EPILEPSY: WHAT IT IS AND ITS EFFECT ON EYE HEALTH

Epilepsy is the fourth most common neurological condition in the world which affects sixty-five million people. One out of twenty-six individuals within the USA will certainly develop epilepsy at some point in their lives. The primary symptom of epilepsy is unforeseeable as well as reoccurring seizures. A medical professional will diagnose a patient with epilepsy if they have actually had at least two such seizures that can’t be chalked up to some other cause like low blood sugar. An individual with epilepsy can have several different kinds of seizures ranging from absence seizures in which they simply quit what they are doing and stare into space for a couple of secs as if becoming a statue to full-blown convulsions. In the old days, individuals used to call absence seizures ‘petit mal’ seizures and convulsions ‘grand mal’ seizures.
In about sixty percent of situations, the doctor will not be able to identify a reason for the patient’s epilepsy. Epilepsy in general, is caused by irregular brain activity and can develop at any age. Some individuals are born with the defect in the structure of their brain Others have had a head injury, growth or tumour, stroke, or an infection causing epilepsy. An epileptic seizure may not take place until years after the injury, however in all situations, a seizure is the common symptom.

Causes of Epilepsy
Different epilepsies are due to many different underlying causes. The reasons can be intricate, and occasionally tough to identify. An individual might begin having seizures due to the fact that they have several of the following:
– A genetic tendency, coming from one or both parents (acquired)
– A genetic tendency that is not acquired, yet is a new modification in the patient’s genetics
– A structural (often called ‘symptomatic’) change in the brain, such as the brain not developing properly, or damage caused by a brain injury or trauma, infections like meningitis etc., a stroke or a tumour or abnormal growth in the brain. A brain scan, such as Magnetic Resonance Imaging (MRI), might show this
– Structural changes due to genetic conditions such as tuberous sclerosis, or neurofibromatosis, which can cause growths affecting the brain.
(Tuberous sclerosis- a rare condition that causes growth in organs including the brain;
Neurofibromatosis- a genetic condition that can cause growths on the nerves)

Some scientists now think that the possibility of developing epilepsy is most likely always genetic to some extent, in that anyone who begins having seizures has constantly had some degree of genetic probability to do so. This level can vary from high to low as well as anywhere in between.

Also, if seizures begin after a brain injury or other structural change, this might be because of both the structural change as well as the person’s genetic tendency to seizures, combined. This makes sense if we take into consideration that lots of people may have a similar brain injury, yet not every one of them develop epilepsy afterwards.


Ketogenic Diet
The ketogenic diet is one treatment alternative (yes, it’s a medical alternative) for children or adults with epilepsy whose seizures are not controlled with anti-epileptic medicines (AEDs). The diet may aid to minimize the number or intensity of seizures and may have various other favourable effects.
Up to 70% of people with epilepsy might have their seizures controlled with AEDs. For some individuals who continue to have seizures, the ketogenic diet plan may assist. Nevertheless, the diet regimen is extremely specialized. It needs to be executed with the care, supervision and guidance of trained medical professionals.


What is the ketogenic diet regimen?
The ketogenic diet regimen (KD) is a high fat, low carbohydrate, controlled healthy protein diet regimen that has been made use of since the 1920s for the treatment of epilepsy. The diet regimen is a medical therapy and also is normally only thought about when a minimum of two suitable drugs have been tried and not worked.
The ketogenic diet regimen is an established therapy option for kids with hard to regulate epilepsy. Nevertheless, grownups might also take advantage of dietary therapies.
Nutritional treatments for epilepsy must be followed with the support of a seasoned epilepsy professional and dietitian (food specialist).


Other comparable nutritional treatments for epilepsy
The following diet regimens have much more adaptable approaches, which might fit older kids or grownups. They are still medical treatments, with prospective side effects, and also require to be authorized by the patient’s neurologist. A ketogenic dietitian needs to separately establish the diet plan for each and every person so that it is safe as well as healthy.


Changed Atkins diet plan (MAD) and customized ketogenic diet regimen
The Modified Atkins diet as well as changed ketogenic diet regimen (in some cases called ‘customized ketogenic treatment’) make use of a high proportion of fats and also a stringent control of carbohydrates. These are frequently considered more flexible rather than the classical or MCT ketogenic diet regimens, as even more protein can be eaten, and also approximate portion sizes might be made use of instead of weighted recipes.

