (such as speech, memory, vision, motor role).

Multilobar resection
A multilobar resection involves removal of parts or all of two or more lobes of the brain. It is reserved for more widespread abnormalities causing seizures, providing that no vital functions are in those regions.

Hemispherectomy
The brain is divided into a left and correct hemisphere. In rare instances, children may have astringent, uncontrollable and devastating seizures that can exist associated with weakness on one side of the torso. This may occur with a big amount of damage or injury to one of the hemispheres. Surgery to remove or disconnect a hemisphere, a hemispherectomy may be curative. There are many subtypes of this surgery, the two principal divisions being anatomic and functional hemispherectomy. Anatomic hemispherectomy involves removing the unabridged half of the brain that is injured and is generating the debilitating seizures. This includes the 4 lobes of the hemisphere — frontal, temporal, parietal and occipital. Functional hemispherectomy involves separating the abnormal hemisphere from the normal i by disconnecting fibers that communicate between the two. Often, some portions of the aberrant brain are surgically removed in order to perform this disconnection.

Functional hemispherectomy
Functional hemispherectomy involves separating the aberrant hemisphere from the normal one by disconnecting fibers that communicate between the ii. Often, some portions of the aberrant brain are surgically removed in society to perform this disconnection. This is, very oftentimes, surgically curative.

Surgical disconnection
These surgeries involve cutting and dividing fiber bundles that connect portions of the brain. The rationale is to separate the area of the encephalon generating the seizures from the normal brain.

Corpus callosotomy
The corpus callosum is i of the principal fiber bundles that connect the two hemispheres. When debilitating generalized seizures or falling-type seizures start on one side of the encephalon and apace spread to the other, patients may be candidates for this process. A large part of this fiber package may be cut. The procedure is palliative, pregnant that although seizures may amend, they usually practise not disappear.

Multiple subpial transections (MST)
In certain cases of epilepsy, where the seizures are deemed to be arising from an area of the brain that cannot exist safely removed, multiple subpial transections can exist performed. In this process, a small wire is placed into the brain to perform transections at multiple points in a given region which can decrease seizures past disconnecting the cross-communication of neurons.

Stereotactic radiosurgery
Stereotactic radiosurgery involves the delivery of a focused beam of radiations to a specific target surface area. Gamma Pocketknife radiosurgery, 1 of the most mutual forms of radiosurgery, uses gamma rays to target the surface area to exist treated. In epilepsy, it is by and large reserved for small, deep-seated lesions that are visible on MR imaging.

Neuromodulation
There are currently 2 FDA-approved devices that attune the nervous system with the goal of improved seizure control. This includes vagus nerve stimulation and responsive neurostimulation. Both devices are considered palliative in that the goal is improved seizure control, and rarely do patients get seizure gratis.

Vagus nerve stimulation
The vagus nerve stimulator (VNS) is an FDA-approved device for the treatment of epilepsy that is not controlled with antiepileptic medications. It involves the surgical placement of electrodes around the vagus nervus in the neck and a generator placed below the collar bone in the upper chest region. It requires ii split up incisions, but is an outpatient procedure. Subsequently, a programmer tin can be used by the epileptologist (from outside the skin) to change the intensity, duration and frequency of stimulation to optimize seizure control. VNS decreases seizure frequency past at least one-half in 40 to fifty percentage of patients, but rarely eliminates all seizures. It is an option for those who are non candidates for other types of surgery.

Responsive neurostimulation (RNS)
The NeuroPace responsive neurostimulation (RNS) device was approved past the FDA in 2014 every bit a handling for adults with fractional-onset seizures with i or two seizure onset-zones, whose seizures have non been controlled with 2 or more antiepileptic drugs. Surgery involves placing a neurostimulator in the skull and connecting to two electrodes that are placed either on the surface or into the brain, in or around the expanse which is deemed to be the likely onset region for the seizure. The device records brain waves (EEG), and is trained past the epileptologist to detect the electrical signature of the seizure onset and so deliver an impulse which can cease the seizure. Information collected by the neurostimulator can past uploaded past the patient with the apply of a hand-held wand to a secure spider web-based application which can exist accessed by the epileptologist. This surgery is by and large reserved for patients who are not a candidate for surgical resection, since the RNS improves seizure control merely rarely stops seizures from occurring.

