Epilepsy, Part 1 — Introduction, incidence, diagnosis, and treatment
What is epilepsy?
Epilepsy is a disorder of the central nervous system whose symptoms are
seizures. In other words, a person with epilepsy is prone to seizures
because of a presumed or identified problem in the brain. Some authorities
require at least 2 seizures
before labeling the disorder as “epilepsy”.
Some have suggested waiting until the individual has had 3 seizures. However,
with the availability of new diagnostic technology and a variety of possible
medications, we will often diagnose epilepsy after only 1 or 2 seizures
and begin appropriate treatment.
Neurologists often refer to this as a “seizure disorder”
rather than “epilepsy”, because it is actually a more descriptive term and because there is still a social stigma attached to the older
term.
What is a seizure?
A seizure is a sudden, time-limited event that results
from abnormal activity in the brain. It appears as an involuntary alteration
in perception and/or behavior. Seizures are believed to be due to abnormal
rapid and synchronized discharge of cortical neurons. They are usually
stereotypical and repetitive. Neurologists also identify “non-epileptic
seizures” which are events which look like seizures, but are not
due to abnormal involuntary brain activity.
What does a seizure look like, and are there different types of
seizures?
There are many different types of seizures, and seizures can look very
different from person to person and even from event to event for the same
person. Seizures are categorized by how they start in the brain and how
they affect consciousness.
Partial seizures start in a specific area of the brain, rather than the
entire brain at once. They may cause the individual to feel or see something
that is not there, or to move a part of the body. If the patient remains
fully conscious, it is called a simple partial seizure. If consciousness
is impaired, it is a complex partial seizure. In this type of seizure,
the patient may be only partly responsive, or may appear dazed, or may
have only a dim memory of what happened.
If the seizure seems to start all over the brain, it is called a generalized
seizure. These may appear as sudden staring spells, as loss of consciousness
without much movement (previously called “Petit Mal seizure”),
or as the typical (previously known as) “grand mal seizure”,
which is now referred to as a “generalized tonic-clonic seizure”.
Sometimes, seizures start out as partial or focal,
and then spread to involve the entire brain. These are referred to as
“secondarily generalized”.
Because the brain controls muscle
movements, and because the brain itself causes or “has” the seizures,
a person can do almost anything during a seizure.
However, the child cannot control these actions, and they will NOT be
purposeful or in response to another person.
Treatment
We have many medications to use for treating people with epilepsy. The
choice of medication depends on the type of seizures, the person’s
age and health, and any problems they may have had with other medications
in the past. Sometimes more
than one medication must be tried before the seizures
are controlled. Some people need to take more than one medication every
day for their seizures. Unfortunately, sometime we are not able to completely
control someone’s seizures.
Even someone who is generally “well controlled” may have an occasional seizure, which we call
a “breakthrough” seizure. This may happen due to illness,
especially with fever. It can also happen to some people if they do not
get enough sleep, are under a great deal of stress or, rarely, under other
circumstances. A
person might have emergency medicine to
be given in case of a breakthrough seizure which lasts
more than a few minutes, or reccurs several times.
In patients whose seizures cannot be controlled with medications, there
are several more complicated and serious options. These include
implanting a special pacemaker-like device (the Vagal Nerve Stimulator),
use of a special and very restrictive diet (the Ketogenic Diet), or even surgery to remove the part of the brain where the seizures
start. These measures are rare, and are done under the care of a team of specialists, usually
including neurologists and neurosurgeons.
Epilepsy, Part 1 — Introduction, incidence, diagnosis, and treatment
For more information, please contact:
Kathy Davis, MSEd, PhD
kdavis2@kumc.edu
(913) 588-6305