Epilepsy
 
What is epilepsy?

Epilepsy is a family of more than 40 neurological conditions that share a common symptom Ė seizures. It affects about 2.5 million americans and can result from head injury, infection, fever, brain tumors, or other trauma that damages the brain.

Normally, brain cells communicate with each other through electrical impulses that work together to control the bodyís movement and keep the bodyís organs functioning properly. When thousands to millions of electrical impulses occur at the same time producing abnormal brain activity, the result can be a seizure. The part of the brain where the abnormal electrical activity occurs determines the type of seizure.

There are over thirty types of seizures, some more severe than others. Some people have seizures that last a short time and cause them to stare off into space, giving the appearance that the person is simply daydreaming. Others may experience a more dramatic seizure (tonic-clonic seizure) where the person loses consciousness and the entire body stiffens and then twitches or jerks uncontrollably.

People of all ages, races, and in all walks of life can develop epilepsy. It affects about one in 100 people. It is not contagious, and it is not a mental illness. Most forms of epilepsy are not inherited, but it may run in some families.

While there is, as yet, no cure for epilepsy, todayís treatment options can control most cases. In fact, many people with epilepsy lead normal lives and have no symptoms between seizures. The aim of treatment is to stop the seizures.

What causes epilepsy?

There is no single cause of epilepsy, and in 70% of cases, no known cause is ever found.

Some of the known causes of epilepsy are:

  • Injury to the brain before, during, or after birth
  • Infections that damage the brain
  • Toxic substances that affect the brain
  • Injury and lack of oxygen to the brain
  • Disturbance in blood circulation to the brain (stroke and other vascular problems)
  • Metabolism or nutrition imbalance
  • Tumors of the brain
  • Hereditary disease affecting the brain
  • High fever
  • Other degenerative diseases
How is epilepsy diagnosed?

Because there is no test to diagnose epilepsy, a doctor must rely mainly on interpreting the patientís medical and family history. Thus, it is important that the doctor have experience with and treat people with neurological disorders such as a neurologist. When the patient describes what he or she experience, and someone who witnessed the seizures describes what he saw, the doctor can often determine what kind of seizure the patient experience and treat it.

The doctor asks about the patientís past medical history, the motherís pregnancy, and the familyís medical history. The doctor will do general physical and neurological examinations to look for the underlying cause of the seizure.

The doctor usually orders an electroencephalogram (EEG) test, a painless recording of the patientís brain waves. The EEG, however, may appear normal even if the patient has epilepsy. Another painless test- a magnetic resonance imaging study or MRI- may reveal scar tissue or a structural abnormality within the brain, helping the doctor to make a diagnosis of epilepsy.
 

  What are the symptoms?

The doctor diagnoses epilepsy after a person has had multiple seizures. The frequency and type of seizure varies from person to person. Some people have more than one type.

The medical community classifies epileptic seizures into two major categories: partial and generalized. The form a seizure takes depends on the part of the brain in which it occurs and on how widely and rapidly it fans out from its point of origin.

Partial seizures:

If the abnormal electrical activity involves one area of the brain, the seizure is partial. The person may not lose consciousness, but can experience a range of symptoms: sudden jerky movements of one part of the body, such as an arm or leg; sudden fear; facial movements; disturbances or hallucinations of vision, hearing, or smell; nausea, vomiting, or stomach discomfort.

Some types of partial seizures (called complex partial seizures) may cause the person to have a change of consciousness. They may be dazed and confused, unaware of where they are or what they are doing. They may wander around randomly, mumble, and behave in unusual ways. They may exhibit chewing or repetitive arm and hand movement. Moreover, people with this type of seizure will not remember what they have experienced.

Generalized seizures:

When the entire brain is involved, the seizure is generalized. Like partial seizures, there are many different symptoms, body movements, and activities. Some people stare off into space, while others may have a full convulsion with the complete loss of consciousness and jerking movements of limbs (tonic-clonic seizures).

