Epilepsy

When brain cells send out too many signals

The patient's brain waves are measured painlessly using EEG.(Bild: romaset/stock.adobe.com)

This triggers epileptic seizures. Epilepsy is one of the most common chronic neurological diseases, affecting 90,000 Austrians. Prominent personalities such as Napoleon, Charles Dickens and Vincent van Gogh were also affected. More about diagnosis and treatment in children and adults.

Epileptic seizures are a temporary malfunction of the brain. During a seizure, nerve cells send out too many signals at once.

In principle, epilepsy can occur at any stage of life, but the frequency varies depending on age: "Around a third of cases occur for the first time in infants and young children and 40% before the age of 14. In adults, the incidence decreases up to 60 and then increases again," reports Ao. Prof. Dr. Ekaterina Pataraia, MBA, Department of Neurology, Epilepsy Outpatient Clinic, MedUni Vienna, in Ärzte Krone.

How is the diagnosis made?
"In addition to the medical history and clinical neurological examination, an EEG is used to record changes typical of epilepsy and structural imaging using MRI."

Laboratory tests after the first seizure are used to diagnose the underlying disease causing the seizure. "Neuropsychological testing including screening for neuropsychiatric disorders - including anxiety/panic and affective disorders - should also be carried out at this point in order to identify contraindications for certain seizure-suppressing medication and to be able to offer early intervention," says the specialist.

MRI and EEG are used for diagnosis.(Bild: Siniehina/stock.adobe.com)

Treatment options
"The aim of treatment is to achieve permanent freedom from seizures with the best possible tolerance. In addition, training patients and/or their relatives to adapt their lifestyle is essential," explains Prof. Dr. Pataraia.

"This includes information about compliance [note: a patient's willingness to actively participate in treatment], sleep hygiene, possible accident and injury risks, e.g. during sport, fitness to drive and risk of death."

The aim of treatment is to achieve long-term freedom from seizures with the best possible tolerability.

Ao. Univ.-Prof. Dr. Ekaterina Pataraia, MBA, Univ.-Klinik für Neurologie, Epilepsieambulanz, MedUni Wien

Many substances with different mechanisms of action are currently available. In around two thirds of those affected, they achieve lasting freedom from seizures, but have little or no effect on the progression of the disease.

"Increasingly, the preventive administration of seizure-suppressing medication is therefore recommended in children - even before clinical seizures occur," reports Ao. Prof. Dr. Martha Feucht, Department of Pediatrics and Adolescent Medicine, Outpatient Clinic for Advanced Epilepsy Diagnostics, MedUni Vienna, in Ärzte Krone.

When medication does not help
If there is no response to medication, the possibility of epilepsy surgery should be examined and discussed after clarification at a specialist center. "This is particularly important for infants and young children, as significant and irreversible developmental impairments can be expected very quickly if the condition persists," warns Prof. Dr. Feucht.

Laser ablation (abnormal brain tissue is removed with a laser probe using heat) has also recently become available in Germany. Other possible measures include certain neurostimulation procedures, such as vagus nerve stimulation, which causes a reduction in seizures through electrical impulses.