engleski

Seizures and neurological disorders

There are various causes of new onset seizures. Different risk factors are mostly age-related – in children majority is caused by congenital brain insults. In adults up to 75% are caused by stroke, tumors, neurodegenerative disease, brain infection, alcohol or other metabolic disturbances. Febrile seizures are separate entities that occur in childhood. Approximately 5% of all children are affected by febrile convulsions. About 4-8% of them will develop epilepsy by the age of 25, however, the risk increases with longer lasting convulsions, multiple convulsions or with adjacent focal neurological features, in particular in developmentally delayed population. Head injuries and intracranial infection also increase risk for seizures. It is interesting to note that a family history of epilepsy makes it more likely that a patient with a head injury will develop seizures. Viral encephalitis, cerebral abscesses, and neurocysticercosis carry greater risk of later epilepsy. These factors are more common in developing countries and therefore increase the prevalence of epilepsy, compared to developed nations. Seizures are the first presentation in 5% of acute strokes, and chronic epilepsy affects about 11% of stroke survivors. Recent studies also suggested that seizures might be predictors of subsequent stroke. Alcohol is the commonest cause of seizures in young and middle-aged adults in some countries. These seizures are mostly tonic-clonic, rarely focal. Neurodegenerative disorders, such as Alzheimer’ s disease, Lewy body dementia, Creutzfeldt-Jakob disease and Huntington’ s disease can be associated with increased risk for seizures. Seizures occur in 5% of AD patients, and they are not difficult to control. There are number of metabolic factors that increase risk for seizures. Some of the better documented are hypertension, diabetes, electrolyte disbalance and liver or renal disease. Association between epilepsy and psychiatric diseases is complex: patients with epilepsy may develop a wide spectrum of psychiatric diseases, mostly depression, and seizures occur more frequently in patients with psychiatric disease. Important issue for epilepsy patients is increased comorbidity of medical conditions, compared to general population. There is evidence that prevalence of brain tumors is increased in young adults and meningeomas are more common in older adults. Epilepsy patients also suffer more frequently from neurodegenerative diseases, such as Alzheimer’ s disease. Migraine and multiple sclerosis are also factors for developing epilepsy. Relative risk for developing epilepsy is 3.3 times higher among MS patients compared to general population. In conclusion, there are many risk factors that increase risk for developing epilepsy. Most of them are due to the common medical conditions or neurodegenerative disorders. Recent studies also showed that some of the most frequent comorbidities in epilepsy patients are injuries and poisoning, fractures and psychiatric disorders. It is worth thinking that all of these are either preventable or treatable and are mostly due to inadequate seizure control.

Epilepsy; seizures; neurological disorders

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