Overbreathing Health Dictionary

(See also FIT; SEIZURE.) Epilepsy is the name given to any condition in which a person suffers repeated ?ts or seizures. It is present in one in 200 (0·5 per cent) of the population and up to 5 per cent of all children will have had a ?t by the age of 12, although most of these are harmless accompaniments of an acute feverish illness.

It is a recurrent and paroxysmal disorder starting suddenly and ceasing spontaneously due to occasional sudden excessive rapid and local discharge of the nerve cells in the grey matter (cortex) of the BRAIN. Epilepsy always arises in this way from the brain, but its origin is often of microscopic size. It is diagnosed by the clinical symptoms based on the observations of witnesses. Its cause can sometimes be established by laboratory tests, and brain scanning. Fits can be the ?rst sign of a tumour, or follow a stroke, brain injury or infection, but in the large majority no underlying cause is found – so-called idiopathic epilepsy.

A single epileptic ?t is not epilepsy. Of those people who have a single seizure, a signi?cant minority (20 per cent) have no further attacks.

Major (generalised) seizures have a sudden, often unprovoked onset; the patient emits a cry, then falls to the ground, rigid, blue, and then twitching or jerking both sides of the body: the tonic-clonic convulsion. Drowsiness and confusion may last for some hours after recovering consciousness. Some experience a momentary warning (AURA): a smell, or sensation in the head or abdomen, vision, or déjà vu.

Partial seizures: focal motor (Jacksonian) begin with twitching of the angle of the mouth, the thumb, or the big toe. If the seizure discharge then spreads, the twitching or jerking spreads gradually through the limbs. Consciousness is preserved unless the seizure spreads to produce a secondary generalised ?t. In some attacks the eyes and head may turn, the arm may rise, and the body may turn, while some patients feel tingling in the limbs.

Complex partial seizures (temporal lobe epilepsy) The patient usually appears blank, vacant and may be unable to talk, or may mumble or chatter – though later they often have no memory of this period. They may be able to carry out complex tasks, taking o? gloves or clothes, and may smack their lips or rub repeatedly on one limb (automatisms). A sense of strangeness supervenes: unreality, or a feeling of having experienced it all before (déja vu). There may be a sense of panic. Strange unpleasant smells and tastes are olfactory and gustatory hallucinations. The visual hallucinations evoke complex scenes. An initial rising sense of warmth or discomfort in the stomach, or ‘speeding-up’ of thoughts are common psychomotor symptoms. All these strange symptoms are brief, disappearing within a few seconds or up to 3–4 minutes.

Minor seizures (petit mal) Attacks start in childhood. They last a few seconds. The child ceases what he or she is doing, stares, looks a little pale, and may ?utter the eyelids. The head may drop forwards. Attacks are commonly provoked by overbreathing. The child and parents may be unaware of the attacks

– ‘just daydreaming’. Major ?ts develop in one-third of subjects. By contrast with other types of epilepsy, the ELECTROENCEPHALOGRAM (EEG) is diagnostic.

Precautions Children with epilepsy should take normal school exercises and games, and can swim under supervision. Adults must avoid working at heights, with exposed dangerous machinery, and driving vehicles on public roads. Current legislation allows driving after two years of complete freedom from attacks during waking hours; those who for more than three years have had a history of attacks only while asleep may also drive.

Treatment identi?es, and avoids where possible, any factors (such as shortage of sleep or excessive ?uids) which aggravate or trigger attacks. If ?ts are very infrequent, treatment may not be recommended. However, frequent ?ts may be embarassing, may cause injury or may cause long-term brain damage so treatment is advisable. Anti-epileptic drugs are usually necessary for several years under medical supervision. Carbamazepine and sodium valproate are the most frequently prescribed. The dose is governed by the degree of control of ?ts and sometimes drug levels can be monitored by blood tests to check on dosage. Strict adherence to the drug schedule gives a reasonable chance of total suppression of ?ts, especially in younger patients whose ?ts have started recently. The table summarises anticonvulsant drugs in use. Interactions can occur between anti-epileptics and, if drug treatment is changed, the patient needs careful monitoring. In particular, abrupt withdrawal of a drug should be avoided as this may precipitate severe rebound seizures.