Low glycaemic index treatment (LGIT)
This diet focuses on how carbohydrates affect the level of glucose in the blood (the glycaemic index), in addition to the amount of carbohydrate eaten. Approximate portion sizes are made use of rather than food being weighed or measured.
Just how is a person’s health kept track of?
Routine follow-ups with the dietitian, and medical group, will check your or your kid’s development (height and weight, if appropriate), health, their epilepsy, as well as if there is a requirement for any type of modification to their anti-epileptic medications (AEDs), such as changing to sugar-free variations. If the diet regimen is complied with thoroughly, patients do not gain weight, or slim down inappropriately.
Does the ketogenic diet plan work?
A professional test, and also other studies since then, showed that the diet significantly reduced the variety of seizures in a percentage of children whose seizures did not respond well to AEDs. After three months, around 4 in 10 (38%) kids who began the diet had the number of their seizures minimized by over half, and had the ability to reduce their medicine intake. Although not all children had far better seizure control, some had various other benefits such as enhanced awareness, recognition and responsiveness.
Other tests have actually shown similar results in kids. High quality proof for the performance of dietary therapy for adults is increasing.
Research studies are continuing to check how the different diets work, and why nutritional treatments are effective for some individuals and also not for others.

Epilepsy: exploring retinal inflammation

Could retinal inflammation become a biomarker of epilepsy?

Patients with epilepsy have ‘spontaneous abnormal synchronised hyperexcitation’ in the brain – so called seizures. Seizures can take place any time during the day or evening. For a patient, not recognizing when she or he might instantly lose consciousness or control over his/her body has a significant effect on daily life. About 0.7% of the populace has epilepsy and of these more than 30% are immune to any type of current medication.
Epileptic seizures might arise from nearly anything that harms the brain; brain injury, stroke, infections as well as tumours along with inherited genetic anomalies. Epileptic seizures per se may likewise bring about mental retardation.

The inflammatory reaction
For some time now, the inflammatory response in the brain following epileptic seizures has actually gained increased interest.
The retina is a remote extension of the brain and also an intracranial spread of the inflammation to the retina might as a result be possible. Given that we additionally recognize that epileptic seizures bring about a severe immune response in the blood, the swelling might also spread out systemically to various other organs including the eyes.

The eyes and  epilepsy
The research study that we designed was explorative, because we had extremely little scientific evidence to base our assumptions on. People with epilepsy seldom complain about visual problems, apart from those with seizures originating from the vision-regulated occipital lobe.
There are numerous researches showing visual disturbances and structural modifications of the various layers in the retina in patients with epilepsy because of anti-epileptic medicines.
There are, to our opinion, no journals that have explained damage in retinal samplings from patients with epilepsy. However, there are a number of research studies revealing visual disruptions as well as structural changes of the different layers in the retina in people with epilepsy due to anti-epileptic medicines.

Could patients with epilepsy have visual disruptions because of the seizures themselves, in addition to side-effects of the anti-epileptic treatment?
The research consisted of rats with long term seizures, called status epilepticus. The seizures were generated by electrical stimulation of electrodes implanted into the temporal lobes of the brain.
The seizures were stopped with common anti-epileptic medicine. Six hours, one week and 7 weeks later, the immune action in the brain as well as the retina was evaluated. The time-points represented various stages of the immune reaction within the epileptic focus of the brain.

What were the findings?
Surprisingly, there was no immune reaction in the retina at the earlier time points, yet a strong delayed response at 7 weeks. The microglial cells, the most common immune cells in the brain, increased in numbers, collected in groups/clusters, and also had actually altered their morphology into a phenotype associated with immune activation.
Likewise, the macroglial cells, known as Müller cells, had ended up being activated. Nonetheless, there was no indication of substantial cell death or structural adjustments in the various retinal layers.
Moreover, the retinal immune response was relying on an immune factor, a chemokine receptor called by the technical, scientific name of CX3CR1. After treatment with the CX3CR1 antibody, the immune action in the retina was decreased or lowered.

Further research
Urged by speculative research, medical research studies currently need to be initiated to identify whether patients with epilepsy exhibit a similar immune response as well as visual deficiencies.

Visual perception after brain surgical procedures in youngsters with epilepsy
Brain surgery for epilepsy in children is sometimes needed to stop seizures and also allow children to function normally. Nonetheless, brain surgical procedures carry considerable risks, including disability in visual perception. Normal visual function is not simply information sent from the eye, yet additionally image as well as neurological processing in the brain that permits us to comprehend and act upon that info, or perception. Signals from the eye are first processed in the early visual cortex, a region at the back of the brain that is required for sight. They then travel via various other parts of the cerebral cortex, making it possible for recognition of patterns, faces, objects, scenes, and written words. In adults, also if their vision is still existing, injury or removal of even a small part of the brain’s vision processing facilities can lead to remarkable, permanent loss of perception, making them unable to identify faces, places, or to read, for example. Yet in youngsters, that are still developing, this part of the brain shows up able to rewire itself, a process called plasticity.
According to a study, as a result of this neuroplasticity, children can keep full visual perception – the ability to process as well as comprehend visual info – after brain surgery for severe epilepsy. Plasticity is a kind of “rewiring” process that can occur in children since they are still developing and growing.

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