Epilepsy

Epilepsy Definition

Epilepsy is a seizure disorder. According to the Epilepsy Foundation of America, a seizure happens when a brief, strong surge of electrical activity affects part or all of the brain.1 Seizures can last from a few seconds to a few minutes. They can have different symptoms, too, from convulsions and loss of consciousness, to signs such as blank staring, lip smacking, or jerking movements of arms and legs.2 Some people can have a seizure and yet not have epilepsy. For example, many young children have convulsions from fevers. Other types of seizures not classified as epilepsy include those caused by an imbalance of body fluids or chemicals or by alcohol or drug withdrawal. Thus, a single seizure does not mean that the person has epilepsy. Generally speaking, the diagnosis of epilepsy is made when a person has two or more unprovoked seizures.3

Epilepsy Incidence

About three million Americans have epilepsy. Of the 200,000 new cases diagnosed each year, nearly 45,000 are children and adolescents.4 Epilepsy affects people in all nations and of all races. Its incidence is greater in African American and socially disadvantaged populations.

Epilepsy Characteristics

Although the symptoms listed below do not necessarily mean that a person has epilepsy, it is wise to consult a doctor if you or a member of your family experiences one or more of them: • “Blackouts” or periods of confused memory; • Episodes of staring or unexplained periods of unresponsiveness; • Involuntary movement of arms and legs; • “Fainting spells” with incontinence or followed by excessive fatigue; or • Odd sounds, distorted perceptions, or episodic feelings of fear that cannot be explained. Doctors have described more than 30 different types of seizures. These are divided into two major categories—generalized seizures and partial seizures (also known as focal seizures).

Epilepsy Generalized Seizures

This type of seizure involves both sides of the brain from the beginning of the seizure. The best known subtype of generalized seizures is the grand mal seizure. In a grand mal seizure, the person’s arms and legs stiffen (the tonic phase), and then begin to jerk (the clonic phase). That’s why the grand mal seizure is also known as a generalized tonic clonic seizure. Grand mal seizures typically last 1-2 minutes and are followed by a period of confusion and then deep sleep. The person will not remember what happened during the seizure. You may also have heard of the petit mal seizure, which is an older term for another type of generalized seizure. It’s now called an absence seizure, because during the seizure, the person stares blankly off into space and doesn’t seem to be aware of his or her surroundings. The person may also blink rapidly and seem to chew. Absence seizures typically last from 2-15 seconds and may not be noticed by others. Afterwards, the person will resume whatever he or she was doing at the time of the seizure, without any memory of the event.

Epilepsy Partial Seizures

 Partial seizures are so named because they involve only one hemisphere of the brain. They may be simple partial seizures (in which the person jerks and may have odd sensations and perceptions, but doesn’t lose consciousness) or complex partial seizures (in which consciousness is impaired or lost). Complex partial seizures often involve periods of “automatic behavior” and altered consciousness. This is typified by purposeful-looking behavior, such as buttoning or unbuttoning a shirt. Such behavior, however, is unconscious, may be repetitive, and is usually not remembered afterwards. Diagnosis Diagnosing epilepsy is a multi-step process. According to the Epilepsy Foundation of America: ...the doctor’s main tool...is a careful medical history with as much information as possible about what the seizures looked like and what happened just before they began. The doctor will also perform a thorough physical examination, especially of the nervous system, as well as analysis of blood and other bodily fluids.7 The doctor may also order an electroencephalograph (EEG) of the patient’s brain activity, which may show patterns that help the doctor decide whether or not someone has epilepsy. Other tests may also be used—such as the CT (computerized tomography) or MRI (magnetic resonance imaging)—in order to look for any growths, scars, or other physical conditions in the brain that may be causing the seizures. Which tests and how many of them are ordered may vary, depending on how much each test reveals.8

Epilepsy Treatment

Anti-epileptic medication is the most common treatment for epilepsy. It’s effective in stopping seizures in 70% of patients. 9 Interestingly, it’s not uncommon for doctors to wait a while before prescribing an anti-seizure medication, especially if the patient is a young child. Unless the EEG of the patient’s brain is clearly abnormal, doctors may suggest waiting until a second or even third seizure occurs. Why? Because studies show that an otherwise normal child who has had a single seizure has a relatively low (15%) risk of a second one.10 When anti-epileptic medications are not effective in stopping a person’s seizures, other treatment options may be discussed. These include: • surgery to remove the areas of the brain that are producing the seizures; • stimulation of the vagus nerve (a large nerve in the neck), where short bursts of electrical energy are directed into the brain via the vagus nerve; and • a ketogenic diet (one that is very high in fats and low in carbohydrates), which makes the body burn fat for energy instead of glucose. According to the Epilepsy Foundation of America, 10% of new patients cannot bring their seizures disorder under control despite optimal medical management.