Epilepsy is a tendency to have recurrent seizures. Seizures are defined as transient neurological abnormalities that are caused by abnormal electrical activity in the brain. Human activities, thoughts, and emotions are normally the result of the regulated and orderly electrical excitation of nerve cells in the brain. During a seizure, a chaotic and unregulated electrical discharge causes various physical and mental symptoms.

EPILEPSY CAUSES

In many people with epilepsy, the cause is unclear, although a genetic factor may be involved. In other cases, seizures may be the result of brain damage from a head injury; birth trauma; brain infection (such as meningitis or encephalitis); brain tumor; stroke (damage to part of the brain caused by an interruption to its blood supply); drug or alcohol intoxication; or a metabolic disorder.

EPILEPSY SYMPTOMS

Many people who suffer from epilepsy do not have any symptoms between seizures. Some people experience an aura (a peculiar “warming” sensation) shortly beforehand. In some cases, a seizure may be triggered by flashing lights, stress, or lack of sleep. Epileptic seizures may occur more frequently during times of illness.

EPILEPSY TYPES

Epileptic seizures can be classified into two broad groups: generalized and partial seizures.

Generalized epilepsy seizures

These seizures cause loss of consciousness and may affect all areas of the brain. There are two main types of generalized seizure: tonic-clonic (formerly grand-mal) and absence (petit mal) seizures.

During a tonic-clonic seizure, there may initially be an aura, then the body becomes stiff and consciousness is lost. Breathing may be irregular or may stop briefly, then the body jerks uncontrollably. The episode usually ends spontaneously after a few minutes.  The person may be drowsy and disorientated for a few hours afterwards, however, and may have no memory of the event. Prolonged tonic-clonic seizures are potentially life-threatening.

Absence seizures occur mainly in children. Periods of altered consciousness last for only a few seconds and there are no abnormal movements of the body. This type of seizure may occur hundreds of times daily.

Partial seizures

These seizures are caused by abnormal electrical activity in a more limited area of the brain. There may be simple or complex.

In simple partial seizures, consciousness is not lost and an abnormal twitching movement, tingling sensation, or hallucination of smell, vision, or taste occurs, lasting several minutes.

In one type of partial seizure, called temporal lobe epilepsy, conscious contact with the surroundings is lost. The sufferer becomes dazed and may behave oddly. Typically, the person remembers little, if anything, of the event.

EPILEPSY DIAGNOSIS

In order to make a diagnosis, a doctor needs as much information as possible about the seizures. The patient may not be able to recall the events, so an accurate account from a witness may be necessary. Examination of the nervous system is normally carried out between seizures. An EEG (a method of recording the activity of the brain), CT scanning or MRI of the brain, and blood tests may also be carried out.

EPILEPSY TREATMENT

While a seizure is happening, any witnesses should make the surrounding area safe (for example, by removing hazardous objects) and ensure that the person can breathe while unconscious. Clothing around the neck should be loosened, and a soft item, such as a folded piece of clothing, should be placed under the head. Otherwise, witnesses should simply let the attack run its course. Once the convulsions have stopped, the person should be placed in the recovery position. A person having a seizure should never be restrained, and should never have anything put into his or her mouth.

Anticonvulsant drugs usually stop or reduce the frequency of recurrent seizures. The drugs may have unpleasant side effects, however, so the doctor will take care to find the drug that works best for that patient. With severe epilepsy, a combination of drugs may be needed to control seizures. If no seizures occur after two or three years of treatment, and depending on their cause, the doctor may suggest reducing or stopping the drug treatment.

Women who are taking anticonvulsant drugs and are planning a pregnancy will need to have their treatment reviewed before conceiving. They may need to change to another drug to reduce the risk of a fetal abnormality. Stopping treatment is not usually an option because seizures can be profoundly damaging to the fetus.

Surgery may be considered if a single area of damage to the brain is causing the seizures and drug treatment has not proved effective.

EPILEPSY OUTLOOK

Epilepsy that develops during childhood may sometimes disappear soon after adolescence.

Affected adults can enjoy relatively normal lives, but may be restricted in their choice of work. For example, it is inadvisable for people with epilepsy to have occupations involving heights or operating dangerous machinery. In addition, there are certain restrictions on driving vehicles. People with epilepsy are legally required to contact their vehicle licensing agency, who will explain the relevant restrictions.

Many people with epilepsy carry a special card, tag, or bracelet, such as those produced by Medic-Alert, which states that they have the condition. Affected people should also advise their family, friends, and colleagues what to do if a seizure occurs.

Source: A-Z family medical encyclopedia by BMA

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