Epilepsy

What is Epilepsy?

Epilepsy is the name given to a brain (neurological) disorder characterized by chronic, recurrent seizures. Seizures are caused by a chaotic and unregulated disruption of the normal electrical activity of the brain, as measured by the electroencephalogram (EEG).

Epileptic seizures are generally classified into two main types: generalized and partial seizures. Generalized seizures encompass the entire brain, affecting the whole body and causing loss of consciousness. Partial seizures arise from a specific area of the brain and may not cause loss of consciousness. Although partial seizures begin in a limited area of the brain, the electrical disturbance can spread, affecting the whole brain and may evolve into a generalized seizure.

The most recognized type of seizure is the convulsive or motor seizure. It is characterized by abnormal and sometimes violent movements of the whole body or just parts of the body. It can start out as a partial seizure and evolve into a generalized seizure. An example of a generalized motor seizure is the common grand mal seizure. Another type of seizure is the cognitive or absence seizure, which is seen as a brief period when the individual does not respond in a normal manner to his or her surroundings. There is no loss of consciousness. The petit mal seizure is an example of a generalized cognitive seizure.

A third type is a sensory seizure. It can display a wide and strange variety of reported symptoms such as dizziness (vertigo), tingling or numbness in a part of the body (paresthesias), or sounds, visions, or smells that aren't there (auditory, visual and olfactory hallucinations).

Seizures can be the result of various diseases or injuries. Epileptic seizures may be associated with birth trauma, head injury, central nervous system infections, brain tumor, stroke, ingestion of toxic substances, or metabolic imbalance. There may be an inherited tendency toward seizures. Seizures that appear to have no apparent cause (idiopathic epilepsy) account for 75% of the cases in adults. These seizures may actually be due to microscopic brain lesions that occurred during birth or other trauma, or may be caused by unexplained metabolic disturbances. It is important to note that a single seizure or episode of seizures does not mean that the person has epilepsy.

Approximately one in 200 suffers from epilepsy. Epilepsy that begins in childhood or adolescence is often outgrown by the time the individual reaches adulthood.

How is it diagnosed?

History: The type of symptoms the individual describes, or observed physical signs, will depend on what part of the brain was affected. The history is the most important part of the diagnosis of epilepsy. A detailed description of the seizure, from the individual themselves or an observer, is noted. Since individuals often have amnesia of the event, information obtained from someone who had witnessed the seizure is a valuable part of the history.

If the individual is conscious throughout the seizure, he or she may be able to recall symptoms or other details. Many people with epilepsy have no symptoms between seizures (the inter-ictal phase). Others may have an aura, characterized by restlessness, irritability, or an uncomfortable feeling that precedes a seizure (pre-ictal state).

To make the diagnosis of epilepsy, the documented seizures must be recurrent and chronic. An isolated seizure episode, of any type, is not an epileptic seizure. In fact, if there is no history of seizures, a single seizure or repeated seizures in a short period of time, could be a sign of a serious underlying disease, a chemical imbalance, drug and alcohol use, stroke, or a tumor.

Physical exam: The general physical exam may be entirely normal. If the individual is examined immediately after the seizure, a complete neurological exam may be postponed if the individual lost consciousness or is not alert. The period after the seizure is called the post-ictal phase, and some types of seizures leave the individual fatigued or confused and unable to follow directions. It is important to focus on findings that may indicate the area of a brain lesion.

Tests: The approach to testing depends on whether or not this was the first time the individual had a seizure. If it was the first episode, extensive testing is necessary.

Tests include comprehensive blood tests looking for a metabolic or chemical cause for the seizures. The routine tests of skull x-rays, MRI, an electroencephalogram (EEG), CT scan, and possibly a cerebral angiogram. The EEG is the most useful test in classifying the seizures that can direct the best approach to therapy.

If the individual has been seen previously for seizures and the diagnosis of a recurrent seizure disorder or epilepsy is established, then the testing is more limited.

If the individual is on medication for seizures, blood drug levels can determine whether the individual has been taking his medications or if the dosage must be changed.

How is Epilepsy treated?

Individuals with epilepsy are treated with anti-epileptic drugs (AED). Since several AEDs are available, they can be used alone or in combinations. In almost all cases, they lessen the frequency of seizures. These medications may have unpleasant side effects including drowsiness and impaired concentration that may lead to non-compliance. The goal of treatment of epilepsy is to reduce the frequency and severity of the seizures with medication that the individual tolerates best. Depending on the cause of the seizure and if no seizures occur for two or three years, the medication dose may be reduced or stopped. If a structural lesion is causing the seizures, surgery will often eliminate the seizures or make them easier to control.

Medications

• Anticonvulsant drugs. Your response to treatment will be monitored. Medication changes or adjustments are often necessary.
• Learn as much as you can about your seizure medication. The drugs used cause significant side effects, in addition to suppressing seizures.

Information	Brand	Generic	Label	Rating
	Neurontin	Gabapentin

Depakote (Divalproex), Diamox (Acetazolamide), Tegretol (Carbamazepine), Topamax (Topiramate), Mysoline (Primidone), Trileptal (Oxcarbazepine), Klonopin (Clonazepam), Valium (Diazepam), Ativan (Lorazepam)

What might complicate it?

Prolonged or repeated seizures, without a period of recovery, is a condition called status epilepticus. If the type of seizure is grand mal, status epilepticus can be fatal without emergency treatment and intravenous anticonvulsant drugs. Temporal lobe seizures, a type of focal epilepsy caused by severe brain damage, are more difficult to control. Non-compliance with drug therapy, though not a complication per se, must be addressed. Medications may need to be changed to those more tolerable for the individual. Also, some epileptic seizures may not respond to anticonvulsant medication.

Predicted outcome

It is estimated that at least one-third of those suffering from epileptic seizures will eventually outgrow the condition. Another third find their seizures become less frequent while on anticonvulsant medication. The remaining third find their condition remains the same. In most cases, the number one cause of repeat seizures in known epileptics is due to non-compliance with drug therapy.

Alternatives

High fevers, meningitis, encephalitis, brain tumors or other brain lesions, alcohol withdrawal, and certain drugs (cocaine) can cause grand mal seizures.

Appropriate specialists

Neurologist and neurosurgeon.

Last updated 21 December 2011