What Is Epilepsy?


brain-focusEpilepsy is a medical condition that produces seizures which affect a variety of mental and physical functions.  It’s also called a seizure disorder. A seizure occurs when a brief, strong surge of electrical activity affects parts or all of the brain. When a person has two or more unprovoked seizures, they are considered to have epilepsy.

Epilepsy is the fourth most common neurological disorder in the United States after migraines, strokes and Alzheimer’s disease.  Its prevalence is greater than autism spectrum disorder, cerebral palsy, multiple sclerosis and Parkinson’s disease combined.  Despite how common the condition is, and the major advances in diagnosis and treatment, epilepsy is among the least understood of the major chronic conditions.

Anyone can develop epilepsy.  Seizures start for the first time in people over age 65 almost as often as they do in children. Seizures in the elderly are often the aftereffect of other health problems like stroke and heart disease.

  • 65 MILLION people around the world have epilepsy
  • 1 IN 26 people in the United States will develop epilepsy at some point in their lifetime
  • 7 OUT OF 10 people with epilepsy have an unknown cause

 

TYPES OF SEIZURES & EPILEPSY SYNDROMES

There are many different types of seizures. People may experience more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance.

generalized partial othertypes syndromes terms

  • GENERALIZED SEIZURES
    • Tonic-Clonic (grand mal):
      • Stiffening, may utter a cry, lose consciousness, fall, body may jerk
      • Lasts 1-3 minutes
      • Lose bladder or bowel control, may vomit
      • Breathing may decrease or cease during the tonic phase
      • Symptoms after the seizure: confusion, exhaustion, possible agitation or depression, memory loss
      • Should recovery in 15 to 60 minutes
    • Tonic:
      • Stiffening of the body, arms, or legs
      • Should last less than 20 seconds and often occurs while asleep
      • May lose balance and fall
      • May lose consciousness
    • Clonic:
      • Jerking, convulsive movements with no stiffening
      • Lose consciousness without confusion or tiredness afterwards
    • Atonic:
      • Sudden loss of muscle tone in head, arms, or body
      • Brief loss of consciousness lasting less than 15 seconds
      • Injury is common (helmets recommended)
    • Absence (petit mal):
      • Brief episodes of staring with impaired awareness and a lack of responsiveness
      • May experience eye blinks or chewing movements that last between 10-20 seconds or less
      • Promptly resumes the activity he/she was doing prior to seizing.  There are generally no aftereffects but he/she may have no memory of ending and resuming the activity (most common in children)
  • PARTIAL SEIZURES
    • Focal Aware (simple partial):
      • Auras
      • Sense of déjà vu
      • Change in muscle activity
      • Involuntary contractions
      • Weakness of a body part
      • Changes in sensation (touch, smell, taste, vision, hearing)
      • Change in an area controlling automatic bodily function
      • Changes in how we think, feel and experience things
    • Focal Impaired Awareness (complex partial):
      • Can include any of the behaviors under focal aware
      • Activity is indirect, with a dazed appearance (he/she may wander and be unable to understand directions or communicate)
      • Automatisms: staring, lip chewing, picking at clothes
      • Generally lasts from 30 seconds to 5 minutes, but could be longer
    • Secondary Generalized:
      • Starts as focal aware or focal impaired awareness and then moves to the whole brain, usually tonic-clonic

OTHER TYPES OF SEIZURES

EPILEPSY SYNDROMES

COMMON EPILEPSY TERMS

  • Antiepileptic Drugs (AEDs) – medication used to control seizures, also called anticonvulsants
  • Aura – a warning period at the beginning of a seizure that may cause a feeling of fear/doom or strange sensations such as an odd smell, taste, nausea, or palpitations.  This is actually part of a focal aware seizure.   It is possible for focal impaired awareness or secondarily generalized tonic-clonic seizures to begin seconds or minutes after.
  • Automatism – purposeless, automatic & involuntary movements during a seizure, such as chewing, lip-smacking, picking at clothing or wandering around confused.  This may occur during focal impaired awareness & absence seizures.
  • Catamenial Epilepsy -the tendency for seizures to occur around the time of menstruation
  • Corpus Callosum – a broad band of nerve fibers joining the two hemispheres of the brain
  • CT/CAT Scan – Computed Tomography/Computerized Axial Tomography- a scanning technique which uses x-rays & computers to produce images of the structure of the brain to help detect abnormalities
  • EEG – electroencephalogram- a diagnostic test which records the brain’s electrical activity or “brain waves”.  It does not provide a diagnosis of epilepsy but it can help distinguish types of seizures and/or where they begin in the brain.
  • Epileptogenic Zone – a cortical region of the brain that, when stimulated, produces spontaneous seizures or auras
  • Epileptologist – a neurologist with specialty training in epilepsy
  • Idiopathic – used to describe an epileptic seizure of unknown cause, as opposed to seizures caused by an identifiable problem in the brain
  • Intractable – difficult to alleviate or remedy; for example, intractable seizures are difficult to control with the usual antiepileptic drug therapy
  • Ketogenic Diet – a high fat, low carbohydrate, low protein diet used to control seizures in children
  • Partial Seizures – synonymous with focal seizures, in which the seizure starts in one part of the brain
  • PET Scan – Positron Emission Tomography- a diagnostic test that uses a very low and safe dose of a radioactive compound to measure metabolic activity in the brain.  It is helpful in planning epilepsy surgery.
  • Post-ictal or Postictal – the minutes, hours or days of abnormal consciousness, confusion or sleepiness after a seizure, during which the brain is recovering and returning to normal function
  • Refractory Epilepsy – when a person has failed to become (and stay) seizure free with adequate trials of two seizure medications (antiepileptic drugs/AEDs)
  • Responsive Neurostimulation (RNS) System– a new approach to treating medically uncontrolled partial onset seizures.  This device placed in the skull provides responsive neurostimulation that automatically monitors brain signals and provides stimulation to abnormal electrical brain events.
  • Status-Epilepticus – a prolonged seizure- usually defined as lasting longer than 30 minutes in a focal seizure or 5 minutes in a tonic-clonic seizure- or a series of repeated seizures; a continuous state of seizure activity, most common with tonic-clonic, but may occur in almost any seizure type.  This can be life-threatening and requires immediate emergency care.
  • Threshold – the brain’s susceptibility to having a seizure. Antiepileptic drugs raise this threshold and make a person less likely to have a seizure. In contrast, lack of sleep, fever, and other factors can lower the threshold and make seizures more likely.
  • Vagus Nerve Stimulator (VNS) – a surgically implanted generator placed in the chest that sends regular, mild pulses of electrical energy to the brain through the vagus nerve. In some cases it has been effective in decreasing seizure activity.