Epilepsy Surgery

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons,
in the brain sometimes signal abnormally. Neurons normally generate electrochemical
impulses that act on other neurons, glands and muscles to produce human thoughts,
feelings and actions. In epilepsy, the normal pattern of neuronal activity
becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes
convulsions, muscle spasms, and loss of consciousness. During a seizure, neurons
may fire as many as 500 times a second, much faster than the normal rate of
about 80 times a second. In some people, this happens only occasionally; for
others, it may happen up to hundreds of times a day

Doctors have described more than 30 different types of seizures.
According to the National Institute of Neurological Disorders and
Stroke, seizures are divided into two major categories – partial
seizures and generalized seizures. However, there are many different
types of seizures in each of these categories.

Partial Seizures
Partial seizures occur in just one part of the
brain. About 60 percent of people with epilepsy have partial seizures.
These seizures are frequently described by the area of the brain
in which they originate. For example, someone might be diagnosed
with partial frontal lobe seizures.

In a simple partial seizure, the person will remain conscious but
may experience unusual feelings or sensations that can take many
forms. The person may experience sudden and unexplainable feelings
of joy, anger, sadness or nausea. He or she also may hear, smell,
taste, see or feel things that are not real.

In a complex partial seizure, the person has a change in or loss
of consciousness. His or her consciousness may be altered, producing
a dreamlike experience. People having a complex partial seizure may
display strange, repetitious behaviors such as blinks, twitches,
mouth movements or even walking in a circle. These repetitious movements
are called automatisms. They also may fling objects across the room
or strike out at walls or furniture as though they are angry or afraid.
These seizures usually last just a few seconds.

Some people with partial seizures, especially complex partial
seizures, may experience auras – unusual sensations that
warn of an impending seizure. These auras are actually simple partial
seizures in which the person maintains consciousness. The symptoms
an individual person has, and the progression of those symptoms,
tends to be stereotyped, or similar every time.

The symptoms of partial seizures can easily be confused with other
disorders. For instance, the dreamlike perceptions associated with
a complex partial seizure may be misdiagnosed as migraine headaches,
which also can cause a dreamlike state. The strange behavior and
sensations caused by partial seizures also can be mistaken for symptoms
of narcolepsy, fainting, or even mental illness. It may take many
tests and careful monitoring by a knowledgeable physician to tell
the difference between epilepsy and other disorders.

Generalized Seizures
Generalized seizures are a result of abnormal
neuronal activity in many parts of the brain. These seizures may
cause loss of consciousness, falls or massive muscle spasms.

There are many kinds of generalized seizures. In absence seizures,
the person may appear to be staring into space and/or have jerking
or twitching muscles. These seizures are sometimes referred to
as petit mal seizures, which is an older term. Tonic seizures cause
stiffening of muscles of the body, generally those in the back,
legs and arms. Clonic seizures cause repeated jerking movements
of muscles on both sides of the body. Myoclonic seizures cause
jerks or twitches of the upper body, arms or legs. Atonic seizures
cause a loss of normal muscle tone. The affected person will fall
down or may nod his or her head involuntarily. Tonic-clonic seizures
cause a mixture of symptoms, including stiffening of the body and
repeated jerks of the arms and/or legs as well as loss of consciousness.
Tonic-clonic seizures are sometimes referred to by an older term – grand
mal seizures.

Not all seizures can be easily defined as either partial or generalized.
Some people have seizures that begin as partial seizures but then spread
to the entire brain. Other people may have both types of seizures but
with no clear pattern. One of the biggest challenges for parents when
a child has seizures is to help the child maintain self-esteem. Studies
comparing children with epilepsy with children who have other chronic
health conditions, such as asthma or diabetes, show that having seizures
has a more negative effect on how children feel about themselves. Studies
also show the way parents feel about the epilepsy has a major effect
on how the child feels about having seizures and copes with their effects.

Families that are open and accepting, and help the child
build on strengths, can make a positive difference in the child’s life. Experts
at the Epilepsy Foundation give the following suggestions:

• Emphasize the positive; praise success.
• Build on things the child likes and can do.
• Avoid describing the child’s seizures or the financial burden
  of medical care as problems in front of the child.
• Encourage a special hobby or lessons to acquire a special skill.
• Discuss seizures and epilepsy openly with the child and answer
  his or her questions about it.
• Encourage the child to be active and to have as much social
  contact with other children as possible.
• Try not to make your child’s seizures a reason not to do things
  the family would otherwise do, or fail to discipline the child
  on that account.

In addition, the same experts list the following as examples of
signs that may mean a child is having seizures:

• Sudden falls for no reason
• Lack of response to noise or to spoken words for brief periods
• Dazed and confused behavior
• Unusual sleepiness and irritability when wakened in the morning
• Head nodding
• Rapid blinking and staring
• Frequent complaints from the child that things look, sound,
  taste, smell or feel “funny”; episodes of fear that have
  no observable cause
• Clusters of jack-knife movements by babies who are sitting down,
  accompanied by crying
• Clusters of grabbing movements with both arms by babies lying
  on their backs
• Sudden stomach pain followed by confusion and sleepiness
• A blank stare followed by chewing, picking at clothes, random
  movements, unresponsive to surroundings
• Sudden muscle jerks

Any one of these childhood actions could occur and not be related
to seizures, but if a parent or caregiver sees a pattern, a medical
check up is a good idea.

In most cases, seizure management or first aid means keeping a
child safe while the seizure runs its course. Fortunately, most seizures
are brief and stop within several minutes. The Epilepsy Foundation
gives the following suggestions for rendering assistance when an
epilepsy attack occurs:

• Protect the child from injury while the seizure continues, but
  don’t forcefully restrain movements. Whenever possible, attempt
  to lay child on a soft surface and turn on their side.
• Place something flat and soft under the head. Loosen tight neckwear.
• Do not place anything in the mouth.
• CPR should not be given during a seizure.
• Record the approximate length of the seizure.
• Turn on one side to prevent choking.
• As the jerking slows down, make sure breathing is unobstructed
  and returning to normal.
• Do not try to give medicine or fluids until the child is fully
  awake and aware.
• Reassure the child and gently help to re-orient
  him or her as consciousness returns.