Treatment of epilepsy with Domina Pharmaceuticals

What is Epilepsy?

Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. When a person has two or more unprovoked seizures, they are considered to have epilepsy.
A seizure happens when a brief, strong surge of electrical activity affects part or all of the brain.
Seizures can last from a few seconds to a few minutes. They can have many symptoms, from convulsions and loss of consciousness to some that are not always recognized as seizures by the person experiencing them or by health care professionals: blank staring, lip smacking, or jerking movements of arms and legs.
Serial seizures caused by hyponatremia, hypocalcemia, high fever, toxic exposure, intracranial bleeding, or bacterial meningitis are not classified as epilepsy unless they become a recurrent process beyond the acute illness.

Types of Seizures
There are many different types of seizures. People may experience just one type or more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures. Experts divide seizures into generalized seizures (absence, atonic, tonic-clonic, myoclonic), partial (simple and complex) seizures, non-epileptic seizures and status epilepticus.

1. Generalized Seizures

Generalized seizures affect both cerebral hemispheres (sides of the brain) from the beginning of the seizure. They produce loss of consciousness, either briefly or for a longer period of time, and are sub-categorized into several major types: generalized tonic clonic; myoclonic; absence; and atonic.

Generalized tonic clonic seizures (grand mal seizures) are the most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).

Myoclonic seizures are rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot. First aid is usually not needed, however, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.

Atonic seizures produce an abrupt loss of muscle tone. Other names for this type of seizure include drop attacks, astatic or akinetic seizures. They produce head drops, loss of posture, or sudden collapse. Because they are so abrupt, without any warning, and because the people who experience them fall with force, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy. No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the child should be given a thorough medical evaluation.

Absence seizures (also called petit mal seizures) are lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds. There is no warning and no after-effect. More common in children than in adults, absence seizures are frequently so brief that they escape detection, even if the child is experiencing 50 to 100 attacks daily. They may occur for several months before a child is sent for a medical evaluation.

Infantile Spasms are clusters of quick, sudden movements that start between 3 months and two years. If a child is sitting up, the head will fall forward, and the arms will flex forward. If lying down, the knees will be drawn up, with arms and head flexed forward as if the baby is reaching for support. What to Do: No first aid, but doctor should be consulted.

2. Partial Seizures

In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Partial seizures are subdivided into simple partial seizures (in which consciousness is retained); and complex partial seizures (in which consciousness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized.

Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations.

Partial seizures last only a minute or two, although people may be confused and need a lot more time afterwards to recover fully.

3. Non-epileptic Seizures

Non-epileptic seizures are episodes that briefly change a person's behavior and often look like epileptic seizures. The person having non-epileptic seizures may have internal sensations that resemble those felt during an epileptic seizure. The difference in these two kinds of episodes is often hard to recognize by just watching the event, even by trained medical personnel. But there is an important difference. Epileptic seizures are caused by abnormal electrical changes in the brain and, in particular, in its outer layer, called the cortex. Non-epileptic seizures are not caused by electrical disruptions in the brain.

4. Status Epilepticus

Most seizures end after a few moments or a few minutes. If seizures are prolonged, or occur in a series, there is an increased risk of status epilepticus. The term literally means a continuous state of seizure.

What Should I Do for a Person Who Has a Seizure?

- Loosen clothing around the person's neck.

- Do not try to hold the person down or restrain him or her, this can result in injury.

- Do not insert any objects in the person's mouth; this can also cause injury.

- Turn him or her gently onto one side. This will help keep the airway clear.

- Put something flat and soft, like a folded jacket, under the head.

- Reassure bystanders who may be panicking and ask them to give the person room.

- Remove sharp objects (glasses, furniture and other objects) from around the person to prevent injury.

- Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.

- After many seizures, there may be confusion for a period of time and the person should not be left alone.

- In many cases, especially if the person is known to have epilepsy, it is not necessary to call an ambulance. If the seizure lasts longer than 5 minutes, or if another seizure begins soon after the first, or if the person cannot be awakened after the movements have stopped, an ambulance should be called. If you are concerned that something else may be wrong, or the person has another medical condition such as heart disease or diabetes, you should contact a doctor immediately.

Treatment:
When the doctor has made a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment. If the seizure was caused by an underlying correctable brain condition, surgery may stop seizures. If epilepsy -- that is, a continuing tendency to have seizures -- is diagnosed, the doctor will usually prescribe regular use of seizure-preventing medications. If drugs are not successful, other methods may be tried, including surgery, a special diet, complementary therapy or vagus nerve stimulation (VNS). The goal of all epilepsy treatment is to prevent further seizures, avoid side effects, and make it possible for people to lead active lives.