Improved technology and testing has made it possible to place more than accurately where seizures originate in the brain (epileptogenic regions), and advances in surgery have fabricated operative direction safer for all forms of surgery for epilepsy. Of the surgeries presented, surgical resection offers the best gamble of rendering a patient seizure-free. Notwithstanding, the benefits of surgery should always exist weighed advisedly against its potential risks.

People with epilepsy are at gamble for two life-threatening weather: tonic-clonic status epilepticus and sudden unexplained decease in epilepsy (SUDEP). Tonic-clonic status epilepticus is a long-lasting seizure that's considered a medical emergency. If not stopped within well-nigh 30 minutes, it may crusade permanent injury or death.

SUDEP is a rare condition in which immature or middle-anile people with epilepsy die without a clear cause. It accounts for less than ii percent of deaths amidst people with epilepsy. The take chances is about 1 in 3,000 per year for all people with epilepsy. All the same, information technology tin be equally high as 1 in 300 for those who have frequent, uncontrollable seizures and accept loftier doses of seizure medicines. Researchers are uncertain why SUDEP causes death. Some believe that a seizure causes an irregular heart rhythm. More than recent studies have suggested that the person may suffocate from dumb breathing, fluid in the lungs and lying face down on bedding.

Although the hazard is depression, people with epilepsy also can die from inhaling vomit during or simply afterwards a seizure.

Most women with epilepsy can go significant, simply they should discuss their epilepsy and the medications they are taking with their doctors earlier getting pregnant. Many patients with epilepsy take high doses of medication that may lead to potentially harmful drug exposure to unborn babies. In some cases, medications may be reduced before pregnancy, particularly if seizures are well-controlled. While seizure medications can produce nascency defects, astringent nascency defects are rare in infants of women who receive regular prenatal care and whose seizures are carefully managed. Women with epilepsy have a 90 pct or better chance of having a normal, good for you babe.

Epilepsy is a chronic condition that affects people in dissimilar ways. Many people with epilepsy atomic number 82 normal, active lives. Between 70 and 80 percent of people with epilepsy can successfully control their seizures through medication or surgical techniques.

Some people find that they rarely take to think nigh epilepsy, except when taking their medications or going to see the doctor. No matter how epilepsy affects a person, it is important to remember that existence well-informed about the condition and keeping a positive mental attitude are important. Working closely with ahealthcare team and adhering to prescribed medications are essential to helping command seizures and so that the patient can lead a total, balanced life.

• Watch a Good Twenty-four hour period PA piece on epilepsy, featuring an interview with two doctors.
• Rebooting Kimberly's Encephalon: a story of a immature woman's epilepsy handling.
• Acquire about a patient with epilepsy who, with new treatment, is able to accept a baby.
• Hazel began exhibiting symptoms of epilepsy before her first birthday. Learn about her treatment journey.

These websites offer additional helpful data on epilepsy, its causes, handling options, support and more (Note: these sites are not under the augury of The American Clan of Neurological Surgeons, and their listing here should not be seen as an endorsement of these sites or their content).

• Healthline
• Epilepsy Foundation
• National Establish of Neurological Disorders and Stroke Epilepsy Folio
• Epilepsy Therapy Project
• Centers for Illness Command and Prevention Epilepsy Page
• American Epilepsy Society
• International League Against Epilepsy/International Agency for Epilepsy

The AANS does non endorse any treatments, procedures, products or physicians referenced in these patient fact sheets. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific neurosurgical advice or assistance should consult his or her neurosurgeon, or locate one in your expanse through the AANS' Detect a Board-certified Neurosurgeon" online tool.

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Source: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy

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