Epilepsy

What is Epilepsy?

Approximately 2 million people in the United States have epilepsy, a chronic disorder of the brain that causes a tendency to have recurrent seizures. Two or more seizures must occur before a person can receive the diagnosis of epilepsy, also known as a seizure disorder. It’s not uncommon for children to have a single seizure, and an estimated 5 percent to 10 percent of the population will experience a seizure at some time in their life.

Seizures occur when there’s a sudden change in the normal way your brain cells communicate through electrical signals. During a seizure, some brain cells send abnormal signals, which stop other cells from working properly. This abnormality may cause temporary changes in sensation, behavior, movement or consciousness.

The onset of epilepsy is most common during childhood and after age 65, but the condition can occur at any age. Treatments may be able to leave you free of seizures, or at least reduce their frequency and intensity.

Signs and symptoms of Epilepsy

Because abnormal brain cell activity causes seizures, having a seizure can result in the sudden occurrence of any activity that’s coordinated by your brain. This can include slight temporary confusion, complete loss of consciousness, a staring spell, muscle spasms, or uncontrollable, jerking movements of the arms and legs. Seizures originating in your brain’s temporal lobe can be associated with a sense of deja vu, anxiety and panic, or simply an uneasy sensation in your stomach, which can be followed by loss of consciousness.

Signs and symptoms may vary depending on the type of seizure. Most people with epilepsy experience the same type of seizure, with similar symptoms, each time they have a seizure, but others may experience a wide range of types and symptoms.

Doctors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. When seizures appear to result from abnormal activity in just one part of the brain, they’re called partial seizures. When seizures seem to involve most or all of the brain, the seizures are called generalized.

Both classifications are broken up further into smaller, more specific categories:

• Partial seizures are separated into simple partial, complex partial and secondary generalized seizures.
• Primary generalized seizures are separated into absence (petit mal), myoclonic, atonic and generalized tonic-clonic (grand mal) seizures.

Partial seizures
Some people experience a warning sensation, called an aura, before one of the following types of partial seizure begins:

• Simple partial seizures. These seizures begin from a small area in your brain and don’t result in loss of consciousness. They may cause uncontrolled shaking of an arm, leg, or any other part of your body; alter emotions; change the way things look, smell, feel, taste, or sound; or cause speech disturbance.
• Complex partial seizures. These seizures also begin from a small area of your brain. They alter consciousness and usually cause memory loss (amnesia). They can cause staring and nonpurposeful movements, such as repeated hand rubbing, lip smacking, posturing of your arm, vocalization or swallowing. After the seizure ends, you may be confused or sleep for a few minutes and may be unaware you had the seizure. Temporal lobe seizures are the most common type of complex partial seizures.
• Secondary generalized seizures (partial seizures with secondary generalization). These seizures occur when simple or complex seizures spread to involve your entire brain. They may begin as a complex partial seizure with staring and nonpurposeful movements. The seizure then becomes more intense, leading to generalized convulsions characterized by stiffening and shaking of your extremities and your body.

Generalized seizures

• Absence (petit mal seizures). These seizures are characterized by staring, subtle body movement and brief lapses of awareness. They’re usually brief, and typically no confusion or sleepiness occurs when the seizure is over.
• Myoclonic seizures. These seizures usually appear as sudden jerks of your arms and legs. They typically affect only one side of your body, but may affect both sides. Myoclonic seizures may last only a short time from less than a second for single jerks to a few seconds for repeated jerks.
• Atonic seizures. Also known as drop attacks, these seizures cause you to suddenly collapse or fall down. After a few seconds, you regain consciousness and are able to stand and walk.
• Generalized tonic-clonic (grand mal seizures). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes tongue biting or loss of bladder control. After the shaking subsides, a period of confusion or sleepiness usually occurs, lasting for a few minutes to a few hours.

Causes of Epilepsy

The onset of epilepsy can often be traced to an accident, disease or medical trauma  such as a stroke that injures your brain or deprives it of oxygen, often causing a small scar in your brain. In rare occasions, epilepsy may be caused by a tumor in your brain. However, in many cases there’s no identifiable cause for the disease.

Epilepsy isn’t a mental disease, although mental health can influence the control of seizures in epilepsy. Epilepsy doesn’t cause psychiatric problems or mental retardation, but people with epilepsy may also be afflicted with those conditions.

Research suggests that genetic abnormalities contribute significantly to epilepsy. If you have a family history of the disease, you may be at increased risk.

Head injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle, or engaging in other activities with a high risk of head injury.

Stroke and other diseases that affect your vascular system can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol, following a healthy diet, managing your weight, exercising regularly and avoiding cigarettes.