Just before having seizures, some people experience an aura, which is a sensation or warning of a coming seizure. Some people feel a sense of tension or anxiety, may hear a musical sound, sense an odor or taste, or experience some other change in sensation. Often this aura gives the person time to get to a safe place to avoid injury.

Treatments

Most major epileptic seizures (generalized or tonic-clonic) last only a minute or two and demand little of the bystander. All that is necessary is to let the seizure run its course and to ensure that the person is in no physical danger and can breathe.

However, a person who experiences repeated seizures and does not recover consciousness between attacks should get immediate medical attention. This type of repeated seizure is called status epilepticus. This is life threatening, and could also cause brain damage.

Progress through research

Epilepsy research has focused on finding the cause of epilepsy and on understanding ways to accurately diagnose and treat it. Researchers continue to study the chemical and electrical changes that occur within the brain cells. Clinical trails of new drugs are constantly underway, and new surgical procedures are being developed.

Among the new drugs being introduced are some that inhibit or change the brain cell activity that causes seizures. These are new strategies for seizure control and mean that doctors will be able to offer new choices to prevent previously difficult to control seizures.

In addition to developing new drugs, researchers are taking a fresh look at some of the ideas that have been part of epilepsy treatment for many years. It is important that patients talk with their neurologist if they wish to persue these lines of treatment. For example, the ketogenic diet, high in fat and low in carbohydrates and protein, creates a condition in the body known as "ketosis", that has been helpful in controlling seizures, particularly in children. Researchers are looking at the exact mechanism of action of the ketogenic diet to shed new light on the biochemical mechanisms of epilepsy.

Surgeons have found that implanting a small device in the body that gives off electronic signals to the brain can stop seizures. This treatment has been especially promising for those with uncontrollable epilepsy.

Please contact the AAN Education and Research Foundation to contribute to the fight against epilepsy and other neurological disorders. Only through continued research can we hope for more treatments and a cure. Call (612) 695-2712

First Aid

The goal of first aid is to keep the person safe:

  • Keep calm, help the person to the floor, and loosen clothing around the neck
  • Remove sharp or hot objects that could injure
  • Turn the person on one side so saliva can flow out of the mouth
  • Place a cushion such as a folded coat under the head
  • Do Not put anything into the personís mouth
  • After the seizure, allow the person to rest or sleep if necessary
  • Some people will be confused or weak after a seizure. They may need help getting home
  • Contact the parent or guardian if a child had the seizure

People often wonder whether they should call an ambulance when someone has a seizure. If you know the person has epilepsy, an ambulance is probably unnecessary unless the seizure continues for more than five minutes. If you donít know, or if the person is pregnant, diabetic, or seems otherwise ill, play it safe and call for help.

The most common treatment of epilepsy is daily use of anti-convulsant drugs, which allow many people with epilepsy to enjoy a healthy life and continue normal activities. The drugs, prescribed alone or in combination, are adjusted over time until the best combination is found for each person. Many people with epilepsy must take their anti-convulsant drugs for the rest of their lives to prevent further seizures. However, the doctor may advise a slow withdrawal of the drug if a person has had no seizures for several years.

Those for whom anti-convulsant drugs fail to control the seizures, surgery to remove injured brain tissue may be possible. A through evaluation including the recording of a seizure with EEG, video and neuropsychological testing is performed to determine surgical candidacy. Other surgical techniques are being developed that offer new hope to people with uncontrollable epilepsy.

Epilepsy treatment should include discussions about the physical (e.g., side-effects), social, and emotional problems that can accompany the disorder. These discussions should involve family and individual counseling and education. In addition, information about epilepsy should be shared with schools, employers, and friends. Women with epilepsy should seek medical counseling prior to and during pregnancy.

State regulations mandate that persons who suffer altered consciousness due to a seizure abstain from driving a motor vehicle for a specific period thereafter. The period varies from state to state.

Information provided by the American Academy of Neurology, The Brain Matters campaign.

 
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