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. It takes a minimum of two seizures for an individual to be diagnosed with epilepsy, commonly referred to 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, certain neurons transmit irregular signals, causing other neurons to malfunction and cease their usual functioning. Abnormalities like this can lead to short-term alterations in sensation, behavior, mobility, and awareness.
People of any age can suffer from epilepsy, although it is most likely to develop in those under 65 or over 65. Childhood is especially susceptible to this disorder. With the right treatments, you may be able to completely stop seizures or reduce their severity and frequency.
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.
Depending on the kind of seizure, one may experience various signs and symptoms. Epilepsy affects people in different ways, and some may experience the same kind of seizure each time, whilst others may have varied types of seizures with different symptoms.
Doctors classify seizures as either partial or generalized, based on how 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.
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 originate in a localized region of the brain, often starting out small. They alter consciousness and usually cause memory loss (amnesia). They can cause staring and non-purposeful 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.
Secondarily 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 non-purposeful movements. The seizure then becomes more intense, leading to generalized convulsions characterized by stiffening and shaking of your extremities and your body.
Absence (Petit Mal Seizures)
Episodes of this condition involve staring, slight body movements, and brief moments of unawareness. They’re usually brief, and typically no confusion or sleepiness occurs when the seizure is over.
Myoclonic Seizures
Seizures are usually manifested by sudden (or sometimes rapid) contractions of the 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
Commonly referred to as drop attacks, these seizures involve an abrupt collapse or fall. 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, 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. On 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.
Studies show that genetic defects have a major effect on epileptic behavior. If your family has a history of a particular illness, there is a possibility of you having an increased vulnerability to it. Epilepsy is a potential result of head injury in numerous cases. 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 tasks that involve a high possibility of head injuries
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:
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:
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.
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 physician may also inquire about your cognitive abilities, logical reasoning skills, and memory recall.
Your doctor may want to take samples of your blood to be tested for chemical imbalances that may be the cause of your seizures.
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.
To get the most accurate results, you need to stay still throughout the test. You might be asked at certain times to take deep and steady breaths for a couple of minutes or look at a patterned board. At times a light may be flashed in your eyes. These activities are designed to activate your brain’s electrical activity as seen on EEG. Electrodes are placed on your head to capture electrical impulses from your brain and transmit them to a machine, which records the activity and displays your brainwaves in the form of a moving graph digitally on a computer screen.
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.
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
Through the use of a single antiepileptic drug, many people with epilepsy can experience freedom from seizures. Medication can be a great help to some, working to reduce the frequency and severity of seizures. Over half of the children with epilepsy are able to discontinue the use of their medications and experience a seizure-free lifestyle after their symptoms have been successfully managed. After two or more years without seizures, many adult patients can stop taking their medication.
Determining the correct medication and dose may not be an easy task. 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).
Taking any of these medications can have some side effects, such as mild fatigue, feeling lightheaded, and possible weight gain. The more severe side effects of a certain condition or medication could be depression, rash, poor coordination, speech impairment, and extreme tiredness. Discuss any of these side effects with your doctor as soon as possible. People with epilepsy often take these medications for an extended period of time without any major side effects. Ask your doctor to explain these issues to you when you receive the prescription.
To ensure the most effective seizure control, always take the medication in accordance with your doctor’s instructions. 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.
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.
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
Setting goals helps people gain control of their lives by providing a clear objective and direction to focus on. 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
Eating nutritionally, staying active, and getting enough restful sleep. 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.
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