Other epilepsy risk factors include:

• Alzheimer’s disease
• Brain infections
• Poisoning from exposure to lead, carbon monoxide and other toxins

Diagnosing Epilepsy

Because the possible causes of seizures are many, doctors may need to ask detailed questions and perform several tests to diagnose epilepsy, including:

• Medical history. Descriptions of your past seizures from yourself or others who have observed your seizures may help your doctor identify the type and cause of your problem. Your physician may also need to know about your current and past medical conditions and how they’ve been treated.
• Physical and neurologic examination. A neurologic examination may include testing your reflexes, muscle tone and strength, the function of your senses, and your gait, posture, coordination and balance. Your doctor may also ask questions to test your thinking, judgment and memory.
• Blood tests. Your doctor may want to take samples of your blood to be tested for chemical imbalances that may be the cause of your seizures.
• Electroencephalogram (EEG). This procedure records the electrical activity of your brain. An EEG helps determine what type of seizures or epilepsy you have and from which part of the brain seizures may start. During the procedure, which takes about a half-hour, you lie down. Between 16 and 30 small electrodes may be attached to your scalp with paste or an elastic cap. You remain still during the test, but at times you may be asked to breathe deeply and steadily for several minutes or to stare at a patterned board. At times a light may be flashed in your eyes. These actions are intended to stimulate your brain in ways that might be seen on the EEG. The electrodes pick up the electrical impulses from your brain and send them to the EEG machine, which records your brain waves on a moving sheet of paper or digitally on a computer screen.
• Computerized tomography (CT). A CT scan produces detailed cross-sectional images of your brain. The images may reveal abnormalities in brain structure, including tumors, cysts, strokes or tangled blood vessels.
• Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnetic field and radio waves to produce images of your brain. Like CT scans, MRI images may reveal abnormalities in brain structure.

Treating Epilepsy

Medications

Most people with epilepsy can become free of their seizures by using a single antiepileptic drug. For others, medication can make seizures less frequent and less intense. More than half of children with epilepsy whose seizures are controlled by medications can eventually stop their medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.

Finding the right medication and dosage can be complex. It might take more than one drug, or trying several different drugs until the right one is found. Medications available for the treatment of seizures include phenytoin (Dilantin, Phenytek), carbamazepine (Carbatrol, Tegretol), valproic acid (Depakene), divalproex (Depakote), levetiracetam (Keppra), gabapentin (Neurontin), phenobarbital, ethosuximide (Zarontin), clonazepam (Klonopin), lorazepam (Ativan, Lorazepam Intensol) , diazepam (Diastat, Valium), primidone (Mysoline), oxcarbazepine (Trileptal), lamotrigine (Lamictal), topiramate (Topamax), felbamate (Felbatol), tiagabine (Gabitril) and zonisamide (Zonegran).

All of these medications have some side effects, which may include mild fatigue, dizziness and weight gain. More severe side effects include depression, skin rashes, loss of coordination, speech problems and extreme fatigue. Discuss any of these side effects with your doctor as soon as possible. Many people with epilepsy use these medications for years without significant problems. Ask your doctor to explain these issues to you when you receive the prescription.

To achieve the best seizure control possible, take medications exactly as prescribed. Some seizure medications increase the risk of birth defects, so if you’re a woman with epilepsy tell your doctor if you’re considering becoming pregnant.

Surgery
Some people with epilepsy have seizures that medications can’t control, because the drugs either cause intolerable side effects or don’t provide satisfactory seizure control. In such cases, surgery may be an option.

Surgery is most commonly done when seizures occur in the side regions (temporal lobes) or the front regions (frontal lobes) of the brain. Surgery is rarely an option if you have seizures that start in several areas of the brain or if you have seizures originating from a region of the brain that contains vital brain functions.

During the procedure, your surgeon makes an incision in your scalp and removes a piece of the skull bone. Using electrical recordings that monitor brain activity, the surgeon cuts into or removes the area of the brain that’s causing the seizures. After surgery, many people continue to need some medication to help prevent seizures.

Coping Skills

Each person who has epileptic seizures experiences them in a different way. Many people gain complete control of seizures as soon as they begin treatment. Other people take longer to find the right treatment regimen, and some people may never have complete seizure control.

As is the case with other chronic conditions, having epilepsy may cause you to experience emotional or psychological stress. The stress may be due to personal difficulties in adjusting to epilepsy. You may have to give up some of your independence for a period of time, including driving. You may also encounter stressful relationships with family and friends because of your condition. Following these tips may help you cope with your condition:

• Know what to expect. Find out everything you can about your condition and how to treat it. The more you know, the more active you can be in your own care.
• Be proactive. Although you may feel tired and discouraged, don’t simply let others  including your family or your doctor make important decisions for you. Take an active role in your treatment.
• Maintain a strong support system. Having a support system can help you cope with any issues and anxieties that might occur. Although friends and family can be your best allies, the concern and understanding of a formal support group or others coping with epilepsy also may be helpful. Support groups also can be a good source of practical information. You may find you develop deep and lasting bonds with people who are going through the same things you are.
• Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But be realistic  don’t choose goals you can’t possibly reach. It may take time to get your condition under control, so be patient.
• Take time for yourself. Eat well, exercise and get plenty of rest. Also, plan ahead for the times when you may need to rest more or limit what you do.
• Stay active. Receiving the diagnosis of epilepsy doesn’t mean you have to stop doing the things you enjoy or normally do. You may have to modify activities such as driving, but you can still lead a full and active life.