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Epilepsy

Alternate Names

  • seizure disorder
  • Brain structures

Definition

Epilepsy is a neurological disorder characterized by the occurrence of multiple seizures over time. A seizure is the result of an abnormal electrical discharge in the brain. It is important to remember that not everyone who has a seizure has epilepsy.

What is going on in the body?

A seizure occurs when excitable brain neurons (nerve cells) give off abnormal electrical discharges. There are different types of seizures. Epilepsy is diagnosed when an individual has multiple seizures over time.
Seizures are divided into two main types: generalized and partial. Generalized seizures occur when the abnormal discharges are start on both sides of the brain simultaneously. Partial seizures result from abnormal discharges from only one area of the brain.
Partial seizures are further separated into complex or simple. Complex partial seizures affect an individual's awareness or consciousness during the event whereas simple seizures do not.
Generalized seizure types include:
  • absence seizures
  • atonic seizures
  • clonic seizures
  • myoclonic seizures
  • tonic seizures
  • tonic-clonic seizures
Partial seizure types include:
  • complex partial seizures
  • secondary generalized seizures
  • simple partial seizures

Risks

What are the causes and risks of the condition?

Epilepsy may be caused by many diseases and conditions. Some of the conditions that can cause epilepsy are as follows:
  • stroke
  • brain tumors
  • head injury
  • hereditary seizure disorder
  • infections involving the brain, including encephalitis and bacterial meningitis
  • advanced liver disease
  • Alzheimer's disease and other types of dementia
  • history of bleeding into the brain, such as a subarachnoid hemorrhage
  • congenital diseases or conditions
  • hereditary diseases
  • abnormalities in the blood vessels of the brain
  • history of brain surgery
  • illegal drugs, such as cocaine
  • injury during birth or in the uterus
  • lead poisoning

Prevention

What can be done to prevent the condition?

Damage to an unborn child during pregnancy and delivery may increase the risk of epilepsy. Women with high-risk pregnancies should be monitored closely. Many childhood infections can be prevented by appropriate vaccination. Protection against lead poisoning will help prevent epilepsy.
Following sports safety guidelines for children, adolescents, and adults can prevent some injuries. Many times, there is no way to prevent epilepsy. Individuals can lower their risk of seizures by taking the following steps:
  • avoiding excess alcohol
  • avoiding illegal drugs, especially marijuana and cocaine
  • getting enough sleep
  • limiting intake of stimulants such as caffeine
  • recognizing and avoiding known factors that trigger their own seizures
  • seeking prompt treatment for fever and illness
  • taking all medications as prescribed

Diagnosed

How is the condition diagnosed?

Diagnosis of epilepsy begins with a history and physical exam. The healthcare professional will ask about contributing illnesses or injuries. An electroencephalogram (EEG) will be ordered. An EEG measures electrical activity within the brain. If a seizure occurs during the EEG, the abnormal activity can be detected. However, a normal EEG does not rule out epilepsy because it may simply not have been run at the time seizure activity occurred.
Other tests that may be ordered include the following:
  • blood tests to look for diseases or conditions causing the seizures
  • cranial CT scan to look for abnormalities in the brain
  • cranial MRI to provide a closer look at brain structures
  • positron emission tomography (PET) scans, to identify the abnormal brain area

Long Term Effects

What are the long-term effects of the condition?

Seizures can lead to physical injury from falling. Epilepsy may interfere with school or work.

Other Risks

What are the risks to others?

Epilepsy is not contagious and poses no risk to others. Medications used to treat epilepsy can cause damage to an unborn child. Women with epilepsy need careful monitoring during pregnancy because they cannot be continued on the same types or doses of medication.

Treatments

What are the treatments for the condition?

Medications used to treat epilepsy are known as anticonvulsants. Common anticonvulsants include the following:
  • carbamazepine (i.e., Tegretol)
  • ethosuxamide, also known as Zarontin
  • gabapentin (i.e., Neurontin)
  • lamotrigine (i.e., Lamictal)
  • phenobarbital (i.e., Solfoton)
  • phenytoin (i.e., Dilantin)
  • primidone (i.e., Mysoline)
  • tiagabine (i.e., Gabitril)
  • topiramate (i.e., Topamax)
  • valproate sodium (i.e., Epilim)
If a person's seizures are not controlled with medicine, a vagal nerve stimulator may be used. A small pacemaker-like box is inserted under the skin of the chest. It sends regular electrical discharges to the vagus nerve. This discharge can disrupt the abnormal electrical charges. A vagal nerve stimulator does not involve any surgery on the brain.
People with severe, uncontrollable seizures may be candidates for brain surgery. The surgeon opens the skull with a craniotomy. He or she then removes the abnormal brain tissue.
Underlying problems, such as a brain tumor, may require further treatment. A person with epilepsy may be embarrassed or depressed. Counseling about the condition may help the individual and the family. Support groups exist for those with epilepsy.

Side Effects

What are the side effects of the treatments?

Medications used to treat epilepsy may cause side effects. Side effects depend on the drug used; however, drowsiness at least initially is common to all. Insertion of a vagal nerve stimulator involves a small risk for bleeding, infection, or allergic reaction to the anesthetic. With a craniotomy, these risks are somewhat higher.
Many anticonvulsants decrease the effectiveness of oral contraceptives.

After Treatment

What happens after treatment for the condition?

Many substances interfere with the action of anticonvulsants. These include over-the-counter medicines, prescription medications, and herbal remedies. Individuals with epilepsy should consult their healthcare professionals before taking any new products.
Treatment of epilepsy is lifelong. If seizures are well-controlled, the individual may live a normal lifestyle. Some people may have significant disabilities from their epilepsy. Individuals with epilepsy may be able to drive if they are seizure-free. Laws governing driving vary from place to place.
People with seizures can participate in most activities of regular life. They may be advised to avoid hazardous activities. Federal law prohibits discrimination in employment. There are also laws precluding people with epilepsy from certain jobs, such as commercial trucking. A person with epilepsy should use an identification bracelet or card informing others of the condition.

Monitor

How is the condition monitored?

Individuals with epilepsy should routinely be seen by a healthcare professional for follow-up on the success or failure of the antiepileptic medications. Blood is tested regularly to monitor the levels of anticonvulsants and to screen for any untoward effects on the liver, kidney, or bone marrow. Any new or worsening symptoms should be reported to the healthcare professional.

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