Focal epilepsy is treatable

Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.

Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally. It can happen if excessive abnormal electrical discharges affect a particular part of the brain or whole of the brain.

Let us understand focal epilepsy in detail.

What is focal epilepsy?

Focal epilepsy, also known as partial epilepsy, is a type of epilepsy that originates in a specific area of the brain. Unlike generalised epilepsy, where seizures involve the entire brain, focal seizures start in one region of the brain and can spread to other areas or remain localised. Focal epilepsy can affect individuals of all ages and may manifest in various forms, depending on which part of the brain is involved.

Focal Onset Aware Seizures (Simple Partial Seizures): In this type, the person remains conscious and aware during the seizure, although they may experience unusual sensations or movements. These sensations are called “aura” - the patient might perceive these auras as “signals” before or during the start of seizures.

Focal Onset Impaired Awareness Seizures (Complex Partial Seizures): In this case, consciousness is impaired or altered. The person may appear confused or unresponsive during the seizure.

Secondary Generalised Seizures: Secondary generalised seizures occur when seizure activity initiates in a localized region of the brain, but then spreads to involve the entire brain, leading to a generalized seizure presentation. This is when usually the seizures are noticed by the onlookers.

Causes of Focal Epilepsy:

Focal epilepsy can result from various factors, and in many cases, the exact cause remains unknown. However, there are several common triggers and risk factors, including:

Brain injury or trauma: A traumatic brain injury (TBI), such as from an accident or a fall, can damage specific areas of the brain, leading to focal epilepsy.

Brain tumours: Tumors in certain regions of the brain can cause abnormal electrical activity and trigger seizures.

Infections: Infections like meningitis or encephalitis, which cause inflammation in the brain, can result in focal seizures.

Stroke: A stroke can disrupt the normal blood flow to the brain, leading to brain damage and an increased risk of seizures.

Genetic factors: Some forms of focal epilepsy may have a genetic basis, although the range of exact genetic mutations responsible are still being studied.

Structural abnormalities: Conditions like focal cortical dysplasias (FCDs) (abnormal brain development) or brain malformations can predispose individuals to focal seizures. These are commonly missed on low resolution MRI.

Symptoms of Focal Epilepsy:

The symptoms of focal epilepsy can vary widely depending on which part of the brain is affected. Some of the common signs of focal seizures include:

Motor Symptoms

• Eyelid fluttering and body jerks
• Frequent falls
• Muscle spasms or convulsions
• Unconscious actions like pulling at clothes, wandering aimlessly, lip-biting, chewing, or mimicking vehicle-related tasks
• Involuntary jerking or twitching of specific body parts, such as the face, arms, or legs

Sensory Symptoms

• Unusual sensations, like strange tastes or smells
• Tingling or numbness
• Visual disturbances, such as flashing lights or spots

Autonomic Symptoms

• Hallucinations, such as feeling something rising from the stomach
• Changes in bodily functions controlled by the autonomic nervous system (e.g., heart rate, breathing)

Cognitive or Emotional Changes

• Confusion
• Feeling empty-headed
• Difficulty processing information or speaking coherently
• Talking nonsensically
• Hallucinations, such as seeing imaginary scenes or hearing strange sounds
• Sudden shouting, aggression, or irrational behavior
• Changes in mood, such as fear or anxiety

Diagnosing Focal Epilepsy:

Diagnosing focal epilepsy involves several steps to determine the exact nature and origin of the seizures. Common diagnostic procedures include:

Medical history and physical examination: A thorough evaluation of the patient's medical history and a physical examination help the doctor understand the frequency, duration, and nature of the seizures.

Video-Electroencephalogram (Video-EEG): A Video-EEG is a tool that helps to establish the nature of events, the area of onset of seizures, and if the seizures is focal onset, or multifocal onset, or generalised onset.

Magnetic Resonance Imaging (MRI): MRI scans can provide detailed images of the brain and help identify structural abnormalities, tumours, or lesions that may be causing the seizures.

Positron Emission Tomography (PET) or Single-Photon Emission Computed Tomography (SPECT): These imaging techniques can help pinpoint the specific brain regions involved in focal seizures.

Neuropsychological testing: In some cases, additional testing may be performed to assess cognitive and emotional function, which can help identify areas of the brain that may be affected by seizures. This is helpful for long term neuropsychological rehabilitation of patients with epilepsy.

Treatment of Focal Epilepsy:

The treatment for focal epilepsy aims to control seizures and improve the individual's quality of life. Treatment options may include:

1. Medications:

• Anti-Seizure Medications (ASMs) are typically the first line of treatment for focal epilepsy.
• The choice of medication depends on the individual's specific seizure type, patient profile, response to treatment, and potential side effects.
• In some cases, a combination of medications may be necessary if a single drug is not optimal.

2. Surgery:

• Patients whose seizures are not controlled adequately with medications, epilepsy surgery may be an option. Surgery is most effective in patients whose seizures originate from a well-defined abnormal area of the brain that can be safely operated.
• Resective surgery involves removing the abnormal brain tissue where the seizures originate.
• Laser interstitial thermal therapy (LITT) is a minimally invasive technique that uses lasers to destroy the abnormal brain tissue causing seizures.

Conclusion:

Focal epilepsy is a condition that can significantly impact a person's life, but with modern diagnostic tools and treatment options, it is possible to manage and control seizures effectively, with improved Quality of Life (QoL).. Whether through medication, or surgery there are many ways to reduce the burden of focal epilepsy and help individuals live more comfortably and safely. At KD Hospital we have Gujarat’s best epileptologist with a comprehensive Epilepsy Care Centre with two Epileptologists (Epilepsy Specialist Neurologists) and Neurosurgical team under one roof who work to treat focal epilepsy with a rational and scientific approach.