In Part 11 What is discussed is Idiopathic Epilepsy (Unknown Cause) and the Rx of all causes!

Than their is the epilepsy that is diagnosed with a IDIOPATHIC cause – meaning unknown cause and the patient could grow out of it in childhood depending on the type of seizure disorder or not–in where the condition becomes chronic (for life).

Although heredity has been known since antiquity to cause epilepsy, the progress to date in identifying the genetic basis of epilepsy has been limited primarily to the discovery of single gene mutations that cause epilepsy in relatively rare families. For the more common types of epilepsy, heredity plays a subtler role, and it is thought that a combination of mutations in multiple genes likely determine an individual’s susceptibility to seizures, as well as the responsiveness to antiepileptic medications.

Epilepsy can be caused by genetic factors (inherited) or acquired (a etiology—cause) , although in most cases it arises in part from both. The neurology and neurological sciences of Stanford Epilepsy Center Dr. Robert S. Fischer Ph D. presents in the article Genetic Causes of Epilepsy.

He also presents in this article our genes are the instruction set for building the human body. Genes reside on chromosomes.

Going to the basics is every person has 46 chromosomes, carrying a total of about 30,000 genes. We get half our chromosomes from our mother and half from our father. While genes determine the structure of our body, they also control the excitability of our brain cells. Defective genes can make hyperexcitable brain cells, which are prone to seizures.

In recent years, several epilepsy conditions have been linked to mutations in genes, but the matter is complicated by the fact that different genes may be involved in different circumstances.

In general, the most common epilepsy conditions, including partial seizures, seem to be more acquired than genetic.

Gene testing will soon be able to identify predispositions to epilepsy, allowing doctors to help a patient get treatment and to assist with family counseling. One day, doctors may simply be able to swap a patient’s cheek, test his or her genes, and predict response to various epilepsy medicines, eliminating much of the trial and error in medication choice that goes on today. Eventually, we may even be able to repair or replace defective genes that predispose a person to epilepsy, a process called gene therapy.

Lastly, Dr. Robert Fischer Ph D presented in his article, that I found very interesting, the general population has about a 1% risk of developing epilepsy.  Meanwhile, children of mothers with epilepsy have a 3 to 9% risk of inheriting this disease, while children of fathers have a 1.5 to 3% risk of inheritence. Still, the actual risk is upon the specific type of epilepsy. For example, partial seizures are less likely to run in families than are generalized seizures. In any event, with the usual forms of epilepsy, even if a parent does have the condition, there is more than a 90% chance that their child will not. So most epilepsies are acquired than inherited.

Clearly, genes determine a great deal of who we are, including our possible risk for epilepsy but slim versus a actual cause.

But what happens to us in life and what we do is still the larger part of the risk for epilepsy.

A person given this diagnosis in the 1970’s, or before  and even up to the early 1990’s was quiet about ever letting people know about this since in the 1970’s and back with lack of knowledge, information to the public and definitely technology than versus now.  Epilepsy is much more an accepted disease in the overall community compared to 20-25 years ago and back.  Heck in the 1970’s and back these patients when having a seizure episode were characterized as “Freaks”. This was due to ignorance and lack of information but due to the past 20 to 25 years with the computer used more as a must in our lives with media, television and even our government they all have made it possible for society everywhere in the world to learn and understand diseases with acceptance in wanting to help those, particularly the US, but we still need a healthier America. It will take time to get there with the many multicultural lives that all live in the U.S. which practice differently on how important or where a healthy diet with exercise balanced with rest and stress well controlled is on their priority list in living.

Treatment

Doctors generally begin by treating epilepsy with medication. If medications don’t treat the condition, doctors may propose surgery or another type of treatment.

Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Many children with epilepsy who aren’t experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults can discontinue medications after two or more years without seizures. Your doctor will advise you about the appropriate time to stop taking medications.

Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won’t interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled.

For a person diagnosed with or without a cause of epilepsy these steps in learning about the disease with higher technology and continuous research with medications over the years has allowed them to be able to live a completely healthy life doing the same things other people do without the disease but only if the patient is UNDER COMPLETE CONTROL  which includes being COMPLIANT; this does exist in America.

