WHAT IS EPILEPSY?

Defining Epilepsy

Epilepsy is one of the most common neurological disorders. While epilepsy can develop at any age, it is most common in children and the elderly. Epilepsy, also referred to as a seizure disorder, is a neurological condition affecting the nervous system. It is a term used for the tendency to have recurring seizures. Seizures are actually a symptom of an underlying problem in the brain and that underlying problem can be caused by many different things, such as a brain injury or stroke, for example. In about 50 percent of the cases, the cause is unknown. This figure is changing, however, with all the recent genetic discoveries underlying some seizure conditions. Epilepsy is usually diagnosed after a person hs had at least two seizures that are unprovoked.

Epilepsy is defined as a condition involving recurrent, unprovoked seizures. A single seizure is not epilepsy. And seizures that are directly caused by some conditions, for instance very low blood sugar, are not considered epileptic seizures.

A seizure can display a variety of symptoms, such as stiffening, sharking or jerking of the extremities, staring spells, other behaviors or sensations, and in some cases, no observable effects at all.

Anyone can have a seizure, and in fact, many people have a single seizure. For most folks the seizures can be controlled with appropriate treatment, typically medication. Unfortunately, about 30 % of those with epilepsy are not as fortunate, and they will have a more difficult time gaining control of their seizures. The majority of people with epilepsy, with proper treatment, can lead productive and fulfilling lives.

Epilepsy by the numbers

65 million people around the world, and 3.4 million people in the U.S., have epilepsy
150,000 people in the U.S. develop epilepsy every year
1 in 26 people in the U.S. will develop epilepsy at some point in their lifetimes
A third of people with epilepsy have seizures that are not well controlled

What causes epilepsy?

The cause of epilepsy is often different for people of different ages. Children often have inherited forms of epilepsy. Birth injuries or other early-life damage to the brain may also cause epilepsy in children. Young adults often develop epilepsy due to trauma, as from motor vehicle crashes or illicit drug side-effects. In people over age 50, the most common cause of epilepsy is stroke. Brain infections, such as meningitis and encephalitis, can also cause seizures and epilepsy at any age. There is a long list of possible causes of epilepsy. In about half of people with epilepsy, no cause can be determined.

Do seizures ever go away?

About two-thirds of people with epilepsy stop having seizures with proper, ongoing treatment. About half of all children with epilepsy “outgrow” their seizures and stop having them by adulthood.

Types of seizures?

There are many different types of seizures. The two main categories, generalized and focal, are defined by where the seizure starts in the brain.

FOCAL (PARTIAL) SEIZURES

Start up in a specific area of the brain and can present in many different ways.

FOCAL AWARE (AURA)

This seizure starts in one specific area of the brain, and the location will determine the symptoms. The person is totally aware throughout the event. Some examples are a funny feeling that “rises up”, visual changes, tingling, other sensations, or feelings, such as déjà vu, a feeling that you have experienced something before, even though you haven’t.

FOCAL UNAWARE (COMPLEX PARTIAL)

This is the most common type of seizure in adults and can take many different forms. It often involves staring with some automatic behaviors such as lip smacking or chewing movements. This seizure typically lasts a minute or longer, and, not infrequently, the person can sense its onset. Seizures that start in one part of the brain can sometimes spread and become a generalized seizure or convulsion. It is common for the person to have no memory of having the seizure.

GENERALIZED SEIZURES

Generalized seizures involve abnormal electrical activity in the entire brain at once. People are not conscious during generalized seizures, and often have no warning of the impending seizure.

There are different types of generalized seizures. These are typically categorized by motor or non-motor onset: Motor onset seizures include:

GENERALIZED MOTOR SEIZURES

TONIC-CLONIC

The most recognizable of seizures, the tonic-clonic seizure (grand mal convulsion) starts with a sudden loss of consciousness with initial muscle stiffening (the tonic stage), followed by shaking of the extremities (clonic movements). These episodes typically last about a minute or so but can last longer. Afterward, the person is exhausted and may need to sleep or rest. This seizure may involve tongue biting, loss of bladder or bowel control.

TONIC SEIZURES

Involve brief, increased muscle tone leading to sudden stiffening without the jerking movements.

ATONIC SEIZURES

Sometimes referred to drop attacks, are caused by a sudden loss of muscle tone followed by a sudden drop. Unless controlled, which can prove difficult, head protection is needed.

MYOCLONIC SEIZURES

Are brief episodes of sudden jerking of the muscles, usually involving the upper body.

MYOCLONIC-TONIC-CLONIC SEIZURES

Are brief episodes of jerking, followed by tonic (stiffening), then back to jerking movements.

MYOCLONIC-ATONIC SEIZURES

Involve brief jerking, and then a sudden drop

EPILEPTIC SPASMS (INFANTILE SPASMS)

Occur typically in infants in their first year of life and involve a brief stiffening, bending, crunching-like activity of the body, often occurring in clusters

NON-MOTOR SEIZURES

ABSENCE SEIZURES (PETIT MAL)

Are brief staring spells without any warning, typically lasting less than 30 seconds. Absence seizures occur most commonly during childhood and adolescence.

Diagnosis:

Diagnosing epilepsy can sometimes be complicated as there are many seizures or seizure-like symptoms that are not caused by abnormal electrical brain activity. Examples are syncopal episodes, migraine with aura, or cardiac arrhythmias. While it can be challenging, there are medical tests that can help with diagnosing the disorder. Some of the primary tests include EEG, MRI, CT scan, MEG, blood and genetic tests. Of primary importance is the history of the patient and related symptoms.

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