Indications First-choice drugs: Ethosuximide PM, JME Phenobarbitone M, P Phenytoin M, P, CP Carbamazepine M, P, CP Valproate M, PM, JME Second-line drugs: Primidone M, P, CP Clobazam M, CP Vigabatrin M, P, CP Lamotrigine M, P, CP Gabapentin M, P, CP Topirimate P

M = major generalised tonic-clonic; P = partial or focal; CP = complex partial (temporal lobe); PM = petit mal; JME = juvenile myoclonic epilepsy.

Anticonvulsant drugs

As all anticonvulsant drugs have an e?ect on the brain, it is not surprising that there may be side-effects, especially inolving alertness or behaviour. In each case careful assessment is necessary for doctor and patient to agree on the best compromise between stopping ?ts and avoiding ill-effects of medication.

Patients who have an epileptic seizure should not be restrained or have a gag or anything else placed in their mouths; nor should they be moved unless in danger of further injury. Any tight clothing around the neck should be loosened and, when the seizure has passed, the person should be placed in the recovery position to facilitate a return to consciousness (see APPENDIX 1: BASIC FIRST AID).

Patients with epilepsy and their relatives can obtain further advice and information from the British Epilepsy Association or Epilepsy Action Scotland.... epilepsy

a condition featuring recurrent episodes of acute distress, mental confusion, and fear of impending death or disaster. The core symptoms of anxiety are often present in an acute panic attack (palpitations, sweating, and tremor). Overbreathing (hyperventilation) often makes the attack worse and can cause tingling in the hands and arms and giddiness. These attacks last ten minutes or less and usually self-terminate; they are especially common in people with *agoraphobia. Treatment is with *antidepressant drugs and *cognitive behavioural therapy. *Anxiety management can also be helpful.... panic disorder

Panic attacks, or panic disorders, are recurrent short episodes of acute distress. Some sufferers may be mentally confused and fear impending death. Initially these attacks tend to occur unexpectedly but, if recurrent, they often become associated with certain places such as a con?ned space (lift) or among crowds. Symptoms include a feeling of breathing diffculties, including overbreathing, PALPITATION, dizziness, sweating, faintness and pains in the chest. Attacks are usually short (a few minutes) but not often associated with physical illness, although victims may have an anxiety disorder or PHOBIA. If troublesome or disabling, attacks can be treated symptomatically with short-term ANXIOLYTICS or on a long-term basis with BEHAVIOUR THERAPY.... panic attacks

A condition characterised by SPASM of muscle, usually caused by a fall in blood CALCIUM levels. This results in hyperexcitability of muscles which may go into spasm at the slightest stimulus. This is well demonstrated in two of the classical signs of the disease: Chvostek’s sign, in which the muscles of the face contract when the cheek is tapped over the facial nerve as it emerges on the cheek; and Erb’s sign, in which muscles go into spasm in response to an electrical stimulus which normally causes only a contraction of the muscle. Tetany occurs in newborn babies, especially if they are premature, and in infants; as a result of RICKETS, excessive vomiting, or certain forms of NEPHRITIS. It may also be due to lack of the active principle of the PARATHYROID glands. Overbreathing may also cause it. Treatment consists of the administration of calcium salts, and in severe cases this is done by giving calcium gluconate intravenously or intramuscularly. High doses of vitamin D are also required.... tetany

(acetylsalicylic acid) n. a drug that relieves pain and also reduces inflammation and fever. Largely superseded by modern anti-inflammatory agents (see NSAID), aspirin is now most commonly taken regularly in low doses as an *antiplatelet drug. In this role it reduces the risk of vascular thrombosis that may lead to events such as heart attack or stroke. Aspirin works by inhibiting the production of *prostaglandins; it may irritate the lining of the stomach, causing nausea, vomiting, pain, and bleeding. High doses cause dizziness, disturbed hearing, mental confusion, and overbreathing (see salicylism). Aspirin has been implicated as a cause of *Reye’s syndrome and should therefore not be given to children below the age of 16 years unless specifically indicated by a physician. See also analgesic.... aspirin