Compliant meaning taking their medications everyday as ordered by their neurologist with yearly or sooner follow-up visits with blood levels of the anti-seizure medications there on.  This is the only way one with chronic epilepsy is guaranteed that living this way MAY stop the seizures from occurring (inactive epilepsy you can call it — meaning you’ll always have the disease but can put the seizure activity in a remission or under control by medications preventing the seizure.)

Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:

• Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin.
• Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.
• Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset.

Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.

When medications fail to provide adequate control over seizures, surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that’s causing seizures.

Doctors usually perform surgery when tests show that:

• Your seizures originate in a small, well-defined area of your brain
• The area in your brain to be operated on doesn’t interfere with vital functions such as speech, language, motor function, vision or hearing

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates, and complication rates with the procedure you’re considering.

Therapies

VagusNerveStimulation

Deep brain stimulation

Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy:

• Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It’s not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent.Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.
• Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that’s high in fats and low in carbohydrates.In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet — under close supervision of their doctors — and remain seizure-free.Consult a doctor if you or your child is considering a ketogenic diet. It’s important to make sure that your child doesn’t become malnourished when following the diet.Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.

  Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.

• Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or your skull that sends electrical pulses to your brain and may reduce your seizures.

Potential future treatments

Researchers are studying many potential new treatments for epilepsy, including:

• Responsive neurostimulation. Implantable, pacemaker-like devices that help prevent seizures are under investigation. These responsive stimulation or closed loop devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure.
• Continuous stimulation of the seizure onset zone (subthreshold stimulation). Subthreshold stimulation — continuous stimulation to an area of your brain below a level that’s physically noticeable — appears to improve seizure outcomes and quality of life for some people with seizures. This treatment approach may work in people who have seizures that start in an area of the brain that can’t be removed because it would affect speech and motor functions (eloquent area). Or it might benefit people whose seizure characteristics mean their chances of successful treatment with responsive neurostimulation are low.
• Minimally invasive surgery. New minimally invasive surgical techniques, such as MRI-guided laser ablation, show promise at reducing seizures with fewer risks than traditional open-brain surgery for epilepsy.
• Stereotactic laser ablation or stereotactic radiosurgery. For some types of epilepsy, stereotactic laser ablation or stereotactic radiosurgery may provide effective treatment when an open procedure may be too risky. In these procedures, doctors direct radiation at the specific area in the brain causing seizures to destroy that tissue in an effort to better control the seizures.
• External nerve stimulation device. Similar to vagus nerve stimulation, this device would stimulate specific nerves to reduce frequency of seizures. But unlike vagus nerve stimulation, this device would be worn externally so that no surgery to implant the device is needed.

In treatment FOLLOW UP VISITS  are part of it, go to the neurologist not a general practitioner and that is a must!!!

The purpose for F/U (follow up) visits is for the neurologist to see how good of a therapeutic drug level your anti-seizure med is in (you get the blood test before the F/U visit).  Possible do a EEG (electroencephalogram); the only test to decipher if you have spikes in your brain waves indicating you had a seizure (a 26 lead to wires on the brain, which is painless).  Go to the expert for keeping you on the right track.  Its just like based on the principle why a person gets a check up on there car by seeing the mechanic (the car’s doctor).

Types of seizures whether with a etiology or unknown:

I-Partial seizures (seizures beginning local)

1-simple partial seizures-(the person is conscious and not impaired).  With motor symptoms, autonomic symptoms and even psychic symptoms.

2.)-Complex partial seizures-(the person is with impairment of consciousness)

II-Generalized seizures-(bilaterally symmetrical and without local onset).

3.) Tonic clonic seizures – Grand Mal

For those with epilepsy make your life one without seizures occurring putting your life on HOLD you need to TAKE CARE OF YOURSELF and take the meds including see your neurologist yearly or sooner! That is all up to you the patient diagnosed with it.

“Epilepsy is the fourth most common neurological disorder in the world and affects sixty-five million individuals. One out of twenty-six individuals within the United States will develop epilepsy at some point in their lives. The main symptom of epilepsy is unpredictable and recurrent seizures. A doctor will diagnose a patient with epilepsy if they have had at least two such seizures that can’t be chalked up to some other cause like low blood sugar that can cause a seizure.”

