Epilepsy

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or synchronous neuronal activity in the brain.

About 50 million people worldwide have epilepsy, with almost 90% of these people being in developing countries. Epilepsy is more likely to occur in young children, or people over the age of 65 years, however it can occur at any time. Epilepsy is usually controlled, but not cured, with medication, although surgery may be considered in difficult cases. However, over 30% of people with epilepsy do not have seizure control even with the best available medications.

Not all epilepsy syndromes are lifelong – some forms are confined to particular stages of childhood. Epilepsy should not be understood as a single disorder, but rather as syndromic with vastly divergent symptoms but all involving episodic abnormal electrical activity in the brain.

CAUSES

Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain.

Sometimes seizures are related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, or abnormal levels of sodium or glucose in the blood. In the repeated seizures do not happen again once the underlying problem is corrected, the person does not have epilepsy.

In other cases, injury to the brain (for example, stroke or head injury) causes brain tissue to be abnormally excitable. In some people, an inherited abnormality affects nerve cells in the brain, which leads to seizures. In these cases, the seizures happen spontaneously, without an immediate cause. This IS epilepsy.

Some seizures are idiopathic, which means the cause cannot be identified. These seizures usually begin between ages 5 and 20, but they can happen at any age. People with this condition have no other neurological problems, but sometimes have a family history of seizures or epilepsy.

Disorders affecting the blood vessels, such as stroke and TIA, are the most common cause of seizures after age 60. Illnesses that cause the brain to deteriorate and dementia such as Alzheimer's diesease, can also lead to seizures.

Some of the more common causes of epilepsy include:

• Problems during the development of the baby in the womb.
• Brain injury
• Early seizures (within 2 weeks of injury) do not necessarily mean that chronic (ongoing) seizures (epilepsy) will develop
• Most common in young adults
• Seizures usually begin within 2 years after the injury
• Genetic conditions present at birth.
• Infections
• Acute severe infections of any part of the body
• Brain abscess
• Brain infections like meningitis and encephalitis
• Chronic infections (such as neurosyphilis)
• Complications of AIDS or other immune disorders
• May affect people of all ages
• May be a reversible cause of seizures (epilepsy may stop)
• Injuries near the time of birth (seizures usually begin in infancy or early childhood)
• Metabolic abnormalities (problems with body chemistry) may affect people of any age and may be a result of
• Kidney failure, uremia (toxic accumulation of wastes)
• Liver Failure
• Nutritional deficiencies
• Phenylketonuria (PKU) -- can cause seizures in infants
• Other metabolic diseases, such as inborn error of metabolism
• Tumors and brain lesions (such as hematomas or abnormal blood vessels)
• May affect any age but are more common after age 30
• May lead to generalized tonic-clonic seizures
• Partial (focal) seizures most common to start with

About 0.5% of the population has epilepsy. Approximately 1.5-5.0% of the population may have a seizure in their lifetime. Epilepsy can affect people of any age.

Risk factors include a family history of epilepsy, head injury, or other condition that causes damage to the brain.

Some factors may present a risk for more seizures in a person with a previously well-controlled seizure disorder:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

SYMPTOMS

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people, each seizure is similar, while some people have many different types of seizures that cause different symptoms each time. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure. Seizures may occur repeatedly without explanation.

Note: Disorders that may cause symptoms resembling seizures include fainting, transient ischemic attacks (TIAs) or stroke, rage or panic attacks, migraine headaches, sleep disturbances, and other disorders that cause loss of consciousness.

SYMPTOMS OF GENERALIZED SEIZURES

Generalized seizures affect all or most of the brain. They include absence seizures (also called petit mal seizures) and tonic-clonic seizures (also called grand mal seizures).

Absence seizures:

Minimal or no movements (usually, except for "eye blinking") -- may appear like a blank stare Brief sudden loss of awareness or conscious activity -- may only last seconds Can happen over and over Occurs most often during childhood Decreased learning (child often thought to be day-dreaming) Tonic-clonic seizures:

Affects a major part of the body Breathing stops temporarily, followed by sighing Confusion following the seizure, lasting minutes to hours Incontinence of urine (loss of bladder control) Loss of consciousness Rigid and stiff Tongue or cheek biting Weakness following the seizure (Todd's paralysis) Whole body, violent muscle contractions

SYMPTOMS OF PARTIAL SEIZURES (SIMPLE AND COMPLEX)

Partial seizures may be complex or simple. Partial seizures affect only a portion of the brain.

Symptoms of simple partial (focal) seizures may include:

Abnormal sensations (feelings) Dilated pupils Feeling as if you've been in this situation before (deja vu) or never been in this situation before (jamais vu) Hallucinations Muscle contractions of a specific body part Nausea Skin flushing Sweating Symptoms of partial complex seizures may include:

Any of the above symptoms, along with altered consciousness or memory Automatism (automatic performance of complex behaviors without conscious awareness) Changes in personality or alertness, with confusion.

TREATMENT

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems.

Medication to prevent seizures, called anti-convulsants, may reduce the number of future seizures. These drugs are taken by mouth. The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time.

Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.

It is very important that you take seizure drugs on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage. No one should stop taking or change seizure drugs without talking with their doctor first.

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy." Some people with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkin's diet, may also be helpful in some adults.

People with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.

PREVENTION

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.