CHAPTER 4: BRAIN DISORDERS

EPILEPSY
TYPES OF SEIZURES

There are two main types of seizures. Generalized seizures affect the whole brain. Focal, or partial seizures, affect just one part
of the brain. A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a
stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

There are several reasons the patient may have a seizure. These include:

 high fever

 head trauma

 very low blood sugar

 alcohol withdrawal
 Anyone can develop epilepsy, but it’s more common in young children and older adults. It occurs slightly more in males than
in females. There’s no cure for epilepsy, but the disorder can be managed with medications and other strategies.

SYMPTOMS
Seizures are the main symptom of epilepsy.
Symptoms differ from person to person and
according to the type of seizure.
Complex partial seizures involve loss of awareness or consciousness. Other
symptoms include:
staring blankly
unresponsiveness
performing repetitive movements
Generalized seizures: Generalized seizures involve the whole brain. There
are six types:
Absence seizures, which used to be called “petit mal seizures,” cause a
blank stare. This type of seizure may also cause repetitive movements like
lip smacking or blinking. There’s also usually a short loss of awareness.
Tonic seizures cause muscle stiffness.

Focal (partial) seizures Atonic seizures lead to loss of muscle control and can make you fall down
suddenly.
Clonic seizures are characterized by repeated, jerky muscle movements of

A simple partial seizure doesn’t involve loss the face, neck, and arms.
Myoclonic seizures cause spontaneous quick twitching of the arms and
legs.
of consciousness. Symptoms include: Tonic-clonic seizures used to be called “grand mal seizures.” Symptoms
include:
 alterations to sense of taste, smell, sight, stiffening of the body
shaking

hearing, or touch loss of bladder or bowel control

biting of the tongue

 dizziness loss of consciousness

Following a seizure, the patient may not remember having one, or you
might feel slightly ill for a few hours.
 tingling and twitching of limbs
Triggers of an Epileptic Seizure A better way is that the patient or caregiver is to keep a seizure
journal. After each seizure the following need to be noted:
Some people are able to identify things or situations that can
 day and time
trigger seizures.
 what activity patient was involved in
A few of the most commonly reported triggers are:  what was happening around

 lack of sleep  unusual sights, smells, or sounds

 illness or fever  unusual stressors

 stress  what were the patient eating or how long it had been since it

 bright lights, flashing lights, or patterns had been eaten?

 caffeine, alcohol, medicines, or drugs  level of fatigue and how well you slept the night before

 skipping meals, overeating, or specific food ingredients  The patient can also use this seizure journal to determine if
his/her medications are working
Identifying triggers isn’t always easy. A single incident doesn’t
always mean something is a trigger. It’s often a combination of
factors that trigger a seizure.
 Dietary Therapies to Treat Seizures and Epilepsy

Dietary therapies can help control various types of

seizures in both children and adults when medicines
alone don’t work. There are four major dietary therapies
used today for epilepsy. They are all low in
carbohydrates (like sugar, pasta, and bread) and high in
fat (like butter, oils, bacon, and avocados). The main diet
people think of is the “classic” ketogenic diet. There are 3
other diet therapies used to treat seizures: Medium-chain
triglyceride diet (MCT), Modified Atkins Diet (MAD),
and Low Glycemic Index Treatment (LGIT).
Ketogenic Diet

 The classic ketogenic diet is the oldest of the diet therapies. It works by changing how
the body gets energy from food. Normally, the body uses carbohydrates for energy.
With this diet, the body uses fat instead (this is called “ketosis”). The diet is very high
in fat, it’s low in protein (i.e., meat) and carbohydrates. Dieticians figure out the
number of calories the patient will need. Recipes are created and available through
computer programs. One resource is the Charlie Foundation. Health care providers
usually recommend the ketogenic diet for children, but it can be used at any age. It’s
usually the first choice for children under 2 years of age. The MAD and LGIT are often
recommended for teenagers over 12 years old. To start the diet, you should first see an
epilepsy specialist and a nutritionist to get a personalized food plan.
 How well does it work?
 Many people who try the ketogenic diet have fewer seizures, and some people
will become seizure free. There is good evidence that all 4 major epilepsy
diets have good results. Some work better in young children than others and
some are easier to use in teenagers or adults. The ketogenic diet can lower
seizures by 50% or more in half of the people who try it. Many people on
dietary therapies can also reduce doses of their seizure medicines too.
 Dietary therapy may be specifically used for people with certain epilepsy
syndromes or types such as: Angelman syndrome, Complex 1 mitochondrial
disease, FIRES, Ohtahara syndrome, super-refractory status epilepticus, Dravet
syndrome, Doose syndrome, Glut-1 deficiency syndrome, formula fed children,
infantile spasms, pyruvate dehydrogenase deficiency, tuberous sclerosis
complex.
 Other Dietary Therapies
1. MCT DIET

The MCT diet is like the classic ketogenic diet but focuses on a specific type of fat called MCT. MCT refers to the type
of oil used (medium chain triglycerides). MCT oil can be used as a supplement instead of normal fats in the diet.
Sometimes people can have more carbohydrates on the MCT diet, but that need to be checked with diet team first.
2. MODIFIED ATKINS DIET

The Modified Atkins diet (MAD) limits the number of carbohydrates you eat to usually 20 grams each day. Eating fat in
the diet is encouraged. It can be started at home and doesn’t need specific meal plans. This means you can eat a wider
variety of foods. This is the most common epilepsy diet used for adults and teenagers with epilepsy. The Low Glycemic
Index Treatment (LGIT) limits the type of carbohydrates the patient can eat. This diet allows carbohydrates that are less
likely to raise your blood sugar quickly, like whole grains and berries. Foods that raise your blood sugar a lot (called
high glycemic index foods) are avoided. Like the MAD diet, it is started at home and foods don’t have to be weighed .
Practical Work

 Plan one day diet for a 14 year old normal weight girl with epilepsy