Health Prep (healthprep.com)

“There’s no cure yet for multiple sclerosis. However, treatments can help speed recovery from attacks, modify the course of the disease and manage symptoms.”

MAYO CLINIC

“Multiple sclerosis (MS) is a potentially disabling disease of the brain and spinal cord (central nervous system.  Eventually, the disease can cause permanent damage or deterioration of the nerves.  Signs and symptoms of MS vary widely and depend on the amount of nerve damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others may experience long periods of remission without any new symptoms.”

MAYO CLINIC

“In multiple sclerosis (MS), damage to the myelin coating around the nerve fibers in the central nervous system (CNS) and to the nerve fibers themselves interferes with the transmission of nerve signals between the brain, spinal cord and the rest of the body. Disrupted nerve signals cause the symptoms of MS, which vary from one person to another and over time for any given individual, depending on where and when the damage occurs.

The diagnosis of MS requires evidence of at least two areas of damage in the CNS, which have occurred at different times.”

National Multiple Sclerosis Society

“The United States continues to have one of the lowest TB case rates in the world, and the 2019 case count represents the lowest number of TB cases on record. Still, too many people suffer from TB disease and our progress is too slow to eliminate TB in this century.  Up to 13 million: estimated number of people in the United States living with latent TB infection.”

Centers for the Disease Control and Prevention (Data & Statistics | TB | CDC)

How does PTB develop? TB bacilli enters the body and lodges in the lungs (TB Infection). In the lungs, they multiply and slowly eat the cells and the body begins to experience symptoms (TB Disease)  A person who develops a TB disease, when remain untreated, can then begin to infect others. In some cases, the TB germ migrates to other body organs and begin to destroy them, thus the advent of extra-pulmonary (outside) cases of Tuberculosis like TB of the meninges, bones, etc. A TB disease that remains untreated leads to death.

Airborne to prevent the transmission of highly contagious or virulent infections spread by small airborne droplets (smaller than 5 microns) examples know or suspected TB, chicken pox.

Airborne Precautions: spread of microbes on small droplet nuclei through the air ( 5 microns); which transmit 3 feet in air. (ie) TB, Mumps; Pertussis; Influenza; SARS. Private room / or cohort clients, and mask worn if within 3 feet.

TB can be transmitted in just about any setting. It can be spread in places such as homes or worksites. However, TB is most likely to be transmitted in health care settings when health care workers and patients come in contact with persons who have unsuspected TB disease, who are not receiving adequate treatment, and who have not been isolated from others. All health-care settings need an infection-control program designed to ensure the following:

• Prompt detection of TB disease;
• Airborne precautions; and
• Treatment of people who have suspected or confirmed tuberculosis (TB) disease.

Overview of TB Infection-Control Measures

The TB infection-control program should be based on the following three-level hierarchy of control measures:

1. Administrative controls
2. Environmental controls
3. Use of respiratory protective equipment

Administrative Controls

The first and most important level of the hierarchy, administrative controls, are management measures that are intended to reduce the risk or exposure to persons with infectious TB.  These control measures consist of the following activities:

• Assigning someone the responsibility for TB infection control in the health care setting;
• Conducting a TB risk assessment of the setting;
• Developing and implementing a written TB infection-control plan;
• Ensuring the availability of recommended laboratory processing, testing, and reporting of results;
• Implementing effective work practices for managing patients who may have TB disease;
• Ensuring proper cleaning, sterilization, or disinfection of equipment that might be contaminated (e.g., endoscopes);
• Educating, training, and counseling health care workers, patients, and visitors about TB infection and disease;
• Testing and evaluating workers who are at risk for exposure to TB disease;
• Applying epidemiology-based prevention principles, including the use of setting-related TB infection-control data;
• Using posters and signs to remind patients and staff of proper cough etiquette (covering mouth when coughing) and respiratory hygiene; and
• Coordinating efforts between local or state health departments and high-risk health-care and congregate settings.

Environmental Controls

The second level of the hierarchy is the use of environmental controls to prevent the spread and reduce the concentration of infectious droplet nuclei.  This includes two types of environmental control.

• Primary environmental controls consist of controlling the source of infection by using local exhaust ventilation (e.g., hoods, tents, or booths) and diluting and removing contaminated air by using general ventilation.
• Secondary environmental controls consist of controlling the airflow to prevent contamination of air in areas adjacent to the source airborne infection isolation (AII) rooms; and cleaning the air by using high efficiency particulate air (HEPA) filtration, or ultraviolet germicidal irradiation.

Respiratory Controls

The third level of the hierarchy is the use of respiratory-protection control. It consists of the use of personal protective equipment in situations that pose a high risk of exposure to TB disease.

Use of respiratory protection equipment can further reduce risk for exposure of health care workers to infectious droplet nuclei that have been expelled into the air from a patient with infectious TB disease. The following measures can be taken to reduce the risk for exposure:

• Implementing a respiratory protection program;
• Training health care workers on respiratory protection; and
• Educating patients on respiratory hygiene and the importance of cough etiquette procedures.

Determining the Infectiousness of TB Patients

The infectiousness of a TB patient is directly related to the number of droplet nuclei carrying M. tuberculosis (tubercle bacilli) that are expelled into the air.  The number of tubercle bacilli expelled by a TB patient depends on the following factors:

• Presence of a cough
• Cavity in the lung
• Acid-fast bacilli on sputum smear
• TB disease of the lungs, airway, or larynx
• Patient not covering mouth and nose when coughing
• Not receiving adequate treatment or having prolonged illness
• Undergoing cough-inducing procedures
• Positive sputum cultures

Patients can be considered noninfectious when they meet all of the following three criteria:

• They have three consecutive negative AFB sputum smears collected in 8- to 24-hour intervals (one should be an early morning specimen);
• They are compliant with an adequate treatment regimen for two weeks or longer; and
• Their symptoms have improved clinically (for example, they are coughing less and they no longer have a fever).

“A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). Worldwide, TB is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS).

In 2019, an estimated 10 million people fell ill with tuberculosis(TB) worldwide. 5.6 million men, 3.2 million women and 1.2 million children. TB is present in all countries and age groups. But TB is curable and preventable.”

World Health Organization (WHO)

Symptoms of active TB include a cough that contains thick, cloudy, and sometimes bloody mucus from the lungs, called sputum, for more than two weeks, tiredness and weight loss, night sweats and a fever, a rapid heartbeat, swelling of the lymph nodes, and shortness of breath and chest pain.

DIAGNOSIS:

There are numerous ways for a doctor to diagnose a patient with tuberculosis. Doctors can typically find latent, or not active, TB by doing a tuberculin skin test, where TB antigens are injected under the skin. If the patient has TB bacteria within their body, a red bump will appear at the injection spot in two days. A blood test can also be performed to detect if a patient has TB. For doctors to discover pulmonary TB, they will often test a sample of mucus from the lungs to see if the TB bacteria are present there. Other tests may include further testing on sputum, or mucus from the lungs, other blood tests, or a chest X-ray to find pulmonary TB. To diagnose extrapulmonary TB, a doctor may take a sample of tissue, or a biopsy, to test as well as a CT scan or an MRI to get a clear visual of the inside of the patient’s body.

TREATMENT:

In the majority of cases, doctors will combine four antibiotics to treat active TB, and it is essential for patients to take this medicine for a minimum of six months. A majority of patients are cured of the TB bacteria if they take all the required medicine necessary to destroy the infection. If tests performed by a doctor reveal active TB is still present in the body after six months, treatment will continue for another two or three months. In the worst case scenario, if the TB bacteria is still resistant to multiple antibiotics, called multidrug-resistant TB, treatment will be necessary for one year or longer. Patients with latent TB may be treated with one antibiotic they consume daily for nine months or with a combination of antibiotics taken once a week for twelve weeks. Ensuring every dose is taken reduces the risk of a patient with latent TB to develop active TB.

“Some people develop TB disease soon after becoming infected (within weeks) before their immune system can fight the TB bacteria. Other people may get sick years later, when their immune system becomes weak for another reason.

Overall, about 5 to 10% of infected persons who do not receive treatment for latent TB infection will develop TB disease at some time in their lives.”

Center for Disease Control and Prevention